Executive Board in Public: February 2015
Item Public
Subject:
Safe Staffing Level’s Update Report -Compliance with Hard Truths
Doc
Author:
Ben Chambers, Lead Nurse for Clinical Assurance
Purpose:
Discussion
Key Issues:

Trust wide Compliance with safe staffing levels January 2015:
 Registered Nurse Day hours – 12,880.5 planned, 12,801
worked representing 99% fill rate overall.
 Registered Nurse Night hours – 10,757 planned 10,183
worked representing 95% fill rate.
 Care Support Worker Day Hours – 22,877 planned, 27,349
worked representing 120% fill rate
 Care Support Worker Night Hours- 12,632 planned, 17,484
worked representing 138% 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 January, shows appropriate shift cover for the day shift and night shifts, with
exceptions discussed below.
In February 2015 the Lead Nurse for Clinical Assurance and the Director of Risk and Safety
(Deputy Director of Nursing) reviewed the safe staffing levels for all the services with support
from the clinical areas. Recalculations were made to account for changes to bed levels, using
the same ratio principles as originally used. The levels will next routinely be reviewed in 6
months-time unless National guidance for MH services is published before this date.
The fill rate for day shift, registered nurse hours was 99% a reduction of 11% on December’s
figures. This reduction reflects the continued commitment of the wards to work with safe
staffing numbers. The safe staffing review carried out in February increased the number of
registered nurses required to work on Spencer ward during the day which affected their % fill
rate for this month, reducing the overall percentage to below 100%. The fill rate for night shift
registered nurse hours was 95% fill rate, the same as the previous month which is lower than
expected due to 2 wards Wingfield and Hayworth House where there have been challenges in
staffing to the required register nurse levels for a number of months as discussed below. Our
fill rate for Care Support Workers was high for both day and night cover with fill rates of 120%
& 138% respectively. These figures however represent a 2% increase and 3% decrease in fill
rate (respectively). The additional use of care staff at night care has been required due to the
acuity of need currently on the wards usually as a result of people requiring 1:1 or 2:1 support.
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2.0 Monthly Safe Staffing Compliance Update
As in the previous 3 months, the January data shows a reduction in the number of wards
which had a figure below the 90% of expected staff.
This is an encouraging trend and
indicates the continued effort of the clinical teams to provide safe and effective care. The
reasons for lower than expected figures on some wards 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 within the safe staffing
levels agreed for their services.
Over the past 4 months, 3 wards (Wingfield, Hayworth House and Spencer ward) have often
found it difficult to staff all their shifts to the levels agreed. The safe staffing review considered
the number of beds each ward had, the context of their care including the needs of the people
they were supporting and the expected work load of the shifts. The review concluded that the
original registered nurse levels at night for both Wingfield and Hayworth House wards were
correct at 3 and 2 respectively and the wards are currently recruiting to support these expected
levels. As described above the February review increased the number of registered staff
expected on Spencer ward during the day. The % fill rate for Spencer ward will continue to be
analysed monthly as their shift patterns flex during the week (as need dictates) to ensure that
the principles of safe staffing are being accurately reflected in our reviews.
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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 January 2015
Total
Ward Name
Bramdean
April Cottage
Oakwood
Ashmount & Derby
Larkfield
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
465.0
455
449.5
565
434.0
457
465.0
466
465.0
538
12,880.5
12,801
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,395.0
1,635
1,798.0
1,628
3,472.0
3,375
2,790.0
3,407
1,395.0
1,373
22,878.0
27,349
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
325.5
315
341.0
341
310.0
314
310.0
310
325.5
311
10,757.0
10,183
Care Staff
Jan-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
651.0
622
98%
117%
97%
96%
341.0
657
126%
91%
100%
193%
930.0
927
105%
97%
101%
100%
930.0
954
100%
122%
100%
103%
325.5
310
116%
98%
95%
95%
12,632.5
17,484
99%
120%
95%
138%
Brief summary by ward
1) Bramdean – Following the review of safe staffing levels this month’s figures show an
improved alignment with the expected safe staffing levels. Bramdean continues to staff
to the support needs of the shifts reducing NHSP use at times when people are at home
with their families.
2) April Cottage – Following the review of safe staffing levels this month’s figures show an
improving 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
CSW 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 CSWs during the day.
5) Larkfield – consistent good staffing levels reported for January. Where figures are
below 100% this is often when NHSP staff are booked for core hours as opposed to for
entire shifts, reflecting the needs of the unit.
