Clear nursing responsibility line
Health Boards should ensure that there is a clear and effective line of professional responsibility between the ward and the Board.
- The Scottish Government's response highlighted the strengthened role of senior charge nurses through the Leading Better Care initiative, establishing clear professional accountability from ward level to board level.
- The Health and Care (Staffing) (Scotland) Act 2019 (provisions in force from 1 April 2024) requires NHS boards to establish clear lines of professional accountability and ensure clinical leaders have sufficient time allocated for management responsibilities (Health and Care (Staffing) (Scotland) Act 2019 (https://www.legislation.gov.uk/asp/2019/6)).
- The HAI Standards require the Infection Control Manager to report directly to the chief executive and the board, establishing a clear line of professional responsibility for infection prevention and control from ward to board level.
- Healthcare Improvement Scotland's Well-Led assessment considers whether there are clear and effective lines of professional responsibility throughout NHS organisations.
How was this evidence gathered?
Response
Accepted
Response
AcceptedSection 2.2 of the Scottish Government's response addresses leadership and management structures. It highlights the strengthened role of senior charge nurses through the Leading Better Care initiative, which provides a template for developing their role as the visible embodiment of clinical leadership in NHS settings. This initiative supports senior charge nurses in coordinating patient care and leading the nursing team, thereby enhancing professional responsibility from the ward level.
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Excellence in Care framework commissioned by Scottish Government specifically in response to the Vale of Leven Inquiry. Operational in every NHS board with dedicated leads. CAIR Dashboard provides nursing and midwifery care quality metrics. Strategy 2022-2025 published June 2022.
View detailed findings
EiC builds on four requirements identified by Vale of Leven families: Person Centredness, Compassion, Fundamentals of Care, and Communication. Over 20 ratified CAIR measures with 30+ additional measures in development.
Despite Vale of Leven recommendation on clear professional responsibility lines, NHS GGC was escalated to Stage 4 of the NHS Scotland performance framework due to IPC governance failures at QEUH (2015-2019). Oversight Board found 'significant failings in governance.'
View detailed findings
The same health board where the Vale of Leven outbreak occurred experienced serious IPC governance failures within years of the inquiry reporting, suggesting systemic governance issues were not fully resolved.