Trust Board: January 2015
Subject:
Safe Staffing Level’s Update Report -Compliance with Hard Truths
Doc- Dec 2014 Report
Author:
Ben Chambers, Lead Nurse for Clinical Assurance
Purpose:
Discussion
Key Issues:

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.
Trust wide Compliance with safe staffing levels November 2014:
 Registered Nurse Day hours – 8,393 planned, 9,341
worked representing 111% fill rate overall.
 Registered Nurse Night hours – 7,634 planned 7,186
worked representing 94% fill rate.
 Care Support Worker Day Hours – 16,885 planned,
19,8086 worked representing 117% fill rate
 Care Support Worker Night Hours- 9,680 planned, 12,337
worked representing 127% fill rate
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 November, shows appropriate shift cover for the day shift and a reasonable cover of
the night shift, with exceptions discussed below.
Out of the 8,393 planned day shift registered nurse hours 9341 were worked representing a
111% fill rate overall representing a 1% increase on last months figures. 7,634 night shift
registered nurse hours were planned and 7,186 hours were actually worked representing a
94% fill rate, which is lower than expected and represents a 3% decrease on last months
figures. Our fill rate for Care Support Workers was high for both day and night cover with fill
rates of 117% & 127% respectively. These figures however represent a 6% and 5% decrease
in fill rate (respectfully) which as the tables below will show means that the number of staff
required to manage the sickness levels and acuity on the wards more closely matched the
anticipated safe staffing levels than during the previous month.
2.0 Monthly Safe Staffing Compliance Update
As in October, the November data shows a reduction in the number of wards which had a
figure below the 90% of expected staff and the reason for these lower than expected figures
are discussed below. We analysed data by looking at the nursing hours planned against
actual hours worked including those hours covered by NHS Professionals. The overall picture
suggesting that staffing levels within the 24/7 services are becoming increasingly consistent in
operating above the safe staffing levels agreed for their services. Encouragingly this month
there has been a % reduction in the number of staff over the anticipated safe staffing levels.
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Key for charts: Red indicates <90%, blue indicates 90% – 110% and yellow indicates >110%.
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.
Table 1 – LD safe staffing data November 2014
Ward Name
Registered Nurse
Total
Total
Monthly Monthly
Planned Actual
Hours
Hours
Bramdean
330.0
341
April Cottage
319.0
341
Oakwood
308.0
314
Ashmount & Derby
330.0
416
Larkfield
330.0
339
Care Staff
Registered Nurse
Care Staff
Nov-14
Total
Total
Total
Total
Total
Total
Monthly Monthly Monthly Monthly Monthly Monthly
Planned Actual Planned Actual Planned Actual % Registered % HCA % Registered % HCA
Hours
Hours
Hours
Hours
Hours
Hours
Day
Day
night
night
1,320.0
1,023
231.0
220
924.0
452
103%
77%
95%
49%
1,595.0
1,191
242.0
240
726.0
455
107%
75%
99%
63%
2,464.0
2,418
220.0
220
660.0
660
102%
98%
100%
100%
1,980.0
2,510
220.0
220
440.0
664
126%
127%
100%
151%
990.0
1,025
231.0
221
231.0
221
103%
104%
96%
96%
Brief summary by ward
1) Bramdean –Low fill rates for HCA cover have been discussed at the monthly Erostering review meeting.
Their budget is currently being reviewed to determine
whether they have been correctly adjusted for the safe staffing levels agreed and
whether these levels remain appropriate with their current reduced bed number.
Recruitment to fill substantive posts is currently underway and will reduce the number of
shifts which are staffed through NHSP following successful long term development
posts created in collaboration with NHSP and SABP.
2) April Cottage – As with Bramdean, April Cottage’s budget is currently being reviewed to
determine whether they have been correctly adjusted for the safe staffing levels agreed
and whether these levels remain appropriate with their current reduced bed number.
Regular agency staff booked for fixed periods of time are being used to increase the
consistency of the staffing on the ward while substantive posts are recruited to.
3) Oakwood – consistent good staffing levels.
4) Ashmount and Derby – consistent good staffing levels with high acuity accounting for
the higher than expected use of HCAs at night. The improvements in ensuring day
shifts have appropriate levels of qualified nursing staff seen last month have been
continued.
