The Royal Wolverhampton NHS Trust
Trust Board Report
Meeting Date:
2 June 2014
Title:
Planned Versus Actual Staffing by Ward - April 2014 Information
Executive Summary:
NHS England have issued guidance on how every NHS Trust must
deliver the commitments detailed in ‘Hard Truths’ in particular to
publishing staffing data regarding nursing, midwifery and care staff.
NHS Choices will publish this data monthly from July when the public
will be able to view ward data split by registered nurses/midwives and
unregistered or ‘care’ staff.
This paper is in advance of the requirement to submit to NHS England
and has used data for April. May figures will be submitted on 10 June
and published in July; the Board will receive monthly information in
advance of being published on NHS Choices.
Action Requested:
The Board will receive the report for information and to support them in
fulfilling their responsibilities to monitor staffing capacity and capability
through regular and frequent reporting on actual staffing on duty on a
shift by shift basis versus planned staffing levels.
Report of:
Cheryl Etches, Chief Nursing Officer
Author:
Contact Details:
Charlotte Hall, Deputy Chief Nursing Officer
Resource
Implications:
Public or Private:
Public
(with reasons if private)
References:
Monthly reports will be presented via the Strategic Nurses Group
(eg from/to other committees)
Appendices/
References/
Background Reading
NHS Constitution:
(How it impacts on any
decision-making)
1. ‘Hard
Truths’
Commitments
NHS
England
http://www.england.nhs.uk/2014/04/01/hard-truths/ April 2014
2. How to ensure the right people, with the right skills, are in the
right place at the right time. National Quality Board Nov 2013
http://www.england.nhs.uk/wp-content/uploads/2013/11/nqbhow-to-guid.pdf
In determining this matter, the Board should have regard to the Core
principles contained in the Constitution of:
Equality of treatment and access to services
High standards of excellence and professionalism
Service user preferences
Cross community working
Best Value
Accountability through local influence and scrutiny
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1.0
Introduction
1.1
As part of the implementation of the guidance on the delivery of the ‘Hard Truths’ commitments
(March 2014) associated with publishing staffing data, this report provides the Board with information on
April’s nursing and midwifery staffing. The report will be supplemented every six months with a more detailed
staffing review, this is due in July.
1.2
The monthly report follows the requirements laid out by NHS England and is designed to support the
Board members fulfil their duties laid out by the National Quality Board and NHS England, to monitor staffing
capacity and capability through regular and frequent reporting on actual staffing on duty on a shift by shift
basis, versus planned staffing levels. The first report due to be published will be uploaded via Unify on 10
June and will report on May data. This report will not be published but is to demonstrate what will be received
in the future. Certain wards are excluded as per NHS England guidance, this report consists of all areas
required.
1.3
The minimum data set will be published on NHS Choices in July using May data and will provide an
overall fill rate for all of the wards for the previous calendar month split down to:
o
o
Registered Nurses/Midwives on day & night shifts
Care Staff on day & night shifts.
1.4
Through NHS Choices, the public will be able to drill down further by selecting “ward level detail”. The
staffing data will the first of a set of indicators being developed for monthly publication on NHS Choices. This
will enable the public will be able to see how individual hospitals are performing, an example of the indicators
is below
Safe Staffing (nursing and midwifery and care staff)
CQC National Standards
Incident Reporting
Infection Control
Responding to Patient Safety Alerts
An illustration of what the staffing information will loook like on NHS Choices is provided below (a fabricated
ward/hospital)
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2.0
Planned staffing with actual ‘fill rate’ on shift
2.1
The table below is an extract from the data set that will be used for NHS England sent monthly using
Unify. In addition it has the actual staff hours planned and on duty. Each ward (column A) demonstrates the
average fill rate by registerd nurse or midwife (B) and health care assistants called ‘care’ staff (D). This is
averaged out over the calender month and is based on numbers of hours planned or rostered for duty
compared to the number of hours actually provided. This 100% means all planned staff were on duty, an
overfill or higher % of staff, 125% for instance means more staff were on duty than planned and this can be
due to a varierty of reasons which are summarised for each ward in column F.
