Executive Board in Public: April 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 March 2015:
 Registered Nurse Day hours – 12,880.5 planned, 12,351
worked representing 96% fill rate.
 Registered Nurse Night hours – 10,757 planned 10,122
worked representing 94% fill rate.
 Care Support Worker Day hours – 22,878 planned, 25,862
worked representing 113% fill rate.
 Care Support Worker Night hours – 12,632.5 planned,
16,575 worked representing 131% 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 March, shows appropriate CSW shift cover for the day shift and night shifts, but a
below expected number of RN shifts for both day and night shifts.
The fill rate for day shift, registered nurse hours was 96% an increase of 1% on February’s
figures. Encouragingly there are fewer wards with average fill rates in the mid 90% range but
there are 3 wards with fill rates below 85%, most notably on Fenby PICU where both
recruitment to vacant RN posts and cover by NHSP is proving challenging partly because of
the skills required to work in a PICU environment and partly because of the nature of the
environment.
Typically for units where between 96 and 100% levels for RNs have been
reported 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 PICU and older adult
services. Options for increasing the number and quality of applicants as well as improving the
retention of registered nurses for inpatient services continue to be explored to delivery
consistent quality staff and leadership.
The fill rate for night shift registered nurse hours was 94% (the same as 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.
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Our fill rate for Care Support Workers was high for both day and night cover with fill rates of
113% & 131% respectively. These figures represent a 16% and 6% decrease in fill rate
respectively on the previous month’s figures reflecting a reduction in acuity on some of the
wards.
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.
2.0 Monthly Safe Staffing Compliance Update
The March data shows the wards that have had staffing levels below 90% of the expected safe
staffing levels are the same as in February, Wingfield, Fenby, Hayworth House, Spencer ward
and April cottage. In January there were only 3 wards with staffing levels below 90%.
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. March’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.
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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 March 2015
Total
Ward Name
Bramdean
April Cottage
Oakwood
Ashmount & Derby
Larkfield
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
465.0
523
449.5
525
434.0
455
465.0
498
465.0
446
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,395.0
1,504
1,798.0
1,194
3,472.0
3,247
2,790.0
3,218
1,395.0
1,375
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
325.5
313
341.0
344
310.0
313
310.0
312
325.5
315
Care Staff
Mar-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
651.0
624
113%
108%
96%
96%
341.0
622
117%
66%
101%
182%
930.0
938
105%
94%
101%
101%
930.0
925
107%
115%
101%
99%
325.5
302
96%
99%
97%
93%
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 have continued to use additional RN time during the day to
facilitate staff development and 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, appropriate staffing levels. Where figures are below 100% this is
often when NHSP staff are booked for core hours as opposed to the entire shifts,
reflecting the needs of the unit.
Current Actions
Teams are organising their staffing to meet the needs of the service. Where there are ongoing
vacancies (including those not being recruited to due to planned reorganisation of services),
short term agreements with temporary staff are being arranged through NHSP to provide
consistent care.
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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 March 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
851
1,069.5
1,015
1,069.5
1,026
713.0
704
713.0
697
713.0
679
1,069.5
886
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
713.0
981
1,069.5
1,176
713.0
809
713.0
706
713.0
698
1,069.5
1,072
1,069.5
1,206
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,069.5
784
1,069.5
1,066
713.0
729
713.0
716
713.0
656
713.0
680
713.0
743
Care Staff
Mar-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
713.0
966
80%
138%
73%
135%
713.0
816
95%
110%
100%
114%
713.0
782
96%
113%
102%
110%
356.5
484
99%
99%
100%
136%
356.5
379
98%
98%
92%
106%
356.5
520
95%
100%
95%
146%
1,426.0
1,352
83%
113%
104%
95%
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
(March) the actual number of people on the ward was less than 18. 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 – appropriate consistent cover, the below 100% RN figure for days is
accounted by the split shift times for the qualified.
3) Clare ward – good consistent cover, the below 100% 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.
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5) Delius ward – appropriate consistent cover.
Additional qualified staff have been
recruited and are awaiting start dates.
6) Elgar ward – appropriate consistent cover. The below 100% RN figure for days is
accounted by the split shift times for the qualified.
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). Whilst last
month not all the beds were occupied in the PICU, this month more have regularly been
occupied and a long term solution to ensuring that the PICU meets the safe staffing
levels needs to be found.
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. However focused recruitment efforts to recruit to
the PICU area are also being progressed, including exploring new advertising options and
recruitment / retention incentives.
The NHSP CSW development placement programme
continues building on the success of earlier trials around the Trust helping to recruit and retain
good staff while increasing the consistency of staffing on the wards.
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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 the number of
care support staff planned for are much greater than those for registered nurses.
Table 3 - OP safe staffing data March 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
1,077
713.0
778
713.0
678
1,023.0
742
356.5
366
356.5
406
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,023.0
2,126
1,069.5
2,234
1,426.0
1,271
1,023.0
1,079
713.0
1,270
713.0
697
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
682.0
654
682.0
643
713.0
469
682.0
687
341.0
355
341.0
346
Care Staff
Mar-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
1,023.0
2,101
105%
208%
96%
205%
1,023.0
1,691
109%
209%
94%
165%
1,069.5
1,307
95%
89%
66%
122%
682.0
735
72%
105%
101%
108%
682.0
1,350
103%
178%
104%
198%
341.0
682
114%
98%
101%
200%
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 a reduction from
last month’s increase in the amount of CSW on days returning them to typical levels for
Victoria 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 – Whilst encouragingly there has been an increase in the frequency of
the safe staffing RN levels being met at night (increasing by 13%) there has been a
reduction of 16% in the number of CSW shifts that met the Safe staffing levels. Further
options for staff recruitment and retention for Hayworth house are currently being
explored by the OPS senior management.
4) Spencer ward – In every staffing category there has been an increasing the % of shifts
that met safe staffing levels including the RN cover during the days. Whilst the RN
cover during the day is lower than expected the direction is encouraging. They are
continuing to flex their workforce when appropriate (e.g. using fewer staff at the
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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.
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 May reflecting safe staffing
expectations and levels as well as information about the safety improvement work that is
happening.
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.
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5.0 Reasons for Gaps in Staffing fill rate
The rolling recruitment processes commenced in September is 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 March no direct correlation has been identified between fill rate and inability
to deliver on quality outcome measures. However there has been an increase in the number
of assaults on Fenby ward during this time which coincides with the lower safe staffing levels
being reported. Recruitment and 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
16th April 2015
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