Executive Board in Public: May 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 April 2015:
 Registered Nurse Day hours – 11,790 planned, 12,485
worked representing 106% fill rate.
 Registered Nurse Night hours – 10,410 planned 10,147
worked representing 97% fill rate.
 Care Support Worker Day hours – 21,705 planned, 25,193
worked representing 116% fill rate.
 Care Support Worker Night hours – 11,880 planned,
15,648 worked representing 132% 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.
Each month the Trust reviews the hours worked by the Trust’s substantive staff and NHSP
against the hours planned for in our 24/7 services. This month following discussion with the
Director for Risk and Safety, we have added additional sensitivity to these calculations by
benchmarking the average staff levels worked against the expected safe staffing levels
required for the average occupancy of the ward. Previously the calculations were based on
the agreed safe staffing levels assuming the wards were at full occupancy.
By using the average occupancy measure the safe staffing figures more accurately reflect the
staffing needs of the ward during the month. The average occupancy figures are calculated
from the average occupancy percentages submitted to NHS England each month for
consistency across the Trust reports.
2.0 Monthly Safe Staffing Compliance Update
The April data before adjusting the figures to reflect the average occupancy levels showed the
wards that have had staffing levels below 90% of the expected safe staffing levels were the
same as in February and March, namely Wingfield, Fenby, Hayworth House, Spencer ward
and April cottage. In previous months this report discussed the importance of viewing these
figures in the context of the actual number of people who were being supported on the ward.
The rationale for lower than expected figures was then described by each team. By
benchmarking against the safe staffing levels required for the actual average occupancy of the
ward, the context is factored into the calculations and demonstrates the validity of what was
previously described, that the ward’s staffing levels were being effectively and safely managed
in line with the number and needs of the people being supported on each ward.
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The safe staffing levels were adjusted for four wards, Wingfield, Fenby, Spencer and April
Cottage, as these were the only wards where their average occupancy was significantly lower
than their full capacity. Consequently this enabled them to safely reduce their staffing levels
whilst still being concordant with the agreed safe staffing levels per occupied bed.
Using the data based on average occupancy, only one area, RN cover at night on Hayworth
house is showing as significantly below the expected 100% safe staffing level at 70%. This
figure has increased from last month’s figure of 66%, but ongoing challenges in recruitment
have prevented the ward team from consistently having two qualified staff on at nights.
The fill rate for day shift, registered nurse (RN) hours was 106% an increase of 10% on
March’s figures. This increase is partly due to an overall increase in the number of wards
where the safe staffing figures were met and partly due to the adjustment of the figures to
reflect the actual staffing requirements of the wards during the month of April.
The fill rate for night shift RN hours was 97% (an increase of 3% from last month). The night
fill rate for registered nurses has remained relatively consistent for the past 7 months with
currently only Hayworth House showing below 90% fill rates as discussed above.
The fill rate for Care Support Workers (CSW) was in excess for both day and night cover with
fill rates of 116% & 132% respectively. These figures represent a 3% and 1% increase in fill
rate respectively on the previous month’s figures reflecting a reduction in acuity on some of the
wards from previous months especially in some older adult services.
Typically for units where between 95 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.
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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 April 2015
Total
Ward Name
Bramdean
April Cottage
Oakwood
Ashmount & Derby
Larkfield
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
450.0
448
435.0
564
420.0
424
450.0
777
450.0
429
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,350.0
1,275
1,305.0
1,255
3,360.0
3,147
2,700.0
2,846
1,350.0
1,388
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
315.0
302
330.0
331
300.0
300
300.0
339
315.0
303
Adjusted figures for average occupancy April 2015
Care Staff
Apr-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
630.0
594
100%
94%
96%
94%
330.0
599
130%
96%
100%
181%
900.0
911
101%
94%
100%
101%
900.0
863
173%
105%
113%
96%
315.0
300
95%
103%
96%
95%
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 support.
3) Oakwood – Consistent appropriate staffing levels.
