Health and Care (Staffing) (Scotland) Act FAQs

We refer to ‘safe staffing legislation’ when we talk about the law – the Health and Care (Staffing) (Scotland) Act 2019 - that places duties on NHS Scotland health boards, care providers across Scotland, and Scottish ministers to ensure safe staffing. However, staffing for safe and effective care across all health and social care services in Scotland is about more than legislation. It is about making sure that all services have the right number of suitably qualified staff  to provide quality care that delivers the best outcomes for everyone – patients, those who rely on care services, their families, and staff. 

Yes. In 2019 the Scottish parliament passed the Health and Care (Scotland) (Staffing) Act (the Act). This is the first legislation in the UK to cover health and social care services. The requirements of the Act come into force from 1 April 2024. Find out more in our guide to the Act. 

The Act sets out requirements for safe staffing across health and care services and all health and care professions. This means it covers most of the health and social care workforce.

Nursing is the largest of the health and care professions and as a member of nursing staff the Act places duties on your employer and gives you additional rights.

The Act places duties on health boards, care service providers (including social care providers), Healthcare Improvement Scotland, the Care Inspectorate, Scottish ministers and the Scottish government. 

It’s important to note that the Act does not place duties on individual frontline members of staff. 

Implementation of the Act should ensure that health and care services have the staffing needed to provide safe, high-quality services that deliver the best outcomes for service users. It is designed to do this do this by placing a duty on NHS and social care providers to make sure that suitably qualified and competent staff in the right numbers are working at all times.

This ground-breaking legislation is the first in the UK to set out requirements for safe staffing across both health and care services. The Act is a significant piece of legislation that should support safe staffing in Scotland. 

It places a statutory duty on health and care providers to ensure that, at all times, the appropriate number of qualified and competent individuals are working to meet the needs of patients, residents or service users. 

The legislation also makes it clear that the wellbeing of staff has a direct impact on their ability to provide safe and high-quality services. Staff wellbeing is referenced a number of times in the legislation. 

It imposes a new duty on the Scottish government to ensure sufficient numbers of registered nurses, midwives and other medical professionals are available to enable health and care employers to comply with their duty to ensure safe staffing levels.

However, the Act alone will not deliver safe staffing levels. Investment in the NHS and in social care, and in the nursing profession is essential if Scotland is to have the right number of staff available to deliver care and for health boards and local authorities to meet their duties under the Act.

Health boards, local authorities and integration authorities are required to produce annual reports on their compliance with the Act, which should support the scrutiny of safe staffing levels at local and national level.

Scottish ministers are required to give an annual report to the Scottish parliament about the operation of the legislation. They are required to take into account the reporting on compliance with the legislation when determining the number of nursing degree places at Scottish universities.

The Act contains a range of duties which, operating successfully together, should support work to improve risk management and help ensure the right people are in the right place at the right time. For example, the Act includes duties to improve escalation of staffing concerns, to give feedback to staff around staffing decisions and to ensure clinical leaders have the time they need to perform their leadership role. 

This means that if you raise a concern about unsafe staffing levels, you can expect – under the new law – to be listened to, for your concerns to be acted on, and to receive feedback to tell you what has been done to improve staffing levels in response to your concerns.

If the provisions within the Act are implemented fully by an employer, staff at all levels should see improvements. We know that the new legislation will not immediately address the current acute staff shortages, but it does create new duties that we expect should make a difference to staff and to patients.

The Act also imposes a new duty on the Scottish government to ensure there are sufficient numbers of registered nurses, midwives and medical professionals available to enable health boards to comply with their duty to ensure safe staffing levels. We believe this is an important provision, which will put pressure on the Scottish government to improve workforce planning.

The plan to legislate for safe staffing was first announced in 2016 at RCN Congress in Glasgow, by the then First Minister of Scotland, Nicola Sturgeon.

The Act came into being following sustained pressure from RCN Scotland and its members. After the intention to create new legislation was announced, RCN members and staff in Scotland worked hard to influence and shape its development for the benefit of patients, care service users and our members. Campaigning by RCN members, staff and the public across Scotland resulted in successful influencing with over 85% of what the RCN asked for included in the final Bill. 

The Health and Care (Staffing) (Scotland) Act was passed by the Scottish parliament in May 2019 but implementation was delayed by the COVID-19 pandemic. In June 2022, following significant lobbying from the RCN, the Scottish government published a timetable for implementation. 