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Current Actions
There is ongoing recruitment in the Division to continue 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 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 January 2015
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
1,069.5
1,112
1,069.5
1,107
1,069.5
1,010
713.0
688
713.0
734
713.0
716
1,069.5
986
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
713.0
828
1,069.5
1,045
713.0
754
713.0
802
713.0
708
1,069.5
1,067
1,069.5
1,140
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,069.5
854
1,069.5
1,059
713.0
723
713.0
691
713.0
684
713.0
674
713.0
678
Care Staff
Jan-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
713.0
982
104%
116%
80%
138%
713.0
799
104%
98%
99%
112%
713.0
790
94%
106%
101%
111%
356.5
504
96%
112%
97%
141%
356.5
434
103%
99%
96%
122%
356.5
356
100%
100%
95%
100%
1,426.0
1,554
92%
107%
95%
109%
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 however recruitment to ensure that the appropriately sized staff
team is in place is currently underway. The low fill rate for qualified staff at nights has
improved this month, but will require additional registered nurses to be in place to
consistently staff the ward with the 3 expected qualified staff. CSWs 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 (bed number reduced to 17 from late December –
safe staffing review reduced the number of CSWs required at nights from 3 to 2 to
reflect this change).
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3) Clare ward – good consistent cover.
4) Anderson ward –good cover with additional CSW use at nights due to acuity.
5) Delius ward – appropriate consistent cover with additional CSW use at nights due to
acuity.
6) Elgar ward – appropriate consistent cover – with additional use of NHSP support
managed well over the period.
7) Fenby ward – appropriate cover across the 24 hr period.
Current Actions
There is an ongoing recruitment programme within the Trust to reduce the impact of people
leaving one clinical area to work in another.
The NHSP CSW development placement
programme is also reported to have worked positively in a number of settings helping to recruit
and retain good staff while increasing the consistency of staffing on the wards.
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 January 2015
Total
Ward Name
Victoria
Albert
Hayworth House
Spenser Ward
Bluebell Ward
Primrose Ward
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,023.0
1,094
713.0
728
713.0
665
1,023.0
734
356.5
366
356.5
382
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,023.0
1,859
1,069.5
2,432
1,426.0
1,861
1,023.0
946
713.0
1,348
713.0
1,142
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
682.0
684
682.0
677
713.0
486
682.0
692
341.0
361
341.0
331
Care Staff
Jan-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
1,023.0
2,094
107%
182%
100%
205%
1,023.0
1,721
102%
227%
99%
168%
1,069.5
1,802
93%
130%
68%
168%
682.0
655
72%
92%
101%
96%
682.0
1,217
103%
189%
106%
178%
341.0
1,109
107%
160%
97%
325%
Brief summary by ward
1) Victoria ward – comparable cover across the 24/7 period with previous months. The
above 100% expected CSW 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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2) Albert ward – comparable cover across the 24/7 period with previous months. The
above 100% expected CSW 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.
3) Hayworth House – consistent cover across the 24/7 period. More CSWs were required
at night than anticipated to compensate for the nearly 40% less than expected use of
qualified staff at nights.
The expectation of having 2 qualified staff members at
Hayworth House every night was confirmed during the February safe staffing review.
4) Spencer ward – during the safe staffing review it was agreed that Spencer ward could
be safely staffed at nights with 2 registered nurses and 2 CSWs due to the needs of the
people they support and the availability of addition support staff from the other ACU
wards should an incident occur requiring immediate support. Cover during the days is
lower than on previous months however these measures do not reflect shifts where the
manager has effectively worked as a nurse on the wards when staff have not been
available at short notice.
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 cover across the 24/7 period with over expected staff fill
rates due to acuity. The very high fill rates for CSWs at nights was due to a number of
people being on 1:1 or 2:1 24/7. The levels of required supportive observation are
reviewed daily.
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. High rates
of CSW use to manage supportive observations are being looked at across the OP directorate
to ensure that approaches match evidenced best practice.
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
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 January 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. The rolling
recruitment programme remains in place to reduce the impact of staff changing roles on the
ward areas they leave by reducing the time between a job being available and the person
being able to begin on the ward. Through the safe staffing programme, the Quality team is
working to ensure there is enhanced effectiveness of the staffing resource leading to
improving quality and care on the wards.
Ben Chambers – Lead Nurse for Clinical Assurance.
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