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5) Larkfield – consistent good staffing levels reported for November, with improvements
seen in the ward consistently reaching safe staffing levels across the shift types. The
risk on the Trust High Level Risk Register outlining the current staffing issues at
Larkfield will be reviewed when each shift type is filled to 100% or over.
Current Actions
There is ongoing recruitment in the Division to meet the agreed safe staffing levels and the
recruitment issues at Larkfield are on the Trust High Level Risk Register although it is noted
that the levels reported for October and November suggest that they are addressing these
immediate concerns. Senior Managers aware of the issues at April cottage and Bramdean
around reduced bed occupancy and the safe staffing levels for these wards regarding HCA
use is being reviewed.
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 for quick responsiveness and flexibility regarding 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.
Table 2 – WAA safe staffing data Nov 2014
Ward Name
Registered Nurse
Total
Total
Monthly Monthly
Planned Actual
Hours
Hours
24 7 Wingfield
506.0
785
24 7 Blake
759.0
838
24 7 Clare
759.0
756
24 7 Anderson
506.0
511
24 7 Delius
506.0
532
24 7 Elgar
506.0
547
24 7 Fenby (PICU)
506.0
732
Care Staff
Registered Nurse
Care Staff
Nov-14
Total
Total
Total
Total
Total
Total
Monthly Monthly Monthly Monthly Monthly Monthly
Planned Actual Planned Actual Planned Actual % Registered % HCA % Registered % HCA
Hours
Hours
Hours
Hours
Hours
Hours
Day
Day
night
night
506.0
724
759.0
564
506.0
750
155%
143%
74%
148%
1,012.0
962
759.0
756
759.0
845
110%
95%
100%
111%
506.0
605
506.0
507
506.0
575
100%
120%
100%
114%
506.0
646
506.0
503
253.0
344
101%
128%
99%
136%
506.0
580
506.0
499
253.0
346
105%
115%
99%
137%
506.0
755
506.0
488
253.0
520
108%
149%
96%
206%
759.0
700
506.0
484
506.0
927
145%
92%
96%
183%
Brief summary by ward
1) Wingfield ward – generally has good cover across the 24hr shifts. The low fill rate for
qualified staff at nights has been investigated as it has occurred in previous months.
On occasions due to short notice cancellations the ward has not been able to staff the
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ward with the 3 expected qualified staff HCAs have been used to ensure that the overall
number of staff have been available on the ward during these shifts. Further work is
necessary to ensure forward compliance with agreed levels as from the 01.12.14 the
ward increased its active bed number to 24. To maintain the safe staffing levels there
will now be 3 qualified and 3 CSW staff on throughout the 2 shifts covering the 24hr
period. The additional staffing ratios are to support the increase in people anticipated
on the ward and to ensure that the Section 136 area can be effectively and safely
managed.
2) Blake ward – good consistent cover with HCA low fill rate during the day a result of the
acuity of the ward on some shifts requiring an additional qualified member of staff. The
Staffing ratios are currently being reviewed as from 01.12.14 Blake ward has reduced
their number of active beds to 17 beds. However as they also manage 2 Section 136
assessment areas their ratios are likely to remain higher than wards with a similar
number of beds. The ward manager has talked positively about now having recruited to
the last of his vacancies which will increase the consistency of care across the shifts as
there should be a reduction in the use of NHSP staff.
3) Clare ward – good consistent cover.
4) Anderson ward – well balanced cover with additional HCA use at nights due to acuity.
5) Delius ward – good consistent cover.
The ward manager reports that Fenby now
staffed to manager the Section 136 assessment area has eased the staffing pressures
on Delius, although they are currently recruiting to some staffing posts.
6) Elgar ward – good consistent cover – the higher than expected use of HCA’s across the
24 hr period was accounted for by acuity and 1:1 support needs.
7) Fenby ward – appropriate cover across the 24 hr period. Improvement work continues.
Current Actions
There is an ongoing programme of reviewing staffing cover in these wards.
The 136
assessment facilities at the ACU, Wingfield and Fenby are now being supported by designated
staff to help regulate the impact of 136 assessments on the staffing levels of the acute wards.
Blake ward has reduced their active beds to 17 and Wingfield increased their active beds to 24
from the 01.12.14. This will adjust the safe staffing levels for each ward going forward. There
remains a number of staff who are currently unable to work either due to sickness or other
issues. The Division will continue to facilitate and review the support of these staff.
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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.
