Trust Board in Public: July 2014
Item 70.14 Public
Subject:
Safe Staffing Level’s Update Report -Compliance with Hard
Truths Commitment
Author:
Billy Hatifani, Director of Risk & Safety (Deputy Director of Nursing)
Purpose:
Discussion
Key Issues:

Trust wide Compliance with safe staffing levels:
o
Out of the 12,054 planned registered nurse Day hours,
12,134 were worked representing 101% fill rate overall.
o
Out of the 9,380 planned registered nurse Night hours
9,214 were worked representing 98% 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 had to be identified 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 – Monthly Update Report
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 embraced the Safe Staffing agenda and implemented a number
of initiatives such as our surge and escalation process to ensure we receive real time
intelligence from our front line staff, on how we are meeting safe staffing levels.
A review of the hours worked against plan for registered nurses in our 24/7 wards for the
month of June, shows good overall shift cover for the day shift. Out of the 12,054 planned
registered nurse day shift hours, 12,134 were worked, representing a fill rate of 101% overall.
9,380 night shift registered nurse hours were planned and 9,214 hours were actually worked
representing a 98% fill rate, which is slightly lower than expected.
2.0 Monthly Safe Staffing Compliance Update
Our analysis of compliance with our agreed safe staffing levels for each ward shows that in
June 2014, some of our wards did not have the sufficient numbers of 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 most reporting more hours
worked than our planned minimum staffing levels, except for Bramdean and Larkfied who
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reported lower staffing cover than planned with a fill rate of 96% and 93% respectively for
registered nursing day hours. The wards however managed to ensure that all planned support
care worker hours were filled for the day shift.
Night shift Cover
Bramdean and Larkfield also reported fewer hours than planned for registered nurses and care
support workers at night. Table 1 below shows the breakdown of all planned hours versus the
total actual staff hours including NHS Professional cover for the month for the Division
Day
Registered
midwives/nurses
Ward name
Total
monthly
planned
staff
hours
Bramdean
April Cottage
Oakwood
Ashmount & Derby
Larkfield
Total
monthly
actual
staff
hours
Night
Care Staff
Registered
midwives/nurses
Day
Care Staff
Total
Total
Total
Total
Total
Total
monthly monthly monthly monthly monthly monthly
planned actual planned actual planned actual
staff
staff
staff
staff
staff
staff
hours
hours
hours
hours
hours
hours
Night
Average fill
Average fill rate rate Average fill
registered
Average fill rate
registered rate - care
nurses/midwives - care staff (%)
nurses/mid
staff (%)
(%)
wives (%)
420
407 1,260.00
1,437
294
290
588
572
96.9%
114.0%
98.6%
97.3%
406
530 1,218.00
1,509
308
309
308
352
130.5%
123.9%
100.3%
114.3%
392
420 3,136.00
3,478
280
280
840
919
107.1%
110.9%
100.0%
109.4%
420
429 2,520.00
3,162
280
322
560
1,089
102.1%
125.5%
115.0%
194.5%
420
392 1,260.00
1,294
294
287
294
287
93.3%
102.7%
97.6%
97.6%
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.
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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. For 24/7 Wingfield, 24/7 Clare and 24/7 Delius, the planned
registered nurse hours were not met as the wards only reported fill rates of 96%, 89% and
97% respectively. It is however important to note that all three wards appear to have increased
their Care Support Worker cover over this period, with the group working more hours than
planned for the month.
Night Shift
The registerd nurse night shift hours worked are morethan planned for all wards except 24/7
Wingfield, 24/7 Elgar and 24/7 Fenby. All wards however reported sufficient Care Support
worker cover, as they had more hours worked than planned for the month. Table 2 below
shows the breakdown of all planned hours versus the total actual staff hours including NHS
Professional cover for the month for the Division.
