Appendix 2 - NICU Workforce Plan 2014-2017
Background:
Portsmouth Hospitals NHS Trust (PHT) neonatal unit is designated as a Neonatal Intensive Care Unit and
is part of the Thames Valley & Wessex Neonatal Network. Within the Thames Valley & Wessex Neonatal
Network there are three units designated as Neonatal Intensive Care Units (NICU). These are PHT,
University Hospital of Southampton NHS Foundation Trust (UHS) and Oxford University Hospitals NHS
Trust (OUH). DH Toolkit (2009), NICE guidelines (2010) and the National Neonatal Service Specification
(2013) states that the following criteria are used to determine infants receive their care, which is highly
technical and specialised in a NICU:
Neonates born below 27 weeks gestation
Multiples born below 28 weeks gestation
Neonates born over 27 weeks gestation but who receive or who are likely to require ventilation for more
than 48 hours and/or whose condition is deteriorating
Neonates born whose weight is below 800grammes
Neonates who require cooling
Neonates requiring specialist care e.g. nitric oxide/HFOV Complex intensive care including neonates with
symptoms of additional organ failure (inotropes, insulin infusion, chest drain, exchange transfusion,
prostaglandin infusion)
OUH and UHS are the designated neonatal surgical units within the Network, with UHS also designated as
the paediatric cardiac centre. The agreed pathway for Portsmouth babies who require cardiac or surgery
intervention is to University Hospital of Southampton NHS Foundation Trust (UHS).
PHT & OUH currently provide the Neonatal Transfer Services within the Network.
PHT Cot capacity is:
Intensive Care Cots (IC): 14
High Dependency Cots (HDU): 0
Special Care Cots (SCU): 13
Staffing:
The nurse staffing levels required for neonatal services are clearly defined in the The DH Toolkit (2009),
NICE Quality Standards for Neonatal Care (2010), BAPM Service Standards for Hospitals providing
Neonatal Care, third edition (2012) and National Neonatal Service Specification (2013). They state that
nurse staffing levels should equate to:
1:1 Intensive Care
1:2 High Dependency
1:4 Special Care
NICU Workforce Plan
Issued: 27 February 2014
Owner: Carol Moore, Matron, NICU
DH Toolkit (2009) also states, supported by BAPM Service Standards for Hospitals providing Neonatal
Care, third edition (2011) and NICE Quality Standards for neonatal care (2010):
‘A minimum of 70% (special care) and 80% (high dependency and intensive care) of the workforce
establishment hold a current Nursing and Midwifery Council (NMC) registration’ and that
‘A minimum of 70% of the registered nursing and midwifery workforce establishment hold an accredited
post-registration qualification in specialised neonatal care (QIS)’
Where unregistered staff are employed, such as nursery nurses or assistant practitioners, these staff
should have undertaken relevant training to a minimum level of NVQ3 or foundation degree and should
work under the direct supervision of a registered nurse. The workforce requires an uplift of 25% in
recognition of the need for continuing education and training within this environment.
Due to the high number of staff required in neonatal units, the dependency of infants will require review on
a regular basis (a minimum of once per shift) to ensure effective use of staff and to maximise capacity
within each unit, ensuring that each baby receives the right care from the right person with the right
knowledge, skills and competence.
5
Current Funded Establishment
Band
8
7
6
5
4
3
Establishment
1.0
7.32
23.37
45.21
5.45
0
82.35
In Post
0.64
6.96
22.73
35.30
4.47
0.92
71.02
OFF TEAM ROLES
Transport 3.0
Community 2.0
Practice Education 1.0
Matron 0.64
Management time 1.0
Feeding Advisor 0.64
8.28
Establishment:
82.35 (funded) – 8.28 (Off team) = 74.07
This includes recent increase in
establishment by 5.6 WTE Band 6 posts
Current vacancy 11.33
Recruitment in progress
Cot numbers
Cots required based on 2012/13 activity
(BAPM 2001, 80% occupancy)
Cots required based on 2013/14 M6 activity
(BAPM 2001, 80% occupancy)
Cots required based on 2012/13 activity
(BAPM 2011, 80% occupancy)
Cots based on 2013/14 M6 activity (BAPM
2011, 80% occupancy)
Declared cots 2013/14
NICU Workforce Plan
Issued: 27 February 2014
Owner: Carol Moore, Matron, NICU
IC
9.2
HD
7.2
SC
15.2
TOTAL
31.6
11.2
6.9
12.9
31.1
8.0
7.7
15.9
31.6
9.7
9.0
12.3
31.1
14
0
13
27
Staffing Numbers – staff required per shift for direct care
Staff requirement per shift, based on declared
cots 2013/14
Staff requirement, including shift leader, per
shift , based on activity (BAPM 2001)
Staff requirement, including shift leader, per
shift , based on activity (BAPM 2011)
Staffing shortage based on BAPM 2011
14
0
4
18
12
4
4
20
10
5
4
19
22% uplift (5.6)
25% uplift (5.8)
99.54 – 74.07 = 25.47
101.99 – 74.07 = 27.92
Plan




A staged increase in staff numbers over 3 years to achieve the identified shortfall.
Review of activity data bi-annually to ensure the staffing requirements are current and meets service
demand.
Maintain skill mix 70/30; registered/unregistered workforce, whilst developing the Band 3/4 roles (yr.
1 = B7 & B4, yr. 2 B5 & yr. 3 B5)
75% of workforce will be QIS
22% Uplift
2014/15
Currently 14 per shift
14 per shift requires 73.34
wte
25% Uplift
Example
rota’s @
22%
Example
rota’s @
25%
Current establishment
74.07 wte
75.15 wte
Minus current establishment
74.07=1.08 WTE required
2015/16
To increase to 16 per shift
Need 83.82 wte
Minus establishment
74.07=9.75 WTE required
2016/17
To increase to 19 per shift
Need 99.54 wte
Minus establishment
83.82=15.72 WTE required
85.88 wte
Minus establishment
75.15=10.73 WTE required
101.99
Minus establishment 85.88
=16.11 WTE required
NICU Staged
Staffing Increase 22% March 14.xlsx
NICU Staged
Staffing Increase 22% March 14.xlsx
NICU Staged
Staffing Increase 22% March 14.xlsx
NICU Staged
Staffing Increase 25% March 14.xlsx
NICU Staged
Staffing Increase 25% March 14.xlsx
NICU Staged
Staffing Increase 25% March 14.xlsx
NICU Workforce Plan
Issued: 27 February 2014
Owner: Carol Moore, Matron, NICU
Recommendations:
PHT recommend using the current 22% uplift and not 25%. The 25% uplift was set many years ago when
agenda for change was rolled out and nationally absence was much higher. Absence on NICU is not
exceptionally high and all absence is well managed under Trust policy where we all have a target of 3% to
achieve. We acknowledge that the Lead nurse report recommends the workforce having an uplift of 25% in
recognition of the need for continuing education and training within this environment, however, an uplift also
includes other leave such as annual and maternity leave. In addition not all staff in the establishment will
require the need for continuing education and training so a blanket approach across the whole
establishment would not be necessary only a proportion.
PHT will be supporting an increase in staffing for 2014/5 as part of the national requirement of the National
Quality Board with funding that all trusts have received (Francis and Keogh funding). PHT have submitted a
board paper to Trust board requesting a further increase of 8 wte band 5’s in acknowledgement of this
action plan.
NICU Workforce Plan
Issued: 27 February 2014
Owner: Carol Moore, Matron, NICU