The Nurses Agencies (Wales) Regulations 2003

CHAPTER 1QUALITY OF SERVICE PROVISION

Fitness of nurses supplied by an agency

12.—(1) The registered person must ensure that no nurse is supplied by the agency unless—

(a)he or she is of integrity and good character;

(b)he or she has the qualifications, skills and experience which are necessary for the work which he or she is to perform;

(c)he or she is physically and mentally fit for that work; and

(d)full and satisfactory information is available in relation to him or her in respect of each of the matters specified in Schedule 3.

(2) The registered person must ensure that the selection of a nurse for supply is made by or under the supervision of a nurse and that in relation to the nurse carrying out the selection full and satisfactory information is available —

(i)except where paragraph (3) applies, in respect of each matter specified in paragraphs 1 to 8 of Schedule 2;

(ii)where paragraph (3) applies, in respect of each matter specified in paragraphs 1 and 3 to 9 of Schedule 2.

(3) This paragraph applies where an individual has applied for a certificate referred to in paragraph 2 of Schedule 2 but the certificate has not been issued.

(4) The registered person must ensure that every nurse supplied by the agency acting as an employment business(1) is instructed that when working for a service user he or she must at all times wear identification showing his or her name, the name of the agency and a recent photograph.

Policies and procedures

13.—(1) Paragraphs (2) and (3) apply where an agency acting as an employment business supplies a nurse to provide nursing care in the private residence of a service user or patient.

(2) The registered person must prepare and implement written policies in relation to —

(a)ensuring that the services provided to each patient are in accordance with the statement of purpose and meet that patient’s individual needs;

(b)circumstances in which nurses may administer or assist in the administration of a patient’s medication;

(c)the other tasks which nurses may or may not perform in connection with a patient’s care, and the tasks which may only be performed if the nurse has received specialist training;

(d)arrangements to assist patients with mobility in their homes, where required;

(e)measures to protect the safety and property of the patient;

(f)arrangements to ensure that the privacy, dignity and wishes of the patient are respected;

(g)measures to safeguard the patient against abuse or neglect;

(h)measures to safeguard nurses against abuse or other harm;

(i)the procedure to be followed after an allegation of abuse, neglect or other harm has been made.

(3) The procedure referred to in paragraph (2)(i) must in particular provide for —

(a)written records to be kept of any allegation of abuse, neglect or other harm and of the action taken in response; and

(b)the appropriate office of the National Assembly to be notified of any incident reported to the police, not later than 24 hours after the registered person—

(i)has reported the matter to the police; or

(ii)is informed that the matter has been reported to the police.

(4) The registered person must ensure that any personal information about a patient for whom a nurse is supplied by the agency is not disclosed to any member of the agency’s staff unless it is necessary to do so in order to provide an effective service to the patient.

Staffing

14.—(1) Where an agency is acting as an employment business, the registered person must, having regard to the size of the agency, its statement of purpose and the number and needs of the service users, take all reasonable measures to ensure that there is at all times an appropriate number of suitably qualified, skilled and experienced persons employed for the purposes of the agency.

(2) The registered person must ensure that each employee of the agency —

(a)receives appropriate supervision; and

(b)is provided with a job description outlining his or her responsibilities.

(3) The registered person must establish a procedure for collecting information from service users about the performance of nurses employed for the purposes of the agency, and must take such steps as may be necessary to address any aspect of a nurse’s clinical practice.

(4) The registered person must provide to each nurse who is employed for the purposes of the agency a written statement of the terms and conditions on which he or she will be supplied to work for, and under the control of, a service user.

(5) The statement of terms and conditions provided under paragraph (4) must, in particular, specify the employment status of the nurse.

Staff handbook

15.—(1) Where the agency is acting as an employment business, the registered person must prepare a staff handbook and provide a copy to every member of staff.

(2) The handbook prepared in accordance with paragraph (1) must include a statement as to —

(a)the conduct expected of staff, and disciplinary action which may be taken against them;

(b)the role and responsibilities of nurses and other staff;

(c)record keeping requirements;

(d)recruitment procedures; and

(e)training and development requirements and opportunities.

Provision of information to service users

16.—(1) The registered person must ensure that before a nurse is supplied, the service user is informed of —

(a)the name of the nurse who is to be supplied and the means of contacting that nurse;

(b)the name of the member of staff of the agency who is responsible for the supply of that nurse; and

(c)where the agency is acting as an employment business, details of how the service user may contact the registered person, or a person nominated to act on behalf of the registered person.

(2) Where the service user is also the patient, the registered person must ensure that the information specified in paragraph (1) is, where appropriate, provided to the person acting on behalf of the patient.

Records

17.  The registered person must ensure that the records specified in Schedule 4 are maintained and that they are —

(a)kept up to date, in good order and in a secure manner; and

(b)retained for a period of not less than three years beginning on the date of the last entry.

Complaints

18.—(1) The registered person must establish a procedure (“the complaints procedure”) for considering complaints made to the registered person by a service user or a person acting on behalf of the service user.

(2) The registered person must supply a written copy of the complaints procedure to every service user and, upon request, to any person acting on behalf of a service user.

(3) The written copy of the complaints procedure must include —

(a)the address and telephone number of any specified appropriate office of the National Assembly; and

(b)the procedure (if any) which has been notified by the appropriate office of the National Assembly to the registered person for making complaints to the appropriate office of the National Assembly relating to the agency.

(4) The registered person must ensure that every complaint made under the complaints procedure is fully investigated.

(5) The registered person must, within the period of 28 days beginning on the date on which the complaint is made, or such shorter period as may be reasonable in the circumstances, inform the person who made the complaint of the action that is to be taken in response.

(6) The registered person must maintain a record of each complaint, including details of the investigation made, the outcome and any action taken in consequence and the requirements of regulation 17 apply to that record.

(7) The registered person must supply to the appropriate office of the National Assembly annually a statement containing a summary of the complaints made during the preceding twelve months and the action taken in response.

(8) The registered person must ensure that any evidence of misconduct by a nurse is reported promptly and in writing to the Nursing and Midwifery Council(2).

Review of quality of service provision

19.—(1) The registered person must introduce and maintain a system for reviewing at appropriate intervals the quality of services provided by the agency.

(2) The registered person must supply to the appropriate office of the National Assembly a report in respect of any review conducted by the registered person for the purposes of paragraph (1) and must make a copy of the report available upon request for inspection by service users and persons acting on behalf of service users.

(3) The system referred to in paragraph (1) must provide for consultation with service users and persons acting on behalf of service users.