Trust Board in Public: June 2014
Item 54/14Public
Subject:
Safe Staffing Level’s Report -Compliance with Hard Truths Doc
Author:
Billy Hatifani, Director of Risk & Safety (Deputy Director of Nursing)
Purpose:
Discussion
Key Issues:
•
•
•
Publication of staffing numbers on wards- all 24/7 wards/ units
with nursing are displaying their staffing cover per shift.
Safe staffing Levels – completion of the daily return is still not fully
embedded, more work required to embed.
Trust wide Compliance with safe staffing levels:
o Out of the 11,795.5 planned registered nurse Day hours,
12,773 were worked representing 108% fill rate overall.
o Out of the 8,897 planned registered nurse Night hours 9189
were worked representing 103% fill rate.
Health/Social
Impact:
Staff in hospitals where the staff levels are not deemed safe have
been known to have higher burnout rates and were approximately
twice as likely to be dissatisfied in their job. Good staffing levels will
lead to positive outcomes for people using our services
Financial
Implications:
£1.2m has been set aside to facilitate improved staffing levels on the
wards. Ongoing review of this investment with our commissioners
should be considered and agreed going forward for any deficits in
staffing establishment that may affect compliance with delivering safe
staffing levels
Diversity/Equality
Impact Assessment:
No Equality issues have come to light; the review has considered all
protected characteristics equally.
Recommendation to
Board:
The Board is asked to note the improvement in staffing levels and
the direction of travel.
24/7 Safe Staffing Levels
1.0 Introduction
NHS England and the Care Quality Commission issued joint guidance to Trusts on the delivery
of the ‘Hard Truths’ commitments associated with publishing staffing data regarding nursing,
and care staff levels. We have instigated a process of real time surge and escalation that
allows senior managers to be informed in real time when a ward is either busy due to low
staffing levels, has lack of bed capacity or an adverse event has occurred that is affecting the
normal functionality. Through this process we anticipate an improved turnaround in the way
additional resource and/ or support is made available to front line staff as and when required.
We appreciate the effects of poor staffing levels on the delivery of high quality care and we
have made it clear and easy for staff to escalate concerns to ensure safe staffing levels are
maintained, including incident reporting and the use of the real time reporting process. We
have confirmed with senior team members their safe staffing levels per ward and are asking
that they ensure the embedding of this understanding in teams.
A review of the hours worked against plan for registered nurses in our 24/7 wards for the
month of May shows that, out of the 11,795.5 planned registered nurse day shift hours, 12,773
were worked representing 108% fill rate overall. The planned registered nurse hours for night
shifts was 8,897 hours and for the month 9,189 hours were worked representing 103% fill rate.
Although there is a good overall fill rate of hours worked against plan, we are still working to
improve in those teams where actual worked hours in May were lower than planned. It is
however important to note that where there appears to be less than planned numbers of
qualified registered nurses, there is a high number of additional hours worked by Care Support
Workers against the plan, ensuring that the ward has good overall nursing cover. The report
provides further analysis on fill rate per Division and ward.
Safe Staffing Levels – Compliance with Hard Truths Doc
BH 06.14
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1.1 Evidence Based Tools
To calculate our safe staffing levels, we have made use of the RCN Safe Nursing Staffing
Levels in UK (2010) guidance which indicates that the average number of patients to
registered nurses in mental health services is 9.2 to a registered nurse. This method has been
supported by the professional judgment method, which allows expert groups (e.g., clinical,
finance
and
personnel
managers),
armed
with
local
intelligence
to
decide
the
ward/department/locality team size and mix by consensus to take account of differences in
acuity and dependency on each unit/ward.
2.0 Monthly Safe Staffing Compliance
Our analysis of compliance with our agreed safe staffing levels for each ward shows that in
May 2014, some of our wards did not have the sufficient numbers staff working on a shift to
meet our planned hours cover for each shift. We analysed data by looking at the nursing
hours planned against actual hours worked including those hours covered by NHS
Professionals.
2.1 Services for People with a Learning Disability Division
Due to the care needs of people using our Learning Disability Service our skill mix includes a
high proportion of care support workers to support with activities of daily living, as such our
care support staff planned number is much greater than those for registered nurses.
Day Shift cover
The safe staffing compliance data for the day shifts worked shows that all our units had
sufficient registered nursing & Care Support Worker cover, with all of them reporting more
hours worked than our planned minimum staffing levels.
Safe Staffing Levels – Compliance with Hard Truths Doc
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Chart 1
Night shift Cover
Ashmount and Derby reported more hours worked than planned for registered nurses, but it is
evident from the data that the other units did not have a sufficient number of registered nursing
cover for the planned hours, with Bramdean reporting the highest number of unfilled hours for
both registered nurses and Care Support Workers, equating to 5 and 27 shifts respectively
where there was insufficient levels of staffing (calculation based on an 11.30 hour shift).
Chart 2
Table 1 below shows the breakdown of all planned hours versus the total actual staff hours
including NHS Professional cover for the month of May for the Division
Safe Staffing Levels – Compliance with Hard Truths Doc
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Table 1
Current Actions
This low fill rate has been escalated to the Divisional Director and further guidance on
expected safe staffing levels has been issued to the team to ensure improvements in fill rate
are achieved. There is ongoing recruitment in the Division to meet the agreed safe staffing
levels.
