Executive Board in Public: June 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 May 2015:
 Registered Nurse Day hours – 12,121 planned, 13,057
worked representing 108% fill rate.
 Registered Nurse Night hours – 10,741.5 planned 10,654
worked representing 99% fill rate.
 Care Support Worker Day hours – 22,242.5 planned,
27,074 worked representing 122% fill rate.
 Care Support Worker Night hours – 12,601.5 planned,
16,894 worked representing 135% 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. As we began last month, we have
benchmarked the staff levels worked against the expected safe staffing levels worked for the
average occupancy of the ward. Previously the calculations were based on the agreed safe
staffing levels assuming the ward were all at full occupancy.
By using the average occupancy measure the safe staffing figures more accurately reflect the
staffing needs of the wards 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
Most wards were operating at near capacity during May. Consequently the safe staffing levels
were only adjusted for 3 wards to determine the safe staffing level their actual staffing should
be benchmarked against. These were Wingfield ward where their full occupancy level
(including 1 x 136) is 24 people, had on average 18 people, Spencer ward where the full
capacity is 20, had on average 18 people and April cottage who had 5 people compared to the
7 their original safe staffing was calculated against.
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 82%.
Encouragingly this figure has increased from last month’s figure of 70%, but ongoing
challenges in recruitment have prevented the ward team from consistently having two qualified
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staff on at nights. Although there were 5 night shifts where they did not meet the
The fill rate for day shift, registered nurse (RN) hours was 108% an increase of 2% 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 May.
The fill rate for night shift RN hours was 99% (an increase of 2% 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 122% & 134% respectively. These figures represent a 6% and 2% increase in fill
rate respectively on the previous month’s figures reflecting a reported increase in acuity on
some of the wards 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.
The exception this month being Wingfield ward where high percentage use of RNs reflects
shifts where there were above 18 people on the ward with staffing flexed in line with our safe
staffing ratios.
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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 May 2015
Total
Ward Name
Bramdean
April Cottage
Oakwood
Ashmount & Derby
Larkfield
Day
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
465.0
474
449.5
522
434.0
424
465.0
892
403.0
452
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,395.0
1,491
1,348.5
1,419
3,472.0
3,274
2,790.0
3,118
1,209.0
1,372
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
325.5
314
341.0
341
310.0
315
310.0
342
310.0
311
Adjusted figures for average ward occupancy May
2015
Care Staff
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
651.0
615
102%
107%
97%
94%
682.0
700
116%
105%
100%
103%
930.0
923
98%
94%
102%
99%
930.0
962
192%
112%
110%
103%
310.0
311
112%
113%
100%
100%
Brief summary by ward
1) Bramdean – Consistent appropriate staffing across the 24/7 period with a slight
increase in CSW use during the day due to acuity but continue to reduce NHSP use at
times when people are away with their families if clinically appropriate.
2) April Cottage – April cottage have continued to use additional RN time during someday
shifts to facilitate staff development. April cottage have also regularly increased their
CSWs at night to meet the current acuity of the ward from 1 CSW to 2.
3) Oakwood – Consistent appropriate staffing levels.
4) Ashmount and Derby – Consistent good staffing levels – the increase in Ashmount and
Derby’s RN staff levels during the day 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),
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mid-term agreements with temporary staff are being arranged through NHSP to provide
consistent care including supporting in the NHSP development programme.
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 May 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
713.0
926
1,069.5
999
1,069.5
1,032
713.0
695
713.0
674
713.0
911
1,069.5
1,021
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
713.0
1,071
1,069.5
1,408
713.0
806
713.0
798
713.0
881
1,069.5
1,044
1,069.5
1,147
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
713.0
795
1,069.5
1,043
713.0
721
713.0
721
713.0
710
713.0
684
1,069.5
1,016
Adjusted figures for average ward occupancy May
2015
Care Staff
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
713.0
1,065
130%
150%
112%
149%
713.0
1,045
93%
132%
97%
147%
713.0
739
96%
113%
101%
104%
356.5
453
97%
112%
101%
127%
356.5
528
94%
124%
100%
148%
356.5
353
128%
98%
96%
99%
1,069.5
1,252
95%
107%
95%
117%
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. This has been evidenced this month
where their average occupancy was 18 people although at times this increased to 20
people. The increased use of RNs both on days and nights reflects those shifts where
a 3rd RN was required to meet the safe staffing ratios set by SABP, i.e. at times when
there were over 18 people being supported on the wards.
2) Blake ward – appropriate consistent cover with the increase in CSW use to manage
acuity during May.
3) Clare ward – appropriate consistent cover.
4) Anderson ward – good cover across 24/7 period with a reduction of CSW use over the
24/7 period compared to last month as acuity has reduced.
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5) Delius ward – appropriate consistent cover. The increase in CSWs has been in part as
a result of ensuring that there is adequate staffing across the MSA&T to support the
PICU and 136 assessment area. Additional qualified staff have been recruited and are
awaiting start dates.
6) Elgar ward – appropriate consistent cover with an increase in RNs during the days
accounted for by the charge nurses having some time put aside to conduct managerial
duties whilst a full time ward manager is recruited.
7) Fenby ward – Appropriate average cover for May across the 24/7 period, however this
has been in the context of increased occupancy and acuity with some people requiring
enhanced observation. Action is being taken by the local senior management to reduce
the pressure on the 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. There has been a slight
reduction in Fenby’s % use of NHSP, but further recruitment to substantive posts is
required.
Current Actions
Work is currently underway following the staff consultation to plan the staff teams for the
working age adult inpatient services when the new wards at Farnham Road hospital (which will
see 3 acute wards and the PICU move to Guildford) become operational at the end of the
year.
Currently efforts to recruit to vacancies continue alongside support for the NHSP
development programme.
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 May 2015
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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
732
713.0
735
682.0
732
356.5
349
356.5
413
Night
Care Staff
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
1,023.0
2,515
1,069.5
2,222
1,426.0
1,822
1,023.0
1,005
713.0
703
713.0
980
Registered Nurse
Total
Total
Monthly Monthly
Planned
Actual
Hours
Hours
682.0
689
682.0
688
713.0
584
682.0
679
341.0
356
341.0
348
Adjusted figures for average ward occupancy May
2015
Care Staff
Total
Total
Monthly Monthly
Planned Actual % Registered % CSW % Registered % CSW
Hours
Hours
Day
Day
night
night
1,023.0
2,440
105%
246%
101%
238%
1,023.0
1,612
103%
208%
101%
158%
1,069.5
1,687
103%
128%
82%
158%
682.0
659
107%
98%
99%
97%
682.0
801
98%
99%
104%
117%
341.0
752
116%
137%
102%
220%
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 but
there has been a reduction of 34% (day) and 12% (night) CSW use compared to last
bringing levels in line with previous months.
3) Hayworth House – There has been a further increase in the frequency of the safe
staffing RN levels being met at night (increasing by 12% this month). This is the highest
compliance figure for Hayworth house for over 6 months. On those nights when only 1
RN was on duty the overall staff ratio to people on the ward were met with an additional
CSWs. 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 reduced
requirement of additional CSWs over the 24/7 period.
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 enhanced observations over the 24/7 period. 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
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the funding for each areas establishment meets the requirements to staff the wards in
accordance with the expected safe staffing levels per occupied bed and to meet the needs of
the people being supported. 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 in the monthly available staffing
meetings which support teams in ensuring that the rosters are managed optimally each month.
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
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. The Trust continues to
work in partnership with NHS professionals to provide consistency of care through longer
term contracts and the development programme.
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
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For the month of May 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
16th June 2015
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