1 Board of Directors Agenda Item Date: May 2014 Maintaining Safe Staffing Levels Title of Report Purpose of the report and the key issues for consideration / decision The report provides an overview, by exception, of actual versus planned staffing levels, for the month of May 2014. Staffing levels are split between day and night duty and between registered staff and care assistants. Judith Morris – Director of Nursing and Midwifery Presented by: Name & Title Tyrone Roberts – Deputy Director of Nursing and Midwifery Prepared by: Name & Title Action Required (please X) Strategic / Corporate Objective(s) supported by this paper Is this on the Trust’s risk register? Approve X Adopt X Yes All No Which Standards apply to this report? Have all implications related to this report been considered? Receive for information CQC NHSLA BAF Objectives 13/14 If Yes, Score Staffing – Outcome 13 Finance Revenue & Capital National Policy / Legislation NHS Contract Human Resources Consultation / Communication Other: Equality & Diversity Patient Experience Governance & Risk Management Terms of Authorisation Human Rights Carbon Reduction Previous Meetings Please insert the date the paper was presented to the relevant Committee: Audit Committee Clinical Quality & Safety Committee Provider Efficiency Board TR Monthly Staffing Report May 2014 ET Remuneration Committee Assurance & Risk Committee Other 2 1. Executive Summary The Francis Inquiry and Patients First and Foremost, the Government’s response to the Francis inquiry have both identified that delivery of high quality care cannot be achieved if staff do not have the capability and capacity to do their job properly. The National Quality Board (NQB) set out 10 expectations to providers and commissioners in meeting the expectations of people who use their services. This was supported by the Chief Nursing Officer who clarified requirements from providers. This paper presents to the Board a staffing report of actual staff in place compared to staffing that was planned for the month of May 2014. This report will be provided monthly going forward. The report adds further evidence to ongoing concerns with staffing levels within the Medicine Business Group which have already been subject to remedial action including the temporary closure of bed capacity. It also highlights a continued movement of staff, particularly during night period, from care of the elderly wards to support deficiencies elsewhere. The Board is asked to note the contents of this report and to accept the recommendations included. 2. Background The National Quality Board produced guidance on establishing and maintaining appropriate nurse and midwifery staffing levels (How to ensure the right people, with the right skills are in the right place at the right time, 2013). This guidance set out ten expectations to providers and commissioners in meeting the expectations of people who use their services. On 31st March 2014, the Chief Nursing Officer on behalf of NHS England and Professor Sir Mike Richards, on behalf of the Care Quality Commission wrote to providers to provide further guidance on the delivery of the commitments associated with monitoring and publishing staffing data associated to nursing, midwifery and care staff The letter, (‘Hard Truths Commitments’) confirms the requirement to publish staffing information by the end of June 2014. This includes a requirement for: A Board report describing the staffing capacity and capability, following an establishment review, using evidence based tools where possible. To be presented to the Board of Directors every six months. Information about the nurses, midwives and care staff deployed for each shift compared to what has been planned and this is to be displayed at ward level. A Board report containing details of planned and actual staffing on a shift by shift basis at ward level for the previous month. To be presented to the Board every month. The monthly report must also be published on the Trust's website, and Trusts will be expected to link or upload the report to the relevant hospital webpage for NHS Choices. TR Monthly Staffing Report May 2014 3 3. Key Issues Generation of this report has been a challenge due to the variation in shift patterns and hours worked on a day by day basis, reflecting changes in acuity and demand. It is anticipated that an electronic solution will be available in the near future with a manual system deployed in the interim. In order to assure consistency and quality assurance, data is entered in ‘real-time’ and quality checked by the respective Matron with monthly sign-off by the respective Head of Nursing 4. Results Data for May 2014 (Appendix A) illustrate that a significant number of in-patient areas achieved good compliance with actual staffing levels. Business Group Exception reports are provided below; Medicine; Reasons for over filling in the wards in the Medicine Business Group was for Specialling (11) which complied with trust policy to maintain patient safety. A1 due to vacancies, area