Executive Board in Public: March 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 February 2015:
 Registered Nurse Day hours - 11,634 planned, 10,998
worked representing 95% fill rate.
 Registered Nurse Night hours - 9,716 planned 9,089
worked representing 94% fill rate.
 Care Support Worker Day Hours - 20,664 planned, 24,583
worked representing 119% fill rate.
 Care Support Worker Night Hours - 11,410 planned, 15,684
worked representing 137% 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 February, shows appropriate CSW shift cover for the day shift and night shifts, but a
reduction in the number of RN shifts covered most notably during the day.
The fill rate for day shift, registered nurse hours was 95% a reduction of 4% on January’s
figures. These figures need to be closely monitored as a number of wards are reporting
figures in the mid 90% range. Typically where 100% has not been achieved it is as a result of
short notice absenteeism or NHSP being unable to provide cover for the shift. Although there
is ongoing recruitment to increase the number of substantive registered nurses on the wards,
there remain vacancies especially in the older adult services.
Options for increasing the
number and quality of applicants as well as improving the retention of registered nurses for
inpatient services continues to be explored to delivery consistent quality staff and leadership.
Where the figures are below 90% further explanation is detailed below. The fill rate for night
shift registered nurse hours was 94% (a reduction of 1% on last month’s figures). The night fill
rate for registered nurses has remained relatively consistent for the past 6 months with the 2
wards showing below 90% fill rates remaining the same, Wingfield and Hayworth House. Our
fill rate for Care Support Workers was high for both day and night cover with fill rates of 129%
& 137% respectively. These figures both represent a 1% decrease in fill rate on the previous
month’s figures. 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.
The surge and escalation process is being reviewed to provide daily information against our
safe staffing levels in the context of the number of people being supported on the wards.
Safe Staffing Levels – Compliance with Hard Truths Doc
BC 13.03.15
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2.0 Monthly Safe Staffing Compliance Update
The February data shows a slight increase in the number of wards which have had a figure
below 90% of the expected safe staffing levels. In February there were 4 wards where safe
staffing levels were not met in one or more areas. This goes against a trend for the last 4
months where the number of wards had reduced month on month reaching 3 in January.
Whilst these figures should be noted and efforts made to ensure the wards are appropriately
staffed, they need to be reviewed in the context of the actual number of people who were
being supported on the wards at the time as the safe staffing levels we report against have
been set assuming that the wards are at capacity.
We analysed data by looking at the nursing hours planned against actual hours worked
including those hours covered by NHS Professionals and use the local intelligence from the
monthly safe staffing tele-conferences each ward has to understand the context of those
figures. February’s data suggests that the majority of our wards are consistently meeting the
safe staffing levels for the number of people they are supporting across the 24hr period with
exceptions discussed below.
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 February 2015
Total
Ward Name
Bramdean
April Cottage
Oakwood
Ashmount & Derby
Larkfield
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
420.0
471
406.0
530
392.0
395
420.0
401
420.0
403
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,260.0
1,298
1,624.0
1,280
3,136.0
2,904
2,520.0
2,940
1,260.0
1,341
Safe Staffing Levels – Compliance with Hard Truths Doc
BC 13.03.15
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
294.0
271
308.0
308
280.0
273
280.0
281
294.0
284
Care Staff
Feb-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
588.0
667
112%
103%
92%
113%
308.0
555
131%
79%
100%
180%
840.0
830
101%
93%
98%
99%
840.0
877
96%
117%
100%
104%
294.0
281
96%
106%
96%
95%
3
Brief summary by ward
1) Bramdean – Consistent appropriate staffing across the 24/7 period.
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 – April cottage has increased their use of RNs during the day due to
acuity needs and staff development assurance and they have reduced their CSW use
accordingly. 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.
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.
Current Actions
There is ongoing recruitment in the Division to continue to meet the agreed safe staffing levels
and to allow responsiveness to the changing acuity needs.
