The Nurses Agencies (Wales) Regulations 2003

PART I GENERAL

Citation, commencement and application

1.—(1) These Regulations may be cited as the Nurses Agencies (Wales) Regulations 2003 and come into force on 2nd October 2003.

(2) These Regulations apply to nurses agencies in Wales only.

Interpretation

2.—(1) In these Regulations —

“1957 Act” (“Deddf 1957”) means the Nurses Agencies Act 1957(1);

“the Act” (“y Ddeddf”) means the Care Standards Act 2000;

“agency” (“asiantaeth”) means a nurses agency;

“appropriate office” (“swyddfa briodol”) means in relation to a nurses agency —

(a)

if an office has been specified under paragraph (4) below for the area in which the nurses agency operates, that office;

(b)

in any other case, any office of the National Assembly;

“authority” (“awdurdod”) means, in respect of a person who —

(a)

carries on, or wishes to carry on, an agency for the supply of nurses within the meaning of the 1957 Act; and

(b)

is the holder of a licence which has been granted to that person by a local authority under section 2 of that Act and which authorises the holder to carry on that agency from premises specified in the licence, or has applied for such a licence,

the local authority which for the purposes of that section is the licensing authority in whose area the premises are situated;

“effective date” (“dyddiad effeithiol”) means the date with effect from which an existing provider is for the purposes of Part II of the Act to be treated, in accordance with paragraph 1(6) of Schedule 5 to these Regulations, as having applied for and been granted registration in respect of the existing undertaking;

“existing undertaking” (“ymgymeriad presennol”) means a person who, immediately before 2nd October 2003 —

(a)

carries on an agency for the supply of nurses within the meaning of the 1957 Act; and

(b)

is the holder of a licence which has been granted to that person by a local authority under section 2 of that Act and which authorises the holder to carry on that agency from premises specified in the licence;

“National Assembly” (“Cynulliad Cenedlaethol”) means the National Assembly for Wales;

“nurse” (“nyrs”) means a registered nurse, registered midwife or registered health visitor(2);

“nurses agency provider” (“darparydd asiantaeth nyrsys”) means a person who, immediately before 2nd October 2003 —

(a)

carries on an agency for the supply of nurses within the meaning of the 1957 Act; and

(b)

is the holder of a licence which has been granted to that person by a local authority under section 2 of that Act and which authorises the holder to carry on that agency from premises specified in the licence;

“NHS trust” (“ymddiriedolaeth GIG”) has the same meaning as in the National Health Service and Community Care Act 1990(3);

“organisation” (“corff”) means a body corporate;

“patient” (“claf”) means a person to whom nursing is provided by a nurse supplied by an agency;

“registered manager” (“rheolwr cofrestredig”), in relation to an agency, means a person who is registered under Part II of the Act as the manager of that agency;

“registered person” (“person cofrestredig”), in relation to an agency, means any person who is the registered provider or the registered manager of that agency;

“registered provider”(“darparydd cofrestredig”), in relation to an agency, means a person who is registered under Part II of the Act as the person carrying on that agency;

“responsible individual” (“unigolyn cyrifol”) is to be construed in accordance with regulation 7;

“service user” (“defnyddiwr gwasanaeth” ) means a person to whom an agency —

(a)

supplies a nurse who is employed by the agency; or

(b)

provides services for the purpose of supplying the service user with a nurse for employment by that service user;

“service user’s guide” (“arweiniad defnyddiwr gwasanaeth” ) means the written guide produced in accordance with regulation 5;

“statement of purpose” (“datganiad o ddiben”) means the written statement compiled in accordance with regulation 4.

(2) In these Regulations, references to the supply of a nurse mean —

(a) the supply of a nurse who is employed for the purposes of an agency to act for and under the control of another person; and

(b) the introduction of a nurse by an agency to a service user for employment by that service user.

(3) In the definition of “service user” in paragraphs (1) and (2), the terms “employed” and “employment” include employment under a contract for services.

(4) The National Assembly may specify an office controlled by it as the appropriate office in relation to a nurses agency situated in a particular part of Wales.

Excepted agencies

3.  For the purposes of the Act, an NHS trust which supplies nurses to work solely for other NHS trusts is excepted from being a nurses agency.