2.2 Mental Health and Social Care Division
Due to the high levels of dependency and acuity of some of the people using our Acute Mental
Health Wards, there is a need to quick responsiveness and flexibility for additional resource,
for example when people are escorted off the ward or are placed on enhanced observation.
We work closely with our front line staff to ensure that any additional demands on staff are
escalated, to ensure prompt action is taken to provide the required support.
Day Shift
The safe staffing compliance data for our Working Age Adult wards shows that there were
shifts that did not have the correct levels of cover by a qualified nurse, as per agreed safe
staffing levels. This deficit in cover is indicated by the difference between planned and actual
hours worked for the month. 24/7 Wingfield had the highest number of hours not sufficiently
covered, which equates to 8 shifts over the month that did not have sufficient levels of
Safe Staffing Levels – Compliance with Hard Truths Doc
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registered nurse day shift cover. It is however important to note that where there appears to be
less than planned numbers of qualified registered nurses, there is a high number of additional
hours worked by Care Support Workers against the plan, ensuring that the ward has good
overall nursing cover.
24/7 Fenby reported the highest number of Care Support Worker hours that were not covered.
The ward covered all registered nurse planned hours for the month, but had lower actual hours
worked against plan for Care Support Workers, equating to about 14 shifts
(calculation based on an
11.30 hour shift).
Chart 3
Night Shift
The night shift hours worked are close to those planned across the Division for registered
nurses, with more hours worked on 24/7 Blake, 24/7 Delius and 24/7 Clare than planned. All
wards also had sufficient Care Support worker cover as they had more hours worked that the
initial planned minimun staffing hours.
Safe Staffing Levels – Compliance with Hard Truths Doc
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Chart 4
Table 2 below shows the breakdown of all planned hours versus the total actual staff hours
including NHS Professional cover for the month of May for the Division
Table 2
Current Actions
This low fill rate has been escalated to the Divisional Director. Additional staff will be made
available to cover the 136 assessment facilities in the Division and these staff will be available
to provide additional cover where required.
Safe Staffing Levels – Compliance with Hard Truths Doc
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2.3 Older Peoples Mental Health Division
Due to the care needs of people using our older people’s services our skill mix includes a high
proportion of care support workers to support with activities of daily living, as such our care
support staff planned number are much greater than those for registered nurses.
Day Shift
The safe staffing compliance data for our older people units shows that for the month of May,
three out of the 7 inpatient wards did not cover all the planned registered nurse hours for the
month. 24/7 Hayworth reported the highest number hours that were not covered, equating to 4
shifts that did not have sufficient levels of cover
(calculation based on an 11.30 hour shift).It
is however
important to note that 24/6 Hayworth had more Care Support Worker hours worked than
planned equating to 27 shifts where more hours were worked than planned. (calculation based on an
11.30 hour shift).
Chart 5
Night Shift
The night shift hours worked by registered nurses were nearly always equal to the planned
hours, with only 24/7 Primrose reporting comparatively more hours not worked against plan.
The unfilled hours for 24/7 Primrose equate to 5 registered nurse shifts that were not
sufficiently covered as per plan but the ward had more hours worked against plan by Care
Support Workers with the additional hours worked equating to 37 shifts that had more staff
than planned minimum safe levels.
Safe Staffing Levels – Compliance with Hard Truths Doc
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Chart 6
Table 3 below shows the breakdown of all planned hours versus the total actual staff hours
including NHS Professional cover for the month of May for the Division
Table 3
Current Actions
This low fill rate has been escalated to the Divisional Director and further guidance on
expected safe staffing levels has been issued to the team to ensure improvements in fill rate
are achieved. There is ongoing recruitment to cover the staffing deficit in some wards.
Safe Staffing Levels – Compliance with Hard Truths Doc
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3.0 Processes in place to enable staffing establishments to be met
The Director of Quality (DoN) continues to coordinate the available staff programme which
reviews & ensures the improvement in the quality of roster planning by ward. The review team
analyse possible future breaches on planned rosters, which should identify any unforeseen low
levels of staffing. This information is then compared with NHSP booking data which will allow
for the robust monitoring of quality. This process also allows us to check that appropriate
allowances have been made in establishments for planned and unplanned leave and the
supervisory role of the ward manager.
4.0 Display information about the nurses and care staff present on each ward.
We now have full compliance with the displaying of nursing numbers on the ward. Further
ongoing assurance work to ensure the process is embedded continues.
5.0 Finance for Additional Staffing
£1.2m has been set aside to facilitate improved staffing levels on the wards. Ongoing review of
this investment with our commissioners should be considered and agreed going forward for
any deficits in staffing establishment that may affect compliance with delivering safe staffing
levels.
6.0 Recommendations for Board
a. The Board is requested to note and discuss the nursing hours fill rate against plan
for May.
b. The Board is asked to agree their ongoing commitment to delivering safe staff levels
by further confirmation of their approval of the financial envelope to facilitate the
recruitment to meet and maintain a staffing establishment that delivers safe staffing
levels.
c. The Board is asked to ensure that the Executive Team is supported to take decisive
action to protect patient safety and experience.
Billy Hatifani, Director of Risk & Safety (Deputy DoN)
Safe Staffing Levels – Compliance with Hard Truths Doc
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