Seize the Opportunity
NQB Safer Staffing Event – 25th March 2014
Mike Wright - Executive Director of Nursing
& Patient Experience
www.cddft.nhs.uk
Content
National Context:
Key RCN documents
Reviewing staffing levels in face of serious supply
and demand concerns
NQB – Ensuring the right people, with the right
skills are in the right place at the right time
Share approach taken at CDDT – the story so
far and next steps – ‘warts and all’
Lessons learned
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Context
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Context cont.
Growing body of evidence of links between RN to
patient ratios and risk of increased harm/mortality
Calls for nationally-mandated minimum nurse staffing
levels, which have not been supported by CNO and
government
National ‘minimum’ could become ‘maximum’ in
financially-challenged times, when there is a need for
nursing/care staffing levels to be flexible sometimes to
match patient acuity and flow
Difference between ‘minimum safe’ and ‘optimum’
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www.cddft.nhs.uk
Context
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Requirements of
NHS Trust Boards
Ten ‘Expectations’
9 for trusts; 1 for
commissioners
A significant
opportunity for
nursing and
midwifery to get this
right
www.cddft.nhs.uk
Process adopted at CDDFT
Board seminar January – presented RCN findings,
supply/demand issues and NQB requirements
Undertaken full review of all Nursing, Midwifery, Health
Visiting and School Nursing posts
Used ‘validated tools’ where they exist as a guide
Involved Finance, HR, Operations and N&M
colleagues – from the start!
It’s been a ‘journey of discovery’ !
www.cddft.nhs.uk
Findings
Baseline information was poor and inconsistent
Understanding was variable and inconsistent across
all staff groups (Finance, N&M, HR)
Different information from ESR and Finance ledger (for
same period)
When is a vacancy a reported vacancy?
Budgets set at mid-incremental point or one below for
all bands
www.cddft.nhs.uk
Findings cont.
60.17% RN/RM at top incremental point
62.71% of HCA’s at top incremental point
Establishment mark-up – range from 17%-23%
(average 20%)
Different understanding of what the ‘mark-up’
comprises, e.g. annual leave or not, how much study
leave, etc.
Some manoeuvring by some senior nurses!
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The ‘Mark-up’ conundrum
Category
Annual Leave
Bank Holidays
Sickness (4%)
Training
TOTALS
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Days Allowance
based on starting
point of 260 possible
working days p.a.
(7.5 hrs) (per wte)
Percentage
Allowance
33
8
10
6
57
13%
3%
4%
2%
22%
Accountability and Responsibility
Expectation 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
Expectation 2: Processes are in place to enable
staffing establishments to be met on a shift-to-shift
basis. [Need written escalation policy]
www.cddft.nhs.uk
Evidence-Based Decision Making
Expectation 3: Evidence-based tools are used to
inform nursing, midwifery and care staffing capacity
and capability [where they exist]
Supporting & Fostering a Professional
Environment
Expectation 4: Clinical and Managerial leaders foster a
culture of professionalism and responsiveness, where
staff feel able to raise concerns [reviewing all
mechanisms against which staff can raise concerns]
www.cddft.nhs.uk
Expectation 5: A multi-professional approach is taken
when setting nursing, midwifery and care staffing
establishments
Expectation 6: Nurses, midwives and care staff have
sufficient time to fulfil responsibilities that are
additional to their direct caring duties [setting baseline
budgets and final mark-up still to be resolved although
agreed in principle]
www.cddft.nhs.uk
Openness and Transparency
Expectation 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.
Expectation 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 [in place from April 1st]
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Planning for future workforce
requirements
Expectation 9: Providers of NHS services take an
active role in securing staff in line with their workforce
requirements
The role of commissioning
Expectation 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 [yet to be
confirmed]
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Preliminary results
Care Group
Additional wte
Acute and Long
Term Conditions
Surgery &
Diagnostics
Care Closer to
Home
Total
46.25 x RN
54.23 x HCA
17.5 RN
3.5 HCA
47.19 RN/RM
18.6 HCA
187.27
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Provisional
Additional
Requirement (before
unsocial hours markup)
£2,483,821
£577,888
£1,867,782
£4,929,492 (basic)
£6,901,298 (x 1.4)
Other factors to be resolved
Current spend on agency = £7m + other variable pay
Cost of setting baseline budgets & ‘mark up’ properly
Reconciliation of filling existing vacancies
Supervisory Ward Sister-Charge Nurse/Team Leader
Establish a sensitivity ‘risk rating’ – proportion away
from desired numbers
Supply and demand issues
How to fill the workforce vacancies – new types of
practitioner
www.cddft.nhs.uk
Summary
It’s challenging to get right but very necessary
Time to stand and be counted
Significant opportunity for nursing and midwifery
Not without its challenges in terms of recruitment and
future supply
Need to consider alternatives to the Registered
Practitioner (inc. foundation degrees, apprenticeships,
assistant practitioner, ward personal assistants, ward
hygienists, etc.)
Good Luck!
www.cddft.nhs.uk