Table 3 - OP safe staffing data November 2014
Ward Name
Victoria
Albert
Hayworth House
Spenser Ward
Bluebell Ward
Primrose Ward
Registered Nurse
Total
Total
Monthly Monthly
Planned Actual
Hours
Hours
726.0
835
506.0
508
506.0
493
484.0
521
253.0
258
253.0
275
Care Staff
Registered Nurse
Care Staff
Nov-14
Total
Total
Total
Total
Total
Total
Monthly Monthly Monthly Monthly Monthly Monthly
Planned Actual Planned Actual Planned Actual % Registered % HCA % Registered % HCA
Hours
Hours
Hours
Hours
Hours
Hours
Day
Day
night
night
726.0
1,521
484.0
484
726.0
1,265
115%
209%
100%
174%
759.0
2,053
484.0
484
726.0
1,483
100%
270%
100%
204%
1,012.0
1,157
506.0
313
759.0
1,325
97%
114%
62%
175%
726.0
723
484.0
481
726.0
483
108%
100%
99%
67%
506.0
555
242.0
252
484.0
596
102%
110%
104%
123%
506.0
657
242.0
253
242.0
428
109%
130%
105%
177%
Brief summary by ward
1) Victoria ward – consistent cover across the 24/7 period. The above 100% expected
HCA use is largely accounted for enhanced observation. A programme of review is
currently underway to provide additional support to the ward including observing
practice to determine if 1:1 support is the most effective way of maintaining safety on
the ward.
2) Albert ward – consistent cover across the 24/7 period. The significantly higher than
expected use of HCAs is similar to last month and reflects the current need for
enhanced observation due to the acuity of the ward.
3) Hayworth House – consistent cover across the 24/7 period. More HCAs were required
at night than anticipated again this may be because of enhanced observation which
were more easily accommodated during the day shifts and to compensate for the nearly
40% less than expected use of qualified staff at nights. Despite the ward increasing the
percentage of night shifts with the expected allocation of qualified staff in October to
70%, this figure has fallen again to 62% in November – the Lead Nurse for Quality
Assurance will discuss these figures with the inpatient service manager to address this
ongoing issue.
4) Spencer ward – good cover during the day, but lower than expected HCA cover at
night.
In October Spencer ward reduced its bed numbers from 20 –18 which has
resulted in their ratio of Qualified staff during the day reducing by 1. CSW support at
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night needs to be further discussed with the service manager to ensure safe staffing
levels are maintained.
5) Bluebell have significantly reduced the number of staff additional use of staff for all of
their shifts this month so that most (apart for HCAs at night) are operating within the
optimum staffing levels.
This is accounted for by a reduction in the acuity and
redeployment of staff.
6) Primrose’s qualified staffing levels are good and consistent – the HCA level is again
high but have continued to reduce from September’s fill rates where both HCA staffing
levels for day and night shift were over 200%.
Current Actions
Where there are either low or unusually high fill rates, queries have been escalated to the
Divisional Director and discussions continue with the teams at the monthly safe staffing
meetings to support the teams in ensuring improvements in fill rate are achieved – this
appears to be working with Bluebell and Primrose trending towards anticipated levels. Further
work is required with Hayworth and Spencer to understand and address their lower than
expected night fill rates.
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 wards. Further
ongoing audit will be undertaken to ensure the process remains embedded.
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.
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5.0 Reasons for Gaps in Staffing fill rate
Over the coming months the Clinical Lead will be reviewing the safe staffing figures with the
teams to better understand the reporting levels.
Recruitment processes commenced in
September are now helping some wards to reach their full staffing levels reducing the amount
of NHSP required. It is anticipated that this will lead to an improved level of compliance to
safe staffing levels going forward. Recruitment processes continue for wards where
vacancies have since arisen. The Trust weekly operational review meeting monitors progress
against all staffing risks currently on the Trust Risk Register.
6.0 Impact on Key Quality Outcome Measures
For the month of November no direct correlation has been identified between fill rate and
inability to deliver on quality outcome measures. Rates of NHSP use should reduce over the
coming months as the reconfigured wards recruit to their new safe staffing levels and the
recruitment to vacancies since September 2014 bring in new staff. The Quality team through
its circle of support process is working to ensure there is enhanced effectiveness of the
additional resource in improving quality and care on the wards.
Ben Chambers – Lead Nurse for Clinical Assurance.
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