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 February 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
966.0
807
966.0
938
966.0
897
644.0
618
644.0
598
644.0
647
966.0
840
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
644.0
937
966.0
1,053
644.0
656
644.0
705
644.0
711
966.0
993
966.0
903
Safe Staffing Levels – Compliance with Hard Truths Doc
BC 13.03.15
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
966.0
798
966.0
953
644.0
628
644.0
638
644.0
604
644.0
604
644.0
649
Care Staff
Feb-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
644.0
906
84%
145%
83%
141%
644.0
738
97%
109%
99%
115%
644.0
697
93%
102%
97%
108%
322.0
414
96%
109%
99%
128%
322.0
414
93%
110%
94%
128%
322.0
367
100%
103%
94%
114%
1,288.0
1,242
87%
94%
101%
96%
4
Brief summary by ward
1) Wingfield ward – Although the RN levels for both days and nights were below those
expected this was in response to the low levels of people they had on the ward during
this month.
The safe staffing levels are fixed at 3 RNs during the day and night
assuming up to 24 people being on the ward. However for the majority of the month
(February) the actual number of people on the ward was less than 15. The same ratio
calculations were used against this actual number to safely reduce the RNs on shifts
when it was clinically appropriate.
2) Blake ward – good consistent cover.
3) Clare ward – good consistent cover, the relatively low RN figure for days is accounted
by the split shift times for the qualified.
4) Anderson ward –good cover with additional CSW use at nights due to acuity.
5) Delius ward – appropriate consistent cover.
Additional qualified staff have been
recruited to and are awaiting start dates.
6) Elgar ward – appropriate consistent cover.
7) Fenby ward – on a number of occasions Fenby have not been able to secure NHSP
RNs for a number of their day shifts. Recruitment of RN’s is ongoing with the manager
and Matron managing any staff shortfall within the unit. As the ward is a PICU, the staff
levels per person is significantly higher than that on the other wards and the safe
staffing ratios set are for a minimum of 1 qualified staff member per 4 people (compared
to a working age adult acute ward of 1 qualified staff member to 9 people). As Fenby
has typically had 8 people on the ward the staffing levels have be reasonable but
should be improved to meet the safe staffing levels set to provide the flexibility of cover
to respond and support the needs of the other working age adult wards consistently.
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. Some qualified
staff that have been recruited are currently awaiting the results of their DBS checks so they
can receive a start date.
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.
Table 3 - OP safe staffing data February 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
924.0
970
644.0
654
644.0
589
924.0
599
322.0
317
322.0
326
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
924.0
2,116
966.0
2,201
1,288.0
1,355
924.0
999
644.0
1,339
644.0
853
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
616.0
597
616.0
626
644.0
340
616.0
610
308.0
316
308.0
312
Care Staff
Feb-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
924.0
1,990
105%
229%
97%
215%
924.0
1,537
102%
228%
102%
166%
966.0
1,397
91%
105%
53%
145%
616.0
653
65%
108%
99%
106%
616.0
1,317
98%
208%
103%
214%
308.0
805
101%
132%
101%
261%
Brief summary by ward
1) Victoria ward – Good cover across the 24/7 period. The above 100% expected CSW
use is largely accounted for enhanced observation. There has been an increase in the
amount of CSW on days with a reduction on nights due to the changing needs of the
people being supported. 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 – 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 50% 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
and recruitment of RNs is being actively pursued.
4) Spencer ward – RN cover during the days is lower than expected.
They have 4
substantive RN positions where staff are not available to work, they are flexing their
workforce levels to safely staff to needs (e.g. using fewer staff at the weekends when
ward reviews do not happen, thus not requiring the same levels of staff to be on duty)
and the ward manager is working as a nurse at times of high acuity.
Safe Staffing Levels – Compliance with Hard Truths Doc
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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. New boards
have been designed and are due to be piloted on Blake ward in April reflecting safe staffing
expectations and levels.
4.0 Processes in place to enable staffing establishments to be met.
The Lead Nurse for Clinical Assurance coordinates 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.
Safe Staffing Levels – Compliance with Hard Truths Doc
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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 February 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 wards recruit to their new safe staffing levels. However retention of
staff will be fundamental in maximising the quality benefits of having a consistent staff team.
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
13th March 2015
Safe Staffing Levels – Compliance with Hard Truths Doc
BC 13.03.15
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