Safe Staffing in Our NHS: Betsi Cadwaladr University Health Board

Dr Minh Alexander retired consultant psychiatrist 1 August 2022

This is a brief post to share FOI data for anyone interested in events at BCUHB

Lack of NHS safe staffing and the linked issue of chronic NHS underfunding are unresolved issues that seem likely to remain with us for the foreseeable future, given our economic woes and troubled politics.

A cycle of politically driven suppression and bullying trail in their wake.

The same story plays out time and gain, and the same care scandals recur, despite investigations and inquiries such as the Mid Staffs public inquiry. The latter was politically awkward in that it advised that care should be driven by fundamental standards (ie. not resource driven). The inquiry laid a heavy emphasis on ensuring safe staffing levels, after cost-cutting, unsafe staffing levels were uncovered as a pivotal failure in the Mid Staffs disaster.

But then Robert Francis was knighted and appointed to the Care Quality Commission’s board and Jeremy Hunt the then Health Secretary scrapped NICE’s work on safe staffing standards and refused to introduce legislation on mandatory safe staffing.

On the frontline, a vicious cycle is set up of forced errors from thinly spread, stressed staff making inevitable errors and omissions and then being harshly scapegoated and punished for what are primarily system failings. Or they may not report incidents for fear of blame. Or if they raise concerns about system faults, they are bullied for that too.

Unsafe staffing is brutalising for both staff and patients. Burnt out staff cannot give of their best.

Quarter 4 vacancy data for the NHS in England roughly showed a one in ten vacancy rate.

2021/22 sickness data for the NHS in England showed overall sickness rate of 5.38%, with higher levels in nurses and midwives.

At Betsi Cadwaladr University Health Board, nursing staff raised concerns about unsafe staffing and associated bullying with local MPs:

Ysbyty Gwynedd nurses reveal shocking treatment of staff

Nurses at Welsh hospital ‘overworked, bullied and afraid to speak out’

BCUHB consequently announced an investigation into these matters. The investigation should have concluded in July.

Via an FOI response of 19 July 2022, the health board has disclosed that staff raised a total of 3006 adverse events affecting staff levels over a three year period:

“From 1st April 2019 to 31st March 2022, there have been 3006 adverse events that affected staffing levels, please note this figure includes staff reporting positive COVID-19 statuses.”

This is a copy of the health board’s whistleblowing policy.

This is a copy of the health board’s very brief terms of reference for the investigation into alleged bullying.

This was the investigation methodology:

The investigation was reportedly overseen by an external party, but my reading of the terms of reference is that an internal “review support team” assisted the external investigator:

Royal College of Nursing

This is a link to the RCN’s ongoing work on safe staffing:

Safe Staffing for Safe and Effective Care

2 thoughts on “Safe Staffing in Our NHS: Betsi Cadwaladr University Health Board

  1. I an a nurse and do not believe the RCN are the right organisation to carry out safe staffing levels. I lost my trust in the RCN when i whisltleblowed on poor care and felt alone and not supported by the RCN until NHS England supported me with superb coaching from their whistlblowing team., otherwise without NHS Egland i would not be a nurse today. Ian


    1. Thanks Ian. Sorry to hear about your experience. The world of whistleblowing is complex. Many whistleblowers are let down by unions. And some local union reps are too close to employers or even complicit in harm. But equally there are also many, many stories of regulatory failure and disinterest, or worse. The NHS England (formerly NHS Improvement) whistleblower employment support scheme has also let many down whistleblowers, or even actively mistreated some. On balance, I would say that in my experience that are more regulatory failures than staffside failures. I recognise that the RCN has had its troubles, worse of late. But the data that it collects still has value I think, especially as the government has shown diminishing interest in staffing ratios. All best.


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