Agenda item
Report to:
Author:
Presented by:
SUBJECT:
For Trust Secretary use
Paper
For Trust Secretary use
Governance Committee – 11th April 2014
Director of Quality
Director of Quality
NHS National Quality Board Staffing Guidance – update
This Report is provided for:
Decision
Endorsement
Assurance
To Note
EXECUTIVE SUMMARY
The January 2014, Governance Committee and Trust Board received a paper on the
proposed implementation of the NHS National Quality Board published new guidance in
November 2013 to support providers and commissioners to make the right decisions
about nursing, midwifery and care staffing capacity and capability: ‘How to ensure the
right people, with the right skills, are in the right place at the right time : A guide
to nursing, midwifery and care staffing capacity and capability’.
This summary report outlines:
a) The ward staffing compliance with planned staffing levels for February 2014
b) The progress that has been made on the key actions from the January 2014
paper
c) Recently published further guidance (31st March 2014) on the exact details of
ward staffing levels to be published
February 2014 compliance with planned ward staffing levels
All wards have been displaying and collating planned staffing levels against actual
staffing levels from the beginning of February 2014. Caroline Driscoll (Matron Manager)
led on the development of exception reporting system by shift, for all wards to collate the
data in a systematic way on Excel spreadsheets.
In summary:
 There were no exception reports where the staff on duty did not meet the needs pf
the patients
 11.4% of shifts during February had a lower staff skill mix than the planned staffing
levels, however the staffing numbers were compliant
 2.6% of shifts during February had a lower number of staff on duty than the planned
levels, however this met the needs of the patients on the ward at the time.
Page 1 of 10
Key actions from the January 2014 implementation actions
The immediate actions have been completed and staffing information is being displayed
and collated for reporting.
Other actions are progressing or have been waiting for national guidance.
Further guidance on publishing staffing information
National guidance was published on 31st March 2014 regarding the publication of
staffing information. This has been reviewed and the paper outlines in detail the
requirements and work completed to date.
Further work is required on the following areas:
 Standardised posters on describing the roles of members of the team

Setting up under the Quality page on the website – ward staffing pages (due to be
completed by the end of May 14)

