Safer Staffing
Agenda Item 8i)
Board of Directors Meeting
Date: 28th May 2014
SOUTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST
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 report.
1.0
PURPOSE OF REPORT
The purpose of this report is to update the Board of Directors on the work undertaken to
review nursing establishments within all the inpatient areas as per the expectation within the
Safer Staffing guidance. This update includes recommendations for each wards safer
staffing establishment requiring agreement and sign off by the Board of Directors.
2.0
EXECUTIVE SUMMARY
In November this year The National Quality Board, sponsored by Jane Cummings, Chief
Nursing Officer in England published new guidance to support providers and commissioners
in making the right decisions about nursing, midwifery and care staffing capacity and
capability. Further to this, guidance has been published on the delivery of the ‘Hard Truths
Commitments’ associated with publishing staffing data regarding nursing, midwifery and care
staff.
As part of this work, it was expected that a report describing the staffing capacity and
capability, following an establishment review by the use of evidence based tools where
possible, be presented to the Board every six months. It is expected that the report: 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.
The guidance clearly states expected content covering the following points: The difference between current establishment and recommendations following the
use of evidence based tool(s);
 What allowance has been made in establishments for planned and unplanned leave;
 Demonstration of the use evidence based tool(s);
 Details of any element of supervisory allowance that is included in establishments for
the lead sister / charge nurse or equivalent;
 Evidence of triangulation between the use of tools and professional judgement and
scrutiny;
 The skill mix ratio before the review, and recommendations for after the review;
 Details of any plans to finance any additional staff required;
 The difference between the current staff in post and current establishment and
details of how this gap is being covered and resourced; details of workforce metrics for example data on vacancies (short and long-term), sickness / absence, staff
turnover, use of temporary staffing solutions (split by bank / agency / extra hours and
over-time); and
 Information against key quality and outcome measures - for example, data on: safety
thermometer or equivalent for non-acute settings, serious incidents, healthcare
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Safer Staffing
associated infections (HCAIs), complaints, patient experience / satisfaction and staff
experience / satisfaction.
The attached report details the process undertaken as part of the establishment review
across all inpatient areas. Details of each ward area with current funded establishment and
recommended staffing establishment are illustrated. As discussed within the guidance, the
recommended safer staffing establishments are based on senior clinical staff utilising
professional judgment and scrutiny to triangulate the results of the evidence based tools with
their local knowledge of what is required to achieve better outcomes for their patients.
3.0
ASSURANCE
CQC Registration Standards, Commissioning Contracts, Trust Annual Plan and
Objectives
The report supports registration and commissioning standards and Trust objectives around
quality of care and workforce.
NHS Constitution
Safer Staffing supports key principle 3 of the NHS Constitution ‘The NHS aspires to the
highest standards of excellence and professionalism’
Data Quality
Staffing establishments are included within the paper. This includes the present funded
establishment and recommended staffing establishments going forward.
Involvement of Service Users /Links
None known.
Communication and consultation with stakeholders
The Safer Staffing Task and Finish Group, led by The Executive Director of Clinical
Governance and Quality/Executive Nurse and supported by the Lead Nurses has senior
representation from across operational services, workforce, human resources, practice
development and the E-Rostering Team.
Service Impact/Health Improvement Gains
There are established and evidenced links between patient care and having the right people
with the right skills in the right place at the right time.
Financial Implications
There are financial implications with this paper to gain the funded establishments required for
each ward area to meet safer staffing levels.
Governance Implications
There will be further strengthening of the Trust’s governance arrangements through
informing the appropriate skill mix requirements and nursing establishment levels to meet
the needs of patients across SEPT services.
Patient Safety/Quality
Patient safety and quality of care provision are the key drivers within the report to ensure
quality of staffing.
4.0
RECOMMENDATION
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Safer Staffing
It is recommended that the Board of Directors:
1. Note the contents of this report
2. Review and agree recommendations outlined within the establishment reviews
3. Agree any further work required to be taken forward.
5.0
ACTION REQUIRED
The Board of Directors is asked to:
1. Note the contents of this report
2. Review and agree recommendations outlined within the establishment reviews
3. Agree any further work required to be taken forward.
Report prepared by
Sarah Browne
Associate Director Clinical Governance & Quality
On behalf of
Andy Brogan
Executive Director of Clinical Governance and Quality
3
Sharan Johal
Project Manager
Safer Staffing
Agenda Item 8i)
Board of Directors Meeting
Date: 28th May 2014
SOUTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST
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 report.
