How to ensure the right people,
with the right skills, are in the
right place at the right time
Hazel Richards
Deputy Chief Nurse
NHS England North
Action Area 5:
‘ensuring we
have the right
staff, with the
right skills in
the right place’
Wider Policy
Context
Francis Recommendations
Evidence to the inquiry suggested that the Trust did not have
reliable nursing establishment figures
23 – NICE to develop evidence-based tools for establishing what
each service is likely to require as a minimum in terms of staff
numbers and skill mix
195 – Nurse ward managers should operate in supervisory
capacity, visible to patients and staff, role model and mentor
205 – Seek and record the advice of Nursing Director on quality
and safety on major change
The Keogh Review
Issues related to nurse staffing in some organisations identified by
reviewers:
• dissonance between nursing establishments, staff in post and staff
available on each shift
• inadequate staffing levels on night shifts and weekends
• poor skill mix
• links to Compassion in Practice Action Area Five Workstream
Berwick Recommendations
Government, Health Education England and NHS England should ensure that
sufficient staff are available to meet the NHS’s needs now and in the future.
Healthcare organisations should ensure that staff are present in appropriate
numbers to provide safe care at all times and are well-supported’.
‘Boards and leaders of provider organisations should take responsibility for
ensuring that clinical areas are adequately staffed in ways that take account of
varying levels of patient acuity and dependency, and that are in accord with
scientific evidence about adequate staffing’.
Reference to NICE work and to staffing ratios
Hard Truths
Department of Health response to the Francis Inquiry
Hard Truths. The Journey to Putting Patients First;
includes the requirement for that:
‘from April 2014, and by June 2014 at the latest, NHS
Trusts will publish ward level information on whether they
are meeting their staffing requirements. Actual versus
planned nursing and midwifery staffing will be published
every month; and every six months Trust boards will be
required to undertake a detailed review of staffing using
evidence based tools’.
Key Objectives of Action Area Five
• Directors of Nursing to agree appropriate staffing levels through
the application of evidence based tools
• All nursing and midwifery staffing levels and quality experience
metrics should be discussed at a public board meeting
• Boards to sign off and publish evidence based staffing levels at
least every six months, providing assurance regarding the
impact on quality of care and patient experience
• Monitoring of compliance (CQC, NTDA, Monitor, Contracts)
• Work with NICE to establish adequate and appropriate staffing
levels for all care settings
Key Objectives of Action Area Five
• Develop Good Practice Guidance with National Quality Board
• Undertake an assessment of ward or community nurse / midwifery
leaders having a supervisory role
• Directors of Nursing to undertake a review of options for each
patient being allocated a named key nurse responsible for coordinating care
• HEE leading the on values / HCSW workstreams
(linked to Cavendish Review)
National Quality Board Guidance
Available at:
http://www.england.nhs.uk/wpcontent/uploads/2013/11/nqb-how-to-guid.pdf
Good Practice Guidance
National Quality Board guidance published on 19/11/13
Includes ten expectations and twenty case studies
Six themes –
Accountability and responsibility
Evidence-based decision making
Supporting and fostering a professional environment
Openness and transparency
Planning for future workforce requirements
Role of commissioning
Work in progress with CQC regarding the monitoring of
implementation of the expectations
Accountability and Responsibility
1. Boards take full responsibility for the quality of care provided
to patients, and as a key determinant of quality, take full and
collective responsibility for nursing, midwifery and care
staffing capacity and capability.
2. Processes are in place to enable staffing establishments to
be met on a shift-to-shift basis.
Evidence-Based Decision Making
3. Evidence-based tools are used to inform nursing, midwifery
and care staffing capacity and capability.
Supporting and Fostering a Professional
Environment
4. Clinical and managerial leaders foster a culture of professionalism
and responsiveness, where staff feel able to raise concerns.
5. A multi-professional approach is taken when setting nursing,
midwifery and care staffing establishments.
6. Nurses, midwives and care staff have sufficient time to fulfil
responsibilities that are additional to their direct caring duties.
Openness and Transparency
7. Boards receive monthly updates on workforce information, and
staffing capacity and capability is discussed at a public Board
meeting at least every six months on the basis of a full nursing
and midwifery establishment review.
8. NHS providers clearly display information about the nurses,
midwives and care staff present on each ward, clinical setting,
department or service on each shift.
Planning for Future Workforce
Requirements
9. Providers of NHS services take an active role in securing staff
in line with their workforce requirements.
The Role of Commissioning
10. Commissioners actively seek assurance that the right people,
with the right skills, are in the right place at the right time within
the providers with whom they contract.
Workforce Planning Tools
Tools for Acute Care:
Safer Nursing Care Tool guidance and multipliers updated in July
2013. Available at: http://shelfordgroup.org/resource/chiefnurses/safety-nursing-care-tool
Work in progress to develop Safer Nursing Care Tool for AMUs / A&E /
Children’s In-Patients / Older People’s care
IPAD-APP in development to record SNCT acuity and dependency
scores at the bedside and generate local reports – proof of concept
stage
Workforce Planning Tools
Tools for Maternity:
Birthrate Plus - RCM published updated guidance in autumn
2013.
Tools for Community:
QNI have undertaken a review of existing tools (publication
pending)
Work being taken forward with NHS England Community
Nursing Strategy Programme
Workforce Planning Tools
Tools for Mental Health
Two workshop sessions held
Pilots of Dr Keith Hurst and NHSScotland tools
Literature review commissioned
Tools for Learning Disabilities
Initial literature review undertaken
Working with MH group on tools for in-patient settings (pilot
as above)
Focus on tools for LD care in community settings (nursing
and social care workforce)
the tools in practice