Quality Management Board: January 2015
Subject:
Safe Staffing Level’s Update Report -Compliance with Hard Truths
Doc
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 – 10,300.5 planned, 11,363
worked representing 110% fill rate overall.
 Registered Nurse Night hours – 9,369 planned 8,887
worked representing 95% fill rate.
 Care Support Worker Day Hours – 19,629 planned, 23,253
worked representing 118% fill rate
 Care Support Worker Night Hours- 10,719 planned, 15,161
worked representing 141% 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 December, shows appropriate shift cover for the day shift and a reasonable cover of
the night shift, with exceptions discussed below.
Out of the 10,300.5 planned day shift registered nurse hours 11,363 were worked representing
a 110% fill rate overall representing a 1% decrease on last month’s figures. 9,369 night shift
registered nurse hours were planned and 8,887 hours were actually worked representing a
95% fill rate, which is lower than expected but represents a 1% increase on last month’s
figures. Our fill rate for Care Support Workers was high for both day and night cover with fill
rates of 118% & 141% respectively. These figures however represent a 1% increase and 14%
increase in fill rate (respectively). The significant rise in the percentage fill rate for HCA staff
on nights is a consequence of a review of the safe staffing levels on two of our wards,
Bramdean and April Cottage which reduced their HCA staff on nights from 4 and 3 to 2 and 1
respectively. The reduction reflects the current number of people they are supporting as the
units.
The original safe staffing levels were calculated on them supporting 10 people as
opposed to the 7 each ward is currently supporting. These amended safe staffing levels still
meet the ratio tests we used to develop the safe staffing figures originally. The increase in
night care fill rate represents the additional staff beyond these figures that the wards required
due to the acuity of need currently on the ward usually as a result of some people requiring 1:1
or 2:1 support.
The NHS England safe staffing data collection service (Unify2) has been advised of these
changes.
Safe Staffing Levels – Compliance with Hard Truths Doc
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2.0 Monthly Safe Staffing Compliance Update
As in the previous 2 months, the December 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.
However there is a consistency noted over the past 3 months on 3 wards (Wingfield, Hayworth
House and Spencer ward) that they are not meeting the expected safe staffing levels as
originally planned on their night shift types (Wingfield and Hayworth House – qualified staff at
night and Spencer HCA staff). The reasons for this are discussed below and will lead to a reevaluation of the safe staffing levels required for all wards by the lead nurse for Clinical
Assurance, the Director of Risk and Safety (Deputy Director of Nursing) and the Operational
Management. This review is scheduled for the beginning of February. The review will consider
the changes in bed numbers and function of each of the wards since the original calculations
were made in August 2014.
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 December 2014
Total
Ward Name
Bramdean
April Cottage
Oakwood
Ashmount & Derby
Larkfield
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
405.0
387
391.5
443
378.0
405
405.0
407
405.0
432
Night
Care Staff
Registered Nurse
Total
Total
Total
Total
Monthly Monthly Monthly Monthly
Planned
Actual Planned Actual
Hours
Hours
Hours
Hours
1,620.0
1,226
283.5
281
1,174.5
1,518
297.0
309
3,024.0
2,807
270.0
273
2,430.0
2,736
270.0
294
1,215.0
1,260
283.5
277
Safe Staffing Levels – Compliance with Hard Truths Doc
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Care Staff
Dec-14
Total
Total
Monthly Monthly
Planned Actual % Registered % HCA % Registered % HCA
Hours
Hours
Day
Day
night
night
567.0
540
96%
76%
99%
95%
297.0
624
113%
129%
104%
210%
810.0
813
107%
93%
101%
100%
540.0
784
100%
113%
109%
145%
283.5
270
107%
104%
98%
95%
3
Brief summary by ward
1) Bramdean – Following the review of safe staffing levels required by Bramdean this
month’s figures show an improved alignment with the expected safe staffing levels. The
low fill rates for HCA on days in December is accounted for by the team further reducing
the number of HCAs required during the days over the weekends and festive period
when a number of the people supported at Bramdean stayed with their families. Where
the support needs for the shift were reviewed and staff duty changed to reduce the
overall requirement of NHSP cover.
2) April Cottage – Following the review of safe staffing levels required by April Cottage this
month’s figures show an improved alignment with the expected safe staffing levels. The
above anticipated fill rates for qualified staff across some days and nights is accounted
for to cover the development needs of the qualified staff such as supervision and
training. Additional HCA staff on nights reflect the acuity of need on the ward at that
time with some people requiring 1:1 or 2:1 support.
3) Oakwood – consistent appropriate staffing levels.
4) Ashmount and Derby – consistent good staffing levels with high acuity accounting for
the higher than expected use of HCAs at night.
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. Bramdean
in particular has had some success in recruiting HCA staff through the NHSP development
programme.