Staffing information to be published on NHS Choices will be completed by June 14

Further consideration should be given to the use of e rostering that will enable
collection of data in a less time consuming
It is stated that the National Quality Board will set the ground rules for publication of this
data, which will form part of an integrated safety dataset that will be published on a
single hospital safety website, covering the key aspects of safe care and in a form
accessible to patients and the public (DH Hard Truths January 2014 Vol 1 para 1.83).
As yet it would appear this has not been published, although the Director of Quality has
asked the question to the Department of Health. In the interim we will continue to
publish the data using the methodology already in place.
RECOMMENDATIONS
The Governance is asked to :
 Note the compliance with planned staffing levels for February 2014
 Agree the publication of this information on the Trust website
 Note the further work required to implement the standardised requirements for
publishing staffing information by ward by June 2014.
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Corporate Considerations
Quality implications:
Resource implications:
Equalities implications:
Risk implications:
The quality of patient care is directly linked to staffing
capacity and capability.
Investment in in-patient staffing of £1m occurred in
Gloucestershire in-patient units in 2013/14.
Herefordshire in-patient unit staffing is reviewed in line
with planned contractual bed reductions.
Equality implications and responding to specific patient
need are reflected in the agreed staffing levels
There is a risk to the quality and safety of patient care if
staffing levels fall below the agreed staffing levels, or
are not flexibly increased if the patient need increases.
WHICH TRUST STRATEGIC OBJECTIVE(S) DOES THIS PAPER PROGRESS OR
CHALLENGE?
Continuously Improving Quality
P
Increasing Engagement
Ensuring Sustainability
P
WHICH TRUST VALUE(S) DOES THIS PAPER PROGRESS OR CHALLENGE?
Seeing from a service user perspective
P
Excelling and improving
P
Inclusive open and honest
P
Responsive
Can do
Valuing and respectful
Efficient
Reviewed by:
Trish Jay Director of Quality
Date
Where in the Trust has this been discussed before?
The published guidance was discussed at the
Date
Nursing Professional Advisory Committee
Executive Committee
Governance Committee
Board
Governance Committee update
What consultation has there been?
Matrons have been involved in the agreement of
minimum staffing levels in their areas during 2013
Date
2.4.14
5th December 2013
December 2013
January 2014
January 2014
March 2014
December 2013
Matrons were consulted on how the format of
presenting the staffing levels on their wards
Feedback from Charlton Lane Matron on staffing
February 2014
Explanation of acronyms
used:
Page 3 of 10
1.
CONTEXT
1.1
The National Quality Board, sponsored by Jane Cummings, Chief Nursing
Officer in England, on 19th November 2013 published new guidance to
support providers and commissioners to make the right decisions about
nursing, midwifery and care staffing capacity and capability: ‘How to ensure
the right people, with the right skills, are in the right place at the right
time : A guide to nursing, midwifery and care staffing capacity and
capability’.
1.2
In January 2014, the Governance Committee and Trust Board received a
paper on the proposed implementation of this guidance and compliance
against the nine key expectations for providers organisation which are :
1. Boards take full responsibility for the quality of care provided
2. Processes to be in place to enable staffing establishments to be met on a
shift by shift basis
3. Evidence based tools to be used
4. Clinical and managerial leaders foster a culture of professionalism and
responsiveness where staff feel able to raise concerns
5. Multi-professional approach is taken when setting staffing establishments
6. Sufficient time to undertake caring duties in practice
7. Boards receive monthly updates on workforce information, and staffing
capacity and capability is discussed in public Board meetings at least
every six months
8. Clearly display information about the nursing and care staff present on
each ward, clinical setting or service on each shift
9. Providers to take an active role in securing staff in line with their workforce
requirements
10. Commissioners to seek assurance from providers about their staffing.
There were a number of specific actions agreed and progressed which are
outlined in this paper.
1.3
On 31st March 2014, further guidance was produced on the implementation of
publishing staff information and this paper outlines in detail these
requirements.
2.
WARD STAFFING COMPLIANCE WITH PLANNED STAFFING LEVELS
2.1
All wards have been displaying and collating planned staffing levels against
actual staffing levels from the beginning of February 2014.
2.2
Caroline Driscoll (Matron Manager) led on the development of exception
reporting system by shift, for all wards to collate the data in a systematic way
on Excel spreadsheets. There were five exception reporting categories
developed and these are outlined below – if there is no exception then the
shift was complaint with the planned staffing levels.
Page 4 of 10
Code
1
Exception explanation
Minimum staff numbers met – skill mix non-compliant but
met needs of patients
Minimum staff numbers not complaint but met needs of
patients e.g. low bed occupancy , patients on leave
Minimum staff numbers met – skill mix non-compliant
and did not meet needs of patients
Minimum staff numbers not compliant did not meet
needs of patients
Other
2
3
4
5
2.3
Exception reporting on staffing levels not meeting the planned staffing levels
During February 2014, there were 1,428 shifts (Herefordshire units work 12
hour shifts this table assume day time shift equates to 2 shifts).
Bed
number
Number of
fully
compliant
shifts in
the month
Exception
Code 1
Exception
Code 2
Exception
Code 3
Exception
Code 4
Exception
Code 5
Minimum
staffing
numbers MET –
skill mix non
compliant
Minimum staff
numbers NOT
MET,not
complaint but
met needs of
patients
Minimum staff
numbers met –
skill mix noncompliant and
did not meet
needs of
patients
Minimum staff
numbers not
compliant did
not meet needs
of patients
Other
Ward
Gloucestershire
Dean
14
84/84
0
0
0
0
0
Abbey
18
84/84
0
0
0
0
0
Priory
22
51/84
32
1
0
0
0
Kingsholm
15
84/84
0
0
0
0
0
Montpellier
12
84/84
0
0
0
0
0
Greyfriars
10
68/84
15
1
0
0
0
Willow
16
81/84
0
3
0
0
0
Chestnut
14
62/84
0
24
0
0
0
Mulberry
18
82/84
2
0
0
0
0
Laurel
12
6784
17
0
0
0
0
Honeybourne
10
64/84
20
0
0
0
0
Westridge
8
59/84
25
0
0
0
0
Hollybrook
8
58/84
25
1
Herefordshire
0
0
0
Moritimer
21
82/84
2
0
0
0
0
8
82/84
2
0
0
0
0
Cantilupe
10
53/84
24
7
0
0
0
Oak House
10
84/84
0
0
0
0
0
1229/
1428
164
37
0
0
0
Jenny Lind
Total
Page 5 of 10
In summary:
 There were no exception reports where the staff on duty did not meet the
needs of the patients
 86% of the shifts exactly complied with the planned staffing levels.
 11.4% of shifts during February had a lower staff skill mix than the planned
staffing levels, however the staffing numbers were compliant. This was a
reduction in qualified staff by 1 per shift with an increase of health care
assistants.
 2.6% of shifts during February had a lower number of staff on duty than
the planned levels, however this met the needs of the patients on the ward
at the time.
3.
KEY ACTIONS FROM THE JANUARY 2014 IMPLEMENTATION ACTIONS
3.1
The following table provides an update on the agreed actions:
Action
1. COMPLETED
Implementing a system for the collection and
collation of actual staffing against planned
staffing which can be reported on a shift by
shift basis. This would then be reported to the
Board monthly as part of the Performance
Dashboard.
Lead
Dir of
Service
Delivery
Timescale for
implementation
September 2014
The wards have been displaying the planned
and actual staffing levels at the entrance to all
wards since the beginning of February 2014.
2. In progress
Escalation policy to be developed that
documents a process for ward/team staff to
escalate staffing issues and shortfalls.
Dir of
Service
Delivery
April 2014
Dir of
Quality
Determined by
the national
timescales
Staff are clear how to escalate concerns
reading staffing – this is being documented in
to a policy document
3. In progress
Staffing to reflect a nationally agreed evidence
based model for mental health and learning
disability clinical areas
The current planned staffing levels for each
ward were calculated using a West Midlands
staffing calculator and professional judgement
applied. These were shared in the public Board
meeting in January 2014.
Page 6 of 10
The Trust is contributing actively to the
development of evidence based model of
staffing for mental health and learning disability
in-patient services.
4. In progress – but stopped due to national
guidance on 31.3.14
Performance dashboard workforce metrics are
reviewed to include staffing capacity metrics
Dir of
OD
April 2014
Dir of
Quality
February 2014
Dir of
Quality
September 2014
Chief
Exec
February 2014
An exception reporting methodology was
developed in the Trust, which is reported
above. The latest March guidance now
stipulates the national performance reporting
requirements, and this is outlined below.
5. COMPLETED
Publication of planned staffing levels and
actual staffing on each ward daily
This was in place from 1st February 2014.
6. Not due
Six monthly Board report on staff capacity and
capability, including information on other teams
as nationally required.
This requirement is reiterated in the national
guidance.
7. No progress
Review the recently published NHS England
publication on 7 day working to determine
implications and work required
4.
FURTHER NATIONAL GUIDANCE ON THE PUBLICATION OF WARD
STAFFING LEVELS
4.1
On 31st March 2014, further guidance was published on the publication of
staffing levels in in-patient wards. This outlined:
 A timetable of actions with implementation dates
 Frequent asked questions and answers
 An example of an establishment review tracker.
4.2
Further actions to be completed
The information below outlines the actions that need to be taken forward.
Page 7 of 10
1. Board report six
monthly – in public