Statement of purpose

4.—(1) The registered person must compile in relation to the agency a written statement (in these Regulations referred to as “the statement of purpose”) which must consist of a statement as to the matters listed in Schedule 1.

(2) The registered person must supply a copy of the statement of purpose to the appropriate office of the National Assembly and must make a copy of it available on request for inspection by every service user and any person acting on behalf of a service user.

(3) Nothing in regulation 20 shall require or authorise the registered person to contravene, or not to comply with —

(a) any other provision of these Regulations; or

(b) the conditions for the time being in force in relation to the registration of the registered person under Part II of the Act.

Service user’s guide

5.—(1) The registered person must prepare a service user’s guide which must include —

(a) a summary of the statement of purpose;

(b) the terms and conditions in respect of the services to be provided to service users, including as to the amount and method of payment of fees;

(c) a summary of the complaints procedure established in accordance with regulation 18; and

(d) the address and telephone number of any specified appropriate office of the National Assembly.

(2) The registered person must make a copy of the service user’s guide available on request for inspection at the agency premises by every service user and any person acting on behalf of a service user.

Review of statement of purpose and service user’s guide

6.  The registered person must —

(a) keep under review and, where appropriate, revise the statement of purpose and the service user’s guide; and

(b) notify the appropriate office of the National Assembly of any significant revision within 28 days.

PART II REGISTERED PERSONS

Fitness of registered provider

7.—(1) A person must not carry on an agency unless that person is fit to do so.

(2) A person is not fit to carry on an agency unless the person —

(a) is an individual who satisfies the requirements set out in paragraph (3); or

(b) is an organisation and —

(i) the organisation has given notice to the appropriate office of the National Assembly of the name, address and position in the organisation of an individual (in these Regulations referred to as “the responsible individual”) who is a director, manager, secretary or other officer of the organisation and is responsible for supervising the management of the agency; and

(ii) that individual satisfies the requirements set out in paragraph (3).

(3) The requirements are that —

(a) the individual is of integrity and good character;

(b) the individual is physically and mentally fit to carry on the agency; and

(c) full and satisfactory information is available in relation to the individual —

(i) except where paragraph (4) applies, in respect of each matter specified in paragraphs 1 to 8 of Schedule 2;

(ii) where paragraph (4) applies, in respect of each matter specified in paragraphs 1 and 3 to 9 of Schedule 2.

(4) 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.

(5) A person must not carry on an agency if —

(a) he or she has been adjudged bankrupt or sequestration of his or her estate has been awarded and (in either case) he or she has not been discharged and the bankruptcy order has not been annulled or rescinded; or

(b) he or she has made a composition or arrangement with his or her creditors and has not been discharged in respect of it.

Appointment of manager

8.—(1) The registered provider must appoint an individual to manage the agency where —

(a) there is no registered manager in respect of the agency; and

(b) the registered provider —

(i) is an organisation; or

(ii) is not a fit person to manage an agency; or

(iii) is not, or does not intend to be, in full-time day to day charge of the agency.

(2) Where the registered provider appoints a person to manage the agency, he or she must forthwith give notice to the appropriate office of the National Assembly of —

(a) the name of the person so appointed; and

(b) the date on which the appointment is to take effect.

Fitness of manager

9.—(1) A person must not manage an agency unless he or she is fit to do so.

(2) A person is not fit to manage an agency unless—

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

(b) having regard to the size of the agency, its statement of purpose and the number and needs of the service users—

(i) he or she has the qualifications, skills and experience necessary to manage the agency; and

(ii) he or she is physically and mentally fit to do so; and

(c) full and satisfactory information is available in relation to him or her —

(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.

Registered person – general requirements and training

10.—(1) The registered provider and the registered manager must, having regard to the size of the agency, its statement of purpose and the number and needs of the service users, carry on or (as the case may be) manage the agency with sufficient care, competence and skill.

(2) If the registered provider is —

(a) an individual, he or she must undertake; or

(b) an organisation, it must ensure that the responsible individual undertakes,

from time to time such training as is appropriate to ensure that he or she has the experience and skills necessary for carrying on the agency.

(3) The registered manager must undertake from time to time such training as is appropriate to ensure that he or she has the experience and skills necessary for managing the agency.