Consultation on the guidance to support implementation ran through 2023. This involved input from stakeholders – including the RCN – followed by a public consultation on the statutory guidance that accompanies the Act. The RCN’s response to the consultation was informed by RCN member-engagement events held in late June and mid-July and by our ongoing engagement with members. Our response was stronger because of the input from members, enabling us to ensure your views directly reached Scottish government and shaped the Act’s guidance. 

The Act comes into force from 1 April 2014.

Responsibility for successful implementation of the Act sits firmly with key parties including NHS Scotland health boards, the Scottish government, Scottish ministers, Health Improvement Scotland, the Care Inspectorate and social care providers. This includes responsibility for training staff in the requirements of the Act. It is important to note that the Act does not place any duties on individual frontline staff members. 

The RCN’s role is to help our members and reps understand what they are entitled to expect when the Act is in force. We are doing this through support for local branches, RCN rep training, employer/staff side partnership structures (where they exist), and through our day-to-day support for members. As the Act beds in, we expect that challenges will become clear. We will lobby Scottish government to address any challenges in the best interest of our members, patients and service users.

Healthcare Improvement Scotland and the Care Inspectorate have developed resources to support health and care staff ahead of implementation of the Act. You can find this approved training through TURAS. 

The RCN is supporting members to find out more and to ask questions locally though our reps. The responsibility for training remains with NHS employers, Healthcare Improvement Scotland (HIS), and the Care Inspectorate.  

We encourage all members to complete relevant training via Turas and to continue to raise any patient safety, clinical decision concerns and flag risks according to local policy and your associated professional code.

Under the Act health boards have a duty to make sure that at all times there are suitably qualified and competent staff working in the right numbers. 

The Act gives you the opportunity to feed into safe staffing processes.

In deciding the number and skill mix of staff required health boards must take account of the service type, local context, the number and needs of the patients and appropriate clinical advice. They must have in place arrangements for the real-time assessment of staffing levels to ensure services are responsive to changing clinical need and to have a process for escalating risks.

The Act does not place any duties on individual frontline members of staff. The duties within the Act sit firmly with employers and others, including Scottish ministers and Healthcare Improvement Scotland.

Under the Act, you have the right to:

Be consulted on staffing decisions – this means you should be able to contribute views on staffing and skill mix in your area of work and you should receive feedback on the decisions made and reasons for these.

Raise concerns – this means that your employer must ensure you are aware of the process for doing this, and you feel empowered to use this process to raise concerns about staffing levels and skill mix at a local level. You have the right to escalate your concerns if necessary. You must also receive feedback on any concerns raised.

Relevant training – this means your employer must ensure that you have the time and resources to complete the training you need to deliver safe, high quality patient care.

Wellbeing – the Act lists staff wellbeing as a guiding principle and as such staffing must be arranged while ensuring the wellbeing of staff in order to provide safe and high-quality services.

You can read more about the detail of the Act here.

You are likely to be the person responsible for running the common staffing method and for providing the evidence for staffing decisions. The Act includes a duty on your health board to sure that, as a clinical leader, you get the time you need to supervise patient care, manage and support the development of your team and lead the delivery of safe, high quality and person-centred care.

All NHS health boards have a duty to use the common staffing method in clinical areas where the workforce and workload planning tools set out in the legislation apply. This means the approved tools are used alongside other considerations – such as vacancies, skill mix, patient need, clinical advice and staff feedback – to set staffing establishments and inform any service design. Information is available on the Healthcare Improvement Scotland website on the 12 tools that are currently available for nursing and midwifery.

Under the Act social care providers have a duty to make sure at all times there are suitably qualified and competent staff working in the right numbers. 

They also have a duty to ensure you have the appropriate training for your role and receive suitable assistance, including time off work, to obtain further qualifications appropriate to your role.

The RCN encourages all nursing staff working in social care to continue to raise any concerns around the safety of residents/service users or around clinical decisions in line with your local policies and the NMC and SSSC codes. 

The Act does not place any duties on individual frontline members of staff.

The duties within the Act sit firmly with key parties including the Scottish government, Scottish ministers, the Care Inspectorate and social care providers. 

The Act gives the Care Inspectorate the power to develop and recommend a staffing method to determine staffing levels in adult care homes and the development of a staffing method framework is already underway.

Under the Act, you have the right to:

Training and support – this means you have the right to appropriate training for your role and to receive suitable assistance, including time off work, to obtain further qualifications appropriate to your work.

You can read more about the detail of the Act here.