Additional methods of increasing the recruitment potential are currently being
explored.
Safe Staffing Levels – Compliance with Hard Truths Doc
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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 December 2014
Total
Ward Name
24 7 Wingfield
24 7 Blake
24 7 Clare
24 7 Anderson
24 7 Delius
24 7 Elgar
24 7 Fenby (PICU)
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
621.0
986
931.5
1,067
931.5
931
621.0
671
621.0
620
621.0
659
621.0
865
Night
Care Staff
Registered Nurse
Total
Total
Total
Total
Monthly Monthly Monthly Monthly
Planned
Actual Planned Actual
Hours
Hours
Hours
Hours
621.0
727
931.5
712
931.5
1,027
931.5
909
621.0
665
621.0
632
621.0
648
621.0
619
621.0
673
621.0
601
621.0
853
621.0
597
931.5
916
621.0
601
Care Staff
Dec-14
Total
Total
Monthly Monthly
Planned Actual % Registered % HCA % Registered % HCA
Hours
Hours
Day
Day
night
night
621.0
833
159%
117%
76%
134%
931.5
952
115%
110%
98%
102%
621.0
637
100%
107%
102%
102%
310.5
351
108%
104%
100%
113%
310.5
450
100%
108%
97%
145%
310.5
358
106%
137%
96%
115%
621.0
1,257
139%
98%
97%
202%
Brief summary by ward
1) Wingfield ward – generally has good cover across the 24hr shifts. The ward has yet to
increase the bed numbers to the anticipated levels due on the 01.12.14 as the demand
is not currently there. During this time they are recruiting the additional staff that will be
required. This process continues as 2 further qualified staff move clinical areas. The
low fill rate for qualified staff at nights has on occasions been due to short notice
cancellations. However the ward Manager reports that more substantive qualified staff
are required to consistently staff the 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.
2) Blake ward – good consistent cover with HCA low fill rate observed in November
addressed partly due to the planned reduction of bed numbers during December.
3) Clare ward – good consistent cover.
4) Anderson ward – well balanced cover with additional HCA use at nights due to acuity.
5) Delius ward – appropriate consistent cover with additional HCA use at nights due to
acuity.
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6) Elgar ward – appropriate 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.
Current Actions
There is an ongoing programme reviewing staffing cover on 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 levels of available staff on the
acute wards. 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.
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 December 2014
Total
Ward Name
Victoria
Albert
Hayworth House
Spenser Ward
Bluebell Ward
Primrose Ward
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
891.0
988
621.0
637
621.0
575
594.0
631
310.5
319
310.5
343
Night
Care Staff
Registered Nurse
Total
Total
Total
Total
Monthly Monthly Monthly Monthly
Planned
Actual Planned Actual
Hours
Hours
Hours
Hours
891.0
2,084
594.0
600
931.5
2,221
594.0
621
1,242.0
1,348
621.0
350
891.0
880
594.0
597
621.0
758
297.0
321
621.0
908
297.0
296
Care Staff
Dec-14
Total
Total
Monthly Monthly
Planned Actual % Registered % HCA % Registered % HCA
Hours
Hours
Day
Day
night
night
891.0
2,070
111%
234%
101%
232%
891.0
1,559
103%
238%
105%
175%
931.5
1,458
93%
109%
56%
157%
891.0
593
106%
99%
100%
67%
594.0
923
103%
122%
108%
155%
297.0
692
110%
146%
100%
233%
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 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 above 100% expected HCA
use is largely accounted for enhanced observation. A programme of review is currently
underway to determine if 1:1 support is the most effective way of maintaining safety on
the ward.
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3) Hayworth House – consistent cover across the 24/7 period. More HCAs were required
at night than anticipated to compensate for the nearly 50% less than expected use of
qualified staff at nights. The Lead Nurse for Quality Assurance has discussed these
figures with the inpatient service manager. The planned review of the safe staffing
levels required for all wards, will review the skill mix requirements for the ward in
addition to the staffing ratios.
4) Spencer ward – good cover during the day, but lower than expected HCA cover at
night. Spencer ward currently have 20 beds with an expected night staffing level of 2
qualified staff and 3 HCAs. However the staffing is often 2 qualified staff and 2 HCAs.
The Lead Nurse for Quality Assurance has discussed these figures with the inpatient
service manager. The planned review of the safe staffing levels required for all wards,
will review the skill mix requirements for the ward in addition to the staffing ratios.
5) Bluebell ward – consistent appropriate cover across the 24/7 period with over expected
staff fill rates due to acuity (1:1 support).
6) Primrose ward – consistent appropriate cover across the 24/7 period with over expected
staff fill rates due to acuity (1:1 support).
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.
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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
During February the Clinical Lead will be reviewing the safe staffing figures with the teams to
better understand the support needs of the wards including the required skill mix.
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 December 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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