Notification of offences

11.  Where the registered person or the responsible individual is convicted of any criminal offence, whether committed in Wales or elsewhere, he or she must forthwith give notice in writing to the appropriate office of the National Assembly of —

(i) the date and place of the conviction;

(ii) the offence of which he or she was convicted; and

(iii) the penalty imposed in respect of the offence.

PART III CONDUCT OF NURSES AGENCIES

CHAPTER 1 QUALITY 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(4) 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(5).

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.

CHAPTER 2 PREMISES

Fitness of premises

20.  The registered person must not use premises for the purposes of an agency unless the premises are suitable for the purpose of achieving the aims and objectives of the agency set out in the statement of purpose.

CHAPTER 3 FINANCIAL MATTERS

Financial position

21.—(1) The registered provider must carry on the agency in such manner as is likely to ensure that the agency will be financially viable for the purpose of achieving the aims and objectives set out in the statement of purpose.

(2) The registered person must, if the appropriate office of the National Assembly so requests, provide that office with such information and documents as it may require in order to consider the financial viability of the agency, including —

(a) the annual accounts of the agency certified by an accountant; and

(b) a certificate of insurance for the registered provider in respect of liability which may be incurred in relation to the agency in respect of death, injury, public liability, damage or other loss.

CHAPTER 4 NOTICES TO BE GIVEN TO THE NATIONAL ASSEMBLY

Notice of absence

22.—(1) Where —

(a) the registered provider, being an individual in full-time day to day charge of the agency; or

(b) the registered manager,

proposes to be absent from the agency for a continuous period of 28 days or more, the registered person must give notice in writing to the appropriate office of the National Assembly of the proposed absence.

(2) Except in the case of an emergency, the notice referred to in paragraph (1) must be given no later than one month before the proposed absence commences or within such shorter period as may be agreed with the appropriate office of the National Assembly and the notice must specify —

(a) the length or expected length of the absence;

(b) the reason for the absence;

(c) the arrangements which have been made for running the agency during that absence;

(d) the name, address and qualifications of the person who will be responsible for the agency during that absence; and

(e) in the case of the absence of the registered manager, the arrangements that have been, or are proposed to be, made for appointing another person to manage the agency during that absence, including the proposed date by which the appointment is to be made.

(3) Where the absence arises as a result of an emergency, the registered person must give notice of the absence within one week of its occurrence specifying the matters set out in paragraph (2)(a) to (e).

(4) Where —

(a) the registered provider, being an individual in full-time day to day charge of the agency; or

(b) the registered manager,

has been absent from the agency for a continuous period of 28 days or more, and the appropriate office of the National Assembly has not been given notice of the absence, the registered person must, without delay, give notice in writing to the appropriate office of the National Assembly of the absence, specifying the matters set out in paragraph (2)(a) to (e).

(5) The registered person must notify the appropriate office of the National Assembly of the return to duty of the registered provider or (as the case may be) the registered manager not later than 7 days after the date of return.

Notice of changes

23.  The registered person must give notice in writing to the appropriate office of the National Assembly as soon as it is practicable to do so if any of the following events takes place or is proposed to take place —

(a) a person other than the registered person carries on or manages the agency;

(b) a person ceases to carry on or manage the agency;

(c) where the registered person is an individual, that individual changes name;

(d) where the registered provider is an organisation —

(i) the name or address of the organisation is changed;

(ii) there is any change of director, manager, secretary or other similar officer of the organisation;

(iii) there is any change in the identity of the responsible individual;

(e) where the registered provider is an individual, a trustee in bankruptcy is appointed;

(f) where the registered provider is a company, a receiver, manager, liquidator or provisional liquidator is appointed;

(g) where a registered provider is in a partnership whose business includes carrying on a nurses agency, a receiver or manager is, or is likely to be, appointed in respect of the partnership; or

(h) the registered provider acquires additional premises for the purposes of the agency.

Appointment of liquidators etc.

24.—(1) Any person to whom paragraph (2) applies must —

(a) forthwith notify the appropriate office of the National Assembly of his or her appointment indicating the reasons for it;

(b) appoint a manager to take full-time day to day charge of the agency in any case where there is no registered manager; and

(c) not more than 28 days after appointment, notify the appropriate office of the National Assembly of the intended future operation of the agency.