The displays should:
 Be in an area within the
clinical area that is
accessible to patients,
their families and carers

Explain the planned and
actual numbers of staff
for each shift (registered
and non-registered)
 Detail who is in charge
of the shift

Describe what each
member of the team’s
role is
 Be accurate
3. Further Board
information and action

Planned
January 2014
September 2014
Implemented at the
beginning of February
2014.
Further work is required
on some standardised
posters on describing
the roles of members of
the team
Draws on expert
professional opinion and
insight into local clinical
need and context
Makes
recommendations to the
Board which are
considered and
discussed
Is presented to and
discussed at the public
Board meeting
Prompts agreement of
actions which are
recorded and followed
up on
Is posted on the Trust’s
public website along with
all the other public Board
papers
2. Display of ward
information about the
nursing and care staff :

Completed
Receives an update
containing details and
summary of planned and
actual staffing on a shiftby-shift basis
Is advised about those
wards where staffing falls
short of what is required
to provide quality care,
Yes
Yes
On a white board
Not in place
Yes
Governance Committee
report April 2014, and
will be in Board briefing
from the Governance
Committee
From April 2014
Planned as part of
performance dashboard
Exception reporting in
dashboard paper
Page 8 of 10
Completed


the reasons for the gap,
the impact and the
actions being taken
Evaluates risks
associated with staffing
issues
Seeks assurances
regarding contingency
planning, mitigating
actions and incident
reporting
4. Making the
information publically
accessible



Will be in the risk
register
Board paper in January
is published
Publishes the report in a
form accessible to
patients and the public
on their Trust website
Published monthly on
Trust website
Published on NHS
Choices relevant hospital
pages
5. Review of staffing
levels
The Trust:

Reviews the actual
versus planned staffing
on a shift by shift basis
 Responds to address
gaps or shortages where
these are identified
Planned
Setting up under the
Quality page on the
website – ward staffing
pages (due to be
completed by the end of
May 14)
Links to NHS Choices
will be made by June 14
A full review of staffing
levels on the wards was
completed in 2013.
These are the levels that
are being worked to
currently. Additional
resources were invested
in Gloucestershire units
- £1m
Systems
• Uses systems and
processes such as erostering and
escalation and contingency
plans to make the most of
resources and optimise care
6. Systems for
monitoring and
escalation
• Uses systems and
processes such as erostering and
Manual system in place
for collecting shift
compliance data, this is
then put onto an excel
spreadsheet.
Consideration should be
given to the use of e
rostering that will enable
collection of data in a
less time consuming
way.
Page 9 of 10
Completed
Planned
escalation and contingency
plans to make the most of
resources and optimise care
4.3
It is stated that the National Quality Board will set the ground rules for
publication of this data, which will form part of an integrated safety dataset
that will be published on a single hospital safety website, covering the key
aspects of safe care and in a form accessible to patients and the public (DH
Hard Truths January 2014 Vol 1 para 1.83). As yet it would appear this has
not be published, although the Director of Quality has asked the question to
the Department of Health. In the interim we will continue to publish the data
using the methodology already in place.
Page 10 of 10