As Hywel Dda prepares to meet new government requirements on nursing levels, it faces further staff shortages with a potential impact on stroke services.

The Nurse Staffing Levels (Wales) Act 2016 has now come into force and Hywel Dda University Health Board members heard that an additional 41 nurses will be needed on top of the current 145 whole time equivalent vacancies.

A further 122 health care support workers would also be needed.

The ‘uplift’ across the 32 wards covered would cost nearly £5million.

Executive director of nursing, quality and patient experience, Mandy Rayani, presented a report to the board on May 31 that included three options that would meet the act’s requirements.

Her preferred option for implementation, and the one that was approved by members following discussion, would see a phased and prioritised process with £2million set aside for the work.

Enhanced clinical leadership on the medical and surgical wards covered by the act will start and band 7 staff, including ward sisters and managers, “protected” with a minimum of two days a week guaranteed for taking charge of their wards. Additional band 6 sister posts will be created.

Health care support workers would also play a key role with existing skills developed in an bid to “release registered nurses to work in areas of greatest need in the medium term.”

Ensuring there are enough nurses on the health board’s four stroke wards would be a first priority following a review of acute stroke bed numbers and a further review of the requirement for permanent staffing of “surge” beds.

“Investment in multi-disciplinary support posts, which will focus on the frail and those requiring rehabilitation should proceed at pace, as the standardisation of the roles and their governance arrangements emerges ,” adds option three.

National clinical guidelines for stroke would require an extra 13 nurses but there are “discussions taking place on a both a local and a national basis which may influence the configuration and provision of acute and hyper-acute stroke services,” Mrs Rayani’s report adds.

Independent member Professor John Gammon, from Swansea University, wanted to assure patients that the current staffing was safe.

“This is about additionality, not about the current staff levels being unsafe. This about over and above,” he said, adding it was unfortunate the act only applied to nurse levels and not other professional groups.

The board heard that there was no additional money provided for implementing the act and trainee vacancies will be commissioned from the Welsh Government in a bid to meet the shortfall.

Chief executive Steve Moore added: “This is a groundbreaking act. Wales is leading the way on this.”