(2) This paragraph applies to any person appointed as —

(a) the receiver or manager of the property of a company which is a registered provider in respect of an agency;

(b) the liquidator or provisional liquidator of a company which is the registered provider in respect of an agency;

(c) the receiver or manager of the property of a partnership whose business includes carrying on an agency;

(d) the trustee in bankruptcy of a registered provider in respect of an agency.

Death of registered person

25.—(1) If more than one person is registered in respect of an agency, and a registered person dies, the surviving registered person must without delay notify the appropriate office of the National Assembly of the death in writing.

(2) If only one person is registered in respect of an agency, and that person dies, his or her personal representatives must notify the appropriate office of the National Assembly in writing —

(a) without delay of the death; and

(b) within 28 days of their intentions regarding the future running of the agency.

(3) The personal representatives of the deceased registered provider may carry on the agency without being registered in respect of it —

(a) for a period not exceeding 28 days; and

(b) for any further period as may be determined in accordance with paragraph (4).

(4) The National Assembly may extend the period specified in paragraph (3)(a) by such further period, not exceeding one year, as the National Assembly determines, and must notify any such determination to the personal representatives in writing.

(5) The personal representatives must appoint a person to take full-time day to day charge of the agency during any period in which, in accordance with paragraph (3), they carry on the agency without being registered in respect of it.

PART IV MISCELLANEOUS

Compliance with regulations

26.  Where there is more than one registered person in respect of an agency, anything which is required under these Regulations to be done by the registered person must, if done by one of the registered persons, not be required to be done by any of the other registered persons.

Offences

27.—(1) A contravention or failure to comply with any of the provisions of regulations 4 to 23 shall be an offence.

(2) The National Assembly may bring proceedings against a person who was once, but no longer is, a registered person, in respect of a failure to comply with regulation 17.

Fees

28.—(1) The Registration of Social Care and Independent Healthcare (Fees) (Wales) Regulations 2002(6) are amended in accordance with the following provisions of this regulation.

(2) In the paragraph headed “Arrangement of Regulations”, the following line is added at the end “13. Annual fee – nurses agencies”.

(3) In regulation 2(1) —

(a) after the definition of “the Act” add —

““the 1957 Act” means the Nurses Agencies Act 1957”;

(b) after the words

““agency” means a fostering agency”

• add the words “or nurses agency”;

  (c)

  in the definition of “existing undertaking” add at the appropriate place —

  “(e) a nurses agency that is licensed immediately before 2nd October 2003 under the 1957 Act;”.

(4) After regulation 12 (Annual fee – fostering agencies and local authority fostering services), insert the following regulation —

“Annual fee – nurses agencies

13.— (1) The annual fee in respect of a nurses agency is £500.

(2) The annual fee in respect of a nurses agency shall be first payable by the registered provider on the date specified in respect of him or her in paragraph (3) (“the first date”) and thereafter on the anniversary of the first date.

(3) The specified date is —

(a) in the case of the registered provider of a nurses agency that is an existing undertaking —

(i) in a case where a licence fee was payable under the 1957 Act in respect of the undertaking, the anniversary of the date on which the last fee was payable;

(ii) in any other case, 31st December 2003;

(b) in the case of a registered provider who is a new provider, the date on which a certificate of registration is first issued under Part II of the Act in respect of that registered provider of the nurses agency.”

Registration

29.  Regulation 2(1) of the Registration of Social Care and Independent Health Care (Wales) Regulations 2002 (7) is amended as follows —

(a) in the definition of “appropriate office of the National Assembly”, after sub-paragraph (e) insert —

“(f) (i) if an office has been specified under regulation 2(4) of the Nurses Agencies (Wales) Regulations 2003 (8), that office;

(ii) in any other case, any office of the National Assembly.”

(b) in the definition of “statement of purpose”, after sub-paragraph (e) insert —

“(f) in relation to a nurses agency, the written statement required to be compiled in relation to the nurses agency in accordance with regulation 4(1) of the Nurses Agency (Wales) Regulations 2003.”

Transitional provisions

30.  Schedule 5 to these Regulations, which makes transitional provisions, shall have effect.

Signed on behalf of the National Assembly for Wales under section 66(1) of the Government of Wales Act 1998(9)

D. Elis-Thomas

The Presiding Officer of the National Assembly

1st October 2003