Staffing concerns escalation
Health Boards should ensure that there is straightforward and timely escalation process for nurses to report concerns about staffing numbers/skill mix.
- The NMC Code requires registered nurses and midwives to escalate concerns regarding patient safety or the level of care. The Scottish Government's response highlighted this professional duty and the need for clear escalation processes.
- The Health and Care (Staffing) (Scotland) Act 2019 (provisions in force from 1 April 2024) requires NHS boards to have procedures for the real-time identification of staffing risks and to address them promptly. It requires clinical leaders to be consulted on staffing decisions (Health and Care (Staffing) (Scotland) Act 2019 (https://www.legislation.gov.uk/asp/2019/6)).
- Scotland's whistleblowing standards (effective April 2021) provide additional protection for staff raising concerns about staffing levels, ensuring there is a clear and protected escalation route.
How was this evidence gathered?
Response
Accepted
Response
AcceptedSection 4.1 of the Scottish Government's response highlights that the NMC code requires registered nurses and midwives to escalate concerns regarding patient safety or the level of care. To support this, a national whistleblowing policy, 'Implementing & Reviewing Whistleblowing Arrangements in NHSScotland,' is in place, requiring NHS boards to have local policies that meet or exceed its terms. Additionally, the NHSScotland Confidential Alert Line provides a dedicated freephone service for staff to report concerns about patient safety or malpractice, including when existing procedures have been exhausted.
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.
Health and Care (Staffing) (Scotland) Act 2019 (in force April 2024) includes statutory requirements for escalation when staffing falls below safe levels. Staffing decisions must account for patient acuity.
View detailed findings
The Act requires employers to have processes for reporting and escalating staffing concerns. Ministerial Annual Report monitors compliance.