1.0
PURPOSE OF REPORT
The purpose of this report is to update the Executive Team on the work undertaken to review
nursing establishments within all the inpatient areas as per the expectations within the Safer
Staffing guidance. This update includes recommendations for each wards establishment
which requires agreement and sign off by the Board of Directors to ensure we provide safe
staffing.
2.0
BACKGROUND
In November this year The National Quality Board, sponsored by Jane Cummings, Chief
Nursing Officer in England published new guidance to support providers and commissioners
to make the right decisions about nursing, midwifery and care staffing capacity and
capability. Further to this, guidance has been published on the delivery of the ‘Hard Truths
Commitments’ associated with publishing staffing data regarding nursing, midwifery and care
staff.
As part of this work, it is expected that 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 every six months. It is expected that the report: 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
3.0
PROCESS
As discussed within previous reports, a weekly task and finish group led by the Executive
Director Clinical Governance and Quality / Executive Nurse has project managed the Safer
Staffing work stream including the establishment review. A full establishment review has
been undertaken of all the inpatient wards across the trust. This has compromised data
collection, use of evidence based tools, triangulation of results of the tools with professional
judgment and scrutiny including benchmarking ward areas across the trust. This work was
followed by final agreement of recommended establishments by Lead Nurses and Executive
Nurse.
As nationally recommended, Hurst’s evidence based tools were utilised. For community
health services inpatient areas, Hurst’s Nursing workforce planning software with
dependency tool was utilised. This tool is based on acute services but on recommendation
from Keith Hurst, elderly care criteria were used to input dependency data into. The
community inpatient areas within SEPT cover a range of services including rehabilitation,
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Safer Staffing
sub-acute care and stroke services. This was taken into consideration when triangulating the
results of the tools with professional judgment, scrutiny and use of senior clinical staff’s local
knowledge of what is required as recommended within the guidance.
For the mental health wards, Hurst’s Nursing mental health workforce planning software with
mental health inpatient dependency tool was utilised. This is a new tool devised as part of
the national safer staffing work and whilst there are different specialities within the tool to
input, not all clinical teams are presently covered and some areas have only been piloted on
a small number of ward areas. Again this was taken into consideration when triangulating the
results of the tools with professional judgment, scrutiny and use of senior clinical staff’s local
knowledge of what is required as recommended within the guidance.
The evidence based tools are based on best practice and within the majority of areas,
identified a higher qualified ratio to patients. The professional judgment meetings undertaken
considered the tools and following criteria followed: Reviewing present establishment to the results of the tools
 Local knowledge and professional judgment of the dependency of the wards to agree
safer staffing shift cover
 Ensuring any standalone units had 2 registered staff on every shift
 Identifying site manager support within sites which had more than one ward area
 Reviewing supervisory status of band 7s
 Within mental health units, the first “1:1 observation” to be managed within
establishments
4.0
ESTABLISHMENT REVIEW
The following tables detail the current safer establishment and recommendations following
the use of evidence based tools and triangulation of data. Within the establishments 19%
absence cover has been included to cover planned and unplanned leave. It is therefore not
expected for wards to staff to full establishment to allow cover for all shifts required. The
absence cover is presently being discussed nationally as to whether a national figure will be
set and indicative figure that has been stated is 21%.
The recommended establishments within the mental health wards only cover the first ‘1:1
observation’ and across the trust due to the increase in dependency of patients, we have
seen an increase in the number of observations required on a shift-by-shift basis.
The table covers the inpatients areas across mental health, learning disability and
community health services. There are 3 further inpatients areas that at present have not
been included in the table outlined below due to the integrated establishments aligned to the
services: Biggleswade – integrated establishment covering community and inpatient areas,
with flexing up of beds as required
 Coppice – integrated establishment covering inpatient and community teams
 Prison healthcare – integrated establishment covering healthcare beds, clinics,
reception duties and medication support.