4) Ashmount and Derby – Consistent good staffing levels – the significant increase in
Ashmount and Derby’s RN staff levels during the day (an increase of 66%) is as a result
of moving towards a staffing model of 1 RN for each area.
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 the 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 April 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
690.0
752
1,035.0
1,070
1,035.0
1,016
690.0
696
690.0
687
690.0
700
1,035.0
981
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
690.0
1,092
1,035.0
1,016
690.0
664
690.0
801
690.0
720
1,035.0
1,027
1,035.0
1,221
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
690.0
726
1,035.0
1,018
690.0
674
690.0
694
690.0
676
690.0
669
1,035.0
987
Adjusted figures for average occupancy April 2015
Care Staff
Apr-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
690.0
927
109%
158%
105%
134%
690.0
747
103%
98%
98%
108%
690.0
694
98%
96%
98%
101%
345.0
627
101%
116%
101%
182%
345.0
375
100%
104%
98%
109%
345.0
352
101%
99%
97%
102%
1,035.0
1,066
95%
118%
95%
103%
Brief summary by ward
1) Wingfield ward – good consistent staff levels for the number of people being supported
on the ward. With current low use of NHSP throughout the month the ward appear well
placed to respond to an increase in admissions as additional NHSP staff would be
working with predominantly substantive staff.
2) Blake ward – appropriate consistent cover
3) Clare ward – appropriate consistent cover
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 and are awaiting start dates.
6) Elgar ward – appropriate consistent cover.
7) Fenby ward – Appropriate average cover for April across all shift types, however the
wards ability to rapidly respond to an increase in admissions is made more challenging
by their current high use of NHSP staff to reach the expected safe staffing levels.
Action is being taken by the local senior management to reduce the pressure on the
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ward by providing additional staff on the acute wards to support 136 assessments.
Long term solutions to improve recruitment and retention for the PICU are currently
being discussed by senior management.
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.
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 April 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
990.0
1,103
690.0
723
690.0
687
660.0
678
345.0
363
345.0
388
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
990.0
1,991
1,035.0
2,501
1,380.0
1,332
990.0
988
690.0
955
690.0
974
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
660.0
663
660.0
643
690.0
481
660.0
660
330.0
348
330.0
333
Adjusted figures for average occupancy April 2015
Care Staff
Apr-15
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
990.0
1,815
111%
201%
101%
183%
990.0
1,688
105%
242%
97%
170%
1,035.0
1,340
100%
97%
70%
129%
660.0
648
103%
100%
100%
98%
660.0
1,216
105%
138%
106%
184%
330.0
889
112%
141%
101%
269%
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.
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 with an
additional 33% CSW use on days this month compared to last month.
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3) Hayworth House – Encouragingly there has been a further increase in the frequency of
the safe staffing RN levels being met at night (increasing by 4%).
Consistency of
nursing care at Hayworth is currently being met by using longer term contracts with
NHSP qualified staff while recruitment to substantive RN positions continues.
4) Spencer ward – good consistent cover across the shift types and effective management
of nursing resource in response to the varying needs across the week.
The ward
appears reasonably positioned to respond to an increase in admissions as their NHSP
use is currently low.
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
The OPS senior management are currently working with the finance department to ensure that
the funding for each areas establishment meets the requirements to staff the wards in
accordance with the expected safe staffing levels per occupied bed. As a directorate regular
discussions are held regarding the high fill rates and use of NHSP staff (especially for CSW
staff). Reviews of people’s support needs are carried out daily and the teams continue to
participate well in the monthly available staffing meetings which aim to support the teams in
ensuring that the rosters are managed optimally each month.
High rates of CSW use to
manage supportive observations are being reviewed 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 June reflecting safe staffing
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expectations and levels as well as information about the safety improvement work currently
underway.
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 the quality of rosters to ensure that they are being managed optimally each month.
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
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 April no direct correlation has been identified between fill rate and inability to
deliver on quality outcome measures. 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
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14th May 2015
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