Day
Registered
midwives/nurses
Ward name
Total
monthly
planned
staff
hours
Total
monthly
actual
staff
hours
Night
Registered
midwives/nurses
Care Staff
Day
Care Staff
Total
Total
Total
Total
Total
Total
monthly monthly monthly monthly monthly monthly
planned actual planned actual planned actual
staff
staff
staff
staff
staff
staff
hours
hours
hours
hours
hours
hours
Night
Average fill
Average fill rate rate Average fill
registered
Average fill rate
registered rate - care
nurses/midwives - care staff (%)
nurses/mid
staff (%)
(%)
wives (%)
966
934
644
702
644
635
644
734
96.7%
109.0%
98.6%
114.0%
966
998
644
1,357
644
984
644
973
103.3%
210.7%
152.8%
151.1%
966
864
644
723
644
656
644
669
89.4%
112.3%
101.9%
103.9%
644
757
644
719
644
674
322
350
117.5%
111.6%
104.7%
108.7%
644
628
644
658
644
647
322
508
97.5%
102.2%
100.5%
157.8%
644
665
644
751
644
618
322
345
103.3%
116.6%
96.0%
107.1%
644
857
966
893
644
608
644
1,082
133.1%
92.4%
94.4%
168.0%
24 7 Wingfield
24 7 Blake
24 7 Clare
24 7 Anderson
24 7 Delius
24 7 Elgar
24 7 Fenby (PICU)
Table 2
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Current Actions
This low fill rate has been escalated to the Divisional Director. Additional staff have been
made available to cover the 136 assessment facilities in the Division and these staff will be
available to provide additional cover where required. Division will continue to monitor and
review the effective use of these staff.
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 June,
two out of the 7 inpatient wards did not cover all the planned registered nurse hours for the
month. 24/7 Spenser reported lower hours worked than planned for the day and night shifts for
both staff groups. 24/7 Bluebell has reported a lower day fill rate than planned for registered
nurses, but has reported that Care Support Workers worked more hours than planned in the
month.
Day
Registered
midwives/nurses
Ward name
Total
monthly
planned
staff
hours
Victoria
Albert
Hayworth House
Spenser Ward
Bluebell Ward
Primrose Ward
Willows
Total
monthly
actual
staff
hours
Night
Registered
midwives/nurses
Care Staff
Total
monthly
planned
staff
hours
Total
monthly
actual
staff
hours
Total
monthly
planned
staff
hours
Total
monthly
actual
staff
hours
Day
Care Staff
Total
monthly
planned
staff
hours
Total
monthly
actual
staff
hours
Night
Average fill
Average fill rate rate Average fill
registered
Average fill rate
registered rate - care
nurses/midwives - care staff (%)
nurses/mid
staff (%)
(%)
wives (%)
924
1,046
924
2,590
616
637
924
2,448
113.2%
280.3%
103.4%
264.9%
644
663
966
1,948
616
633
924
1,780
103.0%
201.7%
102.8%
192.6%
644
683
1,288.00
1,253
644
335
966
1,420
106.1%
97.3%
52.0%
147.0%
924
659
924
900
616
344
924
626
71.3%
97.4%
55.8%
67.7%
322
268
644
743
308
317
616
675
83.2%
115.4%
102.9%
109.6%
322
435
644
890
308
326
308
639
135.1%
138.2%
105.8%
207.5%
322
501
966
1,096
308
316
616
623
155.6%
113.5%
102.6%
101.1%
Chart 5
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. The Division has recruited 5 additional staff this month to meet the safe staffing
levels. Further to this recruitment, it is anticipated that compliance with the safe staffing levels
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will be achieved across the Division going forward.
3.0 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.
4.0 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.
5.0 Reasons for Gaps in Staffing fill rate
The shifts requested through NHS Professionals were not always filled and some teams have
reported some sickness in the month which has affected the fill rate.
The recruitment
process has commenced and it is anticipated that this will lead to an improved level of
compliance to safe staffing levels going forward.
6.0 Impact on Key Quality Outcome Measures
For the month of June no direct correlation has been identified between fill rate and inability
to deliver on quality outcome measures, but it is important to acknowledge that low levels of
staffing and high use of agency may lead to poor outcomes and the Quality Directorate
continues to support teams in the monitoring and learning from all adverse events.
Billy Hatifani, Director of Risk & Safety (Deputy DoN)
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