5
Safer Staffing
Locality and
Service
Type
Ward Name
Current Funded
Establishment
Reg
Bedfordshire
and Luton
Mental
Health
Services
Bedfordshire
Community
Health
Services
Essex Mental
Health
Services
Care
Staff
TOTAL
Recommended
Establishment
As agreed by Executive
Nurse / Lead Nurse /
Senior Manager for the
service
Care
Reg
TOTAL
Staff
Lead Nurse Assurance Statement
Cedar House
Chaucer
10.59
9.29
10.26
11.36
20.85
20.65
9.75
9.47
8.75
11.31
Coral
Crystal
15.22
9.77
15.22
10.89
30.44
20.66
15.36
9.95
14.16
10.83
B7 1.00 wte Supervisory * temporary agreed establishment, further review
29.52* being undertaken following results from tool
20.78 B7 1.00 wte Supervisory
B7 1.00 wte Supervisory * temporary agreed establishment, further review
being undertaken following results from tool
B7 1.00 wte Supervisory
B7 1.00 wte Supervisory
B7 1.00 wte Supervisory
B7 1.00 wte Supervisory
B7 1.00 wte Supervisory
B7 1.00 wte Supervisory
Fountains Court
Jade
Keats
Onyx
105 London Road
MHAU
Townsend
18.50 B7 1.00 wte Supervisory
20.78 B7 1.00 wte Supervisory
13.54
8.82
12.83
11.89
9.22
6.44
9.77
21.68
8.77
15.22
14.22
7.73
6.63
10.89
35.22
17.59
26.35
26.11
16.95
13.07
20.66
13.70
8.99
12.98
12.03
8.08
6.61
9.95
20.83
8.75
14.16
14.16
9.00
6.60
10.83
Whichellos
9.72
7.95
17.67
8.08
8.75
Archer Unit
12.32
16.32
28.64
12.33
17.99
30.32
SMU
11.00
12.44
23.44
10.62
12.04
22.66 Stand alone unit - B7 supervisory 0.40 wte
Beech
9.62
16.92
26.54
11.14
16.10
27.24*
10.11
9.38
15.25
30.93
25.36
40.31
11.14
11.51
15.20
28.32
B7 supervisory 0.40 wte * temporary agreed establishment, further review
26.34*
being undertaken following results from tool
39.83 B7 supervisory 0.40 wte
Cedar ward
Clifton
6
34.53*
17.74
27.14
26.19
17.08
13.21
20.78
16.83 B7 1.00 wte Supervisory
Stand alone unit, works as integrated team across Biggleswade and Archer B7 covers both wards and supervisory
B7 supervisory 0.40 wte * temporary agreed establishment, further review
being undertaken following results from tool
Safer Staffing
Churchview
Gloucester
Locality and
Ward Name
Service
Type
6.06
10.55
16.61
9.43
15.26
24.69
Current Funded
Establishment
Reg
Essex Mental
Health
Services
Essex CHS
West Essex
Community
Health
Services
Trustwide
Care
Staff
TOTAL
5.95
11.11
17.06 B7 supervisory 0.40 wte
11.99
12.77
24.76* B7 supervisory 0.40 wte
Recommended
Lead Nurse Assurance Statement
Establishment
As agreed by Executive
Nurse / Lead Nurse /
Senior Manager for the
service
Care
Reg
TOTAL
Staff
Grangewaters
10.56
13.59
24.15
10.80
11.11
21.91*
B7 supervisory 0.40 wte * temporary agreed establishment, further review
being undertaken following results from tool
Hadleigh
11.06
17.57
28.63
13.02
11.60
24.62*
B7 supervisory 0.40 wte * temporary agreed establishment, further review
being undertaken following results from tool
16.10
20.23
B7 supervisory 0.40 wte * temporary agreed establishment, further review
27.24*
being undertaken following results from tool
29.52 B7 supervisory 0.40 wte
Maple
Mayfield
9.62
9.62
16.92
19.19
26.54
28.81
11.14
9.29
* temporary agreed establishment, further review being undertaken
following results from tool but 2nd qualified put onto night shift to cover
Thurrock wards B7 supervisory 0.40
B7 supervisory 0.40 wte
B8 supervisory 0.40 wte
B7 supervisory 0.40 wte
Meadowview
MHAU
Mountnessing
Rawreth
9.39
13.30
12.26
10.81
19.36
12.96
15.62
29.85
28.75
26.26
27.88
40.66
11.51
14.21
11.51
11.51
15.80
12.77
16.10
28.32
27.31*
26.98
27.61
39.83
Westley
10.08
14.12
24.20
10.80
11.11
21.91* B7 supervisory 0.40 wte
CICC
Poplar Ward
Beech Ward
Plane Ward
9.00
10.80
9.05
10.40
16.26
19.73
16.43
19.85
25.26
30.53