safe A10 beds closed in interim to ensure safe staffing levels A11 additional RNs provided, night fill rate for RNs remained at 50% which represents a reduction from 3 RNs to 2 RNs A12 46% fill rate for Night RNs – this is due to a change in template which places increased HCAs on night duty and reduced RNs – await establishment template change CCU vacancies, however staffing levels remained safe E1, 2 and 3 under fill represents movement of 3rd Night RN to support shortages elsewhere The above areas highlight under fill of Registered Nurses on both day and night shifts. This is due to ongoing vacancies within the business group which are subject to focused recruitment (including overseas). Surgery; D1/D2 reports some under-fill however, May is traditionally a quieter time for admissions for these areas and therefore beds are not at full occupancy. Day duty staffing levels are below establishment to take account of seasonal fluctuations. Where short notice sickness occurs on nights the two wards, which are co-located, work together to cross cover to ensure patient safety. Twilight shifts are also utilised to take account of reduced occupancy. D4 spinal There has been significant short notice sickness and this has left the ward below established compliment for registered nurses and health care assistants on some occasions. This was mitigated with support from ward M4. M4 Support areas where there were gaps in May to ensure safe cover B6 Planned over establishment at Health care assistant level to take account of specials and more dependent workload on this female surgical ward TR Monthly Staffing Report May 2014 4 C3 The surgical assessment unit has been recently funded for additional establishment at both RN and HCA level. Recruitment has commenced. SSSU In May the unit is closed for the Monday bank holidays and traditionally the school holidays have less elective patient throughput, therefore the staffing is flexed down accordingly , which accounts for the deviation in establishment reported . Women and Child Health; The Treehouse children’s unit operates on a summer and winter staffing plan to address the significant peaks in activity in the winter months. This is a summer plan and we would expect to be carrying vacancies and recruiting to fill them to start in September. A larger than expected turnover of staff this year has been observed due to retirements, in house moves and promotions and staff leaving to take up community posts- currently in excess of 7 vacancies at Band 5 staff nurse level. The neonatal unit is currently carrying some registered nurse vacancies and these have been managed by having fewer staff on duty during the night when there are less clinical interventions required. Sickness or vacancies have not been backfilled with any additional bank shifts as the activity on the unit is lower that we would have expected or planned for. 5. Recommendations Work-streams are already in place to further provide a position statement with regard to overall staffing levels and to provide assurance regarding optimal deployment of current resource. Moving forward, the following is required which will fall within the People and Policies work-stream under Building a Sustainable Future; Establishment of a 6 month ‘task and finish’ group with a specified remit to undertake; Comprehensive review of in-patient staffing ratios against acuity audit results and agreed national and local parameters (to include specialist areas) Review of National Quality Board recommendations, including Supervisory ward Sr/CN status Review of E-roster deployment, to agree key performance indicators and establish robust process for monitoring compliance and escalating non compliance Review of all non-ward/dept based Registered Nursing/Midwifery staff Establishment of a ‘minimum staffing escalation policy’ to formalise processes for deployment of staff and actions to be taken in times of extremis Establishment of a staffing dashboard, monitoring in-patient areas against agreed staffing parameters, in conjunction also with key quality performance indicators Review and incorporation of draft proposed, revised NMC Code of Conduct and potential impact on escalation of concerns Liaise with Medicine Business Group regarding winter staffing plan 2014/15 Above actions to be monitored via project plan with agreed timeframes. TR Monthly Staffing Report May 2014 5 6. Conclusions The monthly report for May 2014, whilst recognising areas of concern, is supported by narrative to confirm actions undertaken to mitigate deficiencies and maintain patient safety. Whilst the review of staffing levels currently underway may yield further areas of concern with regard to funded staffing levels, there remains a significant piece of work to ensure recruitment into current funded vacancies is optimised and to ensure current processes maximise efficient deployment of staff. TR Monthly Staffing Report May 2014 6 TR Monthly Staffing Report May 2014
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