The Royal Wolverhampton NHS Trust Inpatient staff planned with actual April 2014
A
B
Ward name
Division 1
C
Average fill rate Average fill rate
registered
- care staff (%)
nurses/midwives
(%)
DAY
D
E
Average fill rate Average fill
registered
rate - care
nurses/midwives
staff (%)
(%)
NIGHT
A5
101%
107.8%
100%
125.0%
A6
91%
123.3%
95%
106.7%
+66.5 hours
used with zero
planned to
address shortfall
in RN cover.
+532 hours of
care staff used
with zero
planned due to
shortfall on
nights
F
Comments
Acuity and additional staff on
night duty as agreed with CNO
Specialing patient and
additional staff on night duty
as agreed with CNO
Increased care staff to
manage increased acuity.
Night duty increased as
agreed with CNO
A9
100%
59.2%
89%
A12
76%
107.3%
70%
A14
87%
91.7%
87%
126.7%
A23
Cardiology
Cardiothoracic
(B8)
Beynon S/Stay
79%
88%
93.3%
85.8%
92%
88%
93.3%
96.7%
92%
106.7%
91%
100.0%
73%
61.3%
100%
93.3%
Additional bed capacity open
Extra care staff to supplement
lack of RMs on night duty
Gynaecology
115%
95.6%
78%
+209 hrs of care
staff used with
zero planned
due to shortfall
on nights
Maternity
90%
103.3%
85%
111.7%
Division 2
A21
Neonatal Unit
Neuro Rehab
West Park
DAY
NIGHT
Night duty care staff used to fill
gap in RN on night duty
Additional Care staff to fill
gaps in RN early shift
COMMENTS
99%
109%
86.7%
61.0%
81%
102%
90.0%
76.7%
93%
123.3%
100%
100.0%
Additional care staff used to fill
RN gap
Ward 1
87%
110.0%
72%
196.7%
Additional care staff used to fill
RN gap
Ward 2
81%
119.5%
95%
123.3%
Additional care staff used to fill
RN gap
Ward 3
78%
117.1%
93%
108.3%
Additional care staff used to fill
RN gap
Acute Medical
Unit
93%
104.4%
90%
76.7%
A7
91%
100.6%
100%
106.7%
3
Additional capacity
Additional staff on night duty
agreed with CNO
A8
99%
96.0%
98%
100.0%
Acute Stroke
Unit
52%
160.0%
92%
56.7%
Additional acuity on day shift
to fill gap in RNs
C22
80%
58.0%
118%
92.9%
Additional RN to fill gap in care
staff on nights
CHU
102%
101.7%
94%
106.7%
Increased care staff at night to
fill RN gap
Deansley
87%
86.7%
100%
100.0%
B7
122%
134.1%
69%
193.3%
C15
106%
91.1%
100%
100.0%
C16
104%
84.4%
100%
200.0%
C17
99%
95.6%
98%
100.0%
C18
95%
108.3%
87%
143.3%
C19
100%
108.7%
103%
103.3%
C24
103%
88.7%
100%
100.0%
C25
3.0
123%
97.3%
100%
200.0%
Specialing patient in day
Additional night care staff to
support gap in RN night and
also special patient increased
falls
Additional RN to fill gap on day
Additional night care staff and
increased acuity
Additional care staff to fill gap
in RN days and to support
mechanical ventilation
Additional staff at night to
support mechanical ventilation
Additional staff at night agreed
with CNO and specialing high
risk falls patients plus
increased dependency due to
increased cognitive
impairment
Summary
This provides a report on individual ward staffing by fill rate for the month of April..
Research demonstrates that staffing levels are linked to the safety of care and that staff shortfalls increase the
risks of patient harm and poor quality care. It is clear that a number of wards are having to use care staff more
frequently than planned in order to fill the gap when they are unable to fill the shift with a registered nurse and
this can raise the risk by diluting the skill and capability of the nursing workforce on shift.
The report provides transparent information to the Board and ultimately to the public. It is vital to ensure data
is accurate and reflects actual staffing so further work will be done to ensure this information can be obtained
via the electronic rostering system and that ward sisters and matrons are able to provide this level of
information live, electronically and in a timely manner.
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