25.48
30.25
9.17
11.28
9.17
9.17
17.55
17.55
19.66
19.66
26.72
28.83
28.83
28.83
Stand alone
B7 supervisory 0.40 wte
B7 supervisory 0.40 wte
B7 supervisory 0.40 wte
Avocet Ward
9.60
16.90
26.50
11.28
14.22
25.50
2nd Qualified for nights as stand alone unit B7 0.40 supervisory
Bronte
0.00
6.56
6.56
1.00
8.89
9.89
7
Units work together, covering qualified support and management cover
Safer Staffing
Learning
Disability
Services
Locality and
Service
Type
Byron
8.12
12.97
21.09
5.95
14.44
20.39
Keats
6.05
8.02
14.07
3.33
7.78
11.11
Ward Name
Current Funded
Establishment
Reg
Forensic
Services
CAMHS
Care
Staff
TOTAL
Recommended
Establishment
As agreed by Executive
Nurse / Lead Nurse /
Senior Manager for the
service
Care
Reg
TOTAL
Staff
B7 supervisory 0.40 wte
Lead Nurse Assurance Statement
Alpine
Aurora
Causeway
Dune
Forest
Fuji
Lagoon
Robin Pinto Unit
12.65
7.31
14.66
9.64
10.40
15.33
12.02
12.36
12.99
11.22
21.45
14.13
9.80
28.96
16.71
16.36
25.64
18.53
36.11
23.77
20.20
44.29
28.73
28.72
13.50
6.85
10.69
10.19
10.19
12.91
13.50
9.89
12.77
8.89
16.66
11.11
8.00
22.21
14.44
11.11
26.27
15.74
27.35
21.30
18.19
35.12
27.94
21.00
Woodlea Clinic
9.20
13.78
22.98
9.89
11.11
21.00 Band 7 supervisory 1.00
Poplar
9.65
12.35
22.00
9.29
14.44
23.73 B8a supervisory 0.40 wte
8
B7 supervisory 0.50
Band 8a supervisory 0.50
Band 7 supervisory 1.00
B7 supervisory 0.50
B7 supervisory 0.50
Band 7 supervisory 1.00
B7 supervisory 0.50
Band 7 supervisory 1.00
Safer Staffing
5.0
WORKFORCE METRICS
Workforce metrics covering vacancies, sickness, staff turnover, mandatory training,
supervision and appraisals are collated on a monthly basis. These are reported and reviewed
through various local and corporate meetings including senior management teams,
Executive team and Performance and Finance Scrutiny committee.
6.0
KEY QUALITY & OUTCOME MEASURES
Key quality and outcome measures are collected on a monthly basis and reported within the
performance report. This includes serious incidents, safeguarding, safety thermometer,
healthcare associated infections (HCAIs), complaints and patient satisfaction surveys.
7.0
CONCLUSION
The establishments identified within the report have been agreed to allow minimum safer
staffing levels on each shift. This requires additional funding as some of ward areas were
under established as identified through overspends within the operational budgets. It should
also be acknowledged that whilst staffing levels have been reviewed and in most areas
increased, the qualified ratio within the majority of ward areas still does not meet “best
practice standards” of 1:8 ratio.
Each of the ward areas have been reviewed by the Executive Director of Clinical
Governance and Quality / Executive Nurse with the relevant lead nurse and senior clinical
staff to utilise professional judgment and agree minimum safer staffing establishments. Ongoing review will be undertaken and further full establishment reviews undertaken in 6
months times as per guidance.
8.0
RECOMMENDATIONS
It is recommended that the Board of Directors:
4. Note the contents of this report
5. Review and agree recommendations outlined within the establishment reviews
6. Agree any further work required to be taken forward.
9.0
ACTION REQUIRED
The Board of Directors is asked to:
4. Note the contents of this report
5. Review and agree recommendations outlined within the establishment reviews
6. Agree any further work required to be taken forward.
Report prepared by
Sarah Browne
Associate Director Clinical Governance & Quality
On behalf of
Andy Brogan
Executive Director of Clinical Governance and Quality
9
Sharan Johal
Project Manager