BOARD OF DIRECTORS. Sue Smith Sue Smith Ext 46697

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1 BOARD OF DIRECTORS Date of Meeting: 29 April 2015 Title of Report: Status: Public Report of: Prepared by and contact details: Sue Smith Sue Smith Ext Purpose of the Report: To apprise the Board of Directors with relevant updates regarding the contribution of the nursing, midwifery and allied health professional team across the Trust. For Decision For Assurance For information Executive Summary: This inaugural report provides members of the Board with an overview of progress being made within the Executive Chief Nurse portfolio. The key areas covered in this report include: Staffing update Maternity escalation and innovation Key achievements and messages; corporate nursing team Successful bids and nursing / midwifery technology Patient observations New-born hearing screening Patient documentation Quality assurance matron Patient information boards Contribution to procurement Recommendation(s): The Board of Directors is asked to note the content of this paper and acknowledge the wider role that the corporate nursing and midwifery team play in the overall effectiveness of healthcare delivery and overall efficiency.

2 Implications and Monitoring Assurance Framework Summary Links to Trust Values: - Please indicate below with an () those values that this report relates to Patients: Our patients will be treated with compassion, dignity and respect. Their experience is our most important measure of achievement. People: Our staff and volunteers are the ones who make a difference. They understand and share our values and this is reflected in their work. Partnerships: Our partnerships make us strong. By investing in them, we will deliver the best possible care to our communities. Performance: Our performance drives our organisation. Providing consistently safe high quality care is how we define ourselves and our success. Progress: Our progress will be improved through innovation, education, research and technology to meet the challenges of the future Links to Strategic and Divisional Objectives(s) - Please insert details below Links to Risks on Board Assurance Framework (BAF),Corporate (CRR) or Divisional Risk Register (DRR) - Please insert details below including the Risk Reference Number (The BAF and CRR can be found on the Governance Webpages) Please indicate below with an () that all areas have been considered Have all implications been considered? Quality and Safety Legal Financial Human Resources IM&T Estates Patients and Carers Engagement and Communication Equality and Diversity Any Action Required? Yes Detail in report N/A Comment Previous Meetings Please insert the name of the committee/group and date the paper was presented and what the outcome was e.g. approved, noted etc. Version Control:- Please insert the final version control number e.g. 1.0.

3 UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST Background 1. This paper aims to provide members of the Board with a summary of key issues, achievements and challenges within the Executive Chief Nurse portfolio of responsibility. 2. The paper will incorporate the monthly hard truths staffing report which describes the hours planned against hours worked data. 3. An update will be provided to ensure that there is wider awareness of the range and depth of work led by the nursing, midwifery and allied health professional teams. 4. Updates on achievements will be provided on a quarterly basis in order to provide the board and members of the public more in depth overview of the wide range of work that nurses, midwives and allied health professionals lead on and/or contribute across the Trust. Staffing update 5. Appendix 1 shows the overall hard truths reporting data by site. None of the sites experienced overall variance of 10% or more, however, during March there were considerable operational pressures which presented variability within sites 6. Appendix 2 describes the position into wards that show more than 10% variance (over or under planned staffing). 7. There are a number of changes that have been made over the last year to improve the effectiveness of the recruitment process in order to ensure that vacancies are filled as quickly as possible. 8. Nursing and midwifery recruitment is commenced at the point an individual informs their manager that they wish to leave the Trust/post. There are no delays in the process which has reduced the time that posts remain vacant. 9. Cohort recruitment has improved the efficiency and effectiveness of the recruitment process and has enabled the Trust to facilitate a one-stop recruitment process. Recruitment events are scheduled for the remainder of the financial year and take place at weekends and in the evenings in line with recommendations from potential staff. 10. The Trust is successfully recruiting locally, nationally and internationally. The recruitment campaign in Spain in March resulted in offers being made to 18 Registered nurses Adult nurses. 4 of the 18 have since withdrawn. 10 are expected to commence in post on 27 April Recruitment for a second cohort of apprentices will commence in March for the September intake.

4 12. Table 1 reflects the number of staff in post (working) and in establishment (budget) as at 31 March 2105 when compared with April Table 1 April 2014 Nursing Budgeted Establishment Staff in Post v Establishment Staff in Staff in Post Post Headcount Variance Vacancy Factor Registered Nursing % Midwives % Unregistered Nursing % Grand Total % Nursing Budgeted Establishment February 2015 Staff in Post v Establishment Staff in Staff in Post Post Headcount Variance Vacancy Factor Registered Nursing % Midwives % Unregistered Nursing % Grand Total % 13. At the end of February 2015, there were 156 more staff working in wards and departments than were working in April The current vacancy rate for the Trust is 4.2 % (table 1). The overall vacancy rate across organisations that provide their nurse staffing establishment data is calculated at 10% by NHS Employers (2014). This demonstrates that despite the recruitment challenges, UHMB is recruiting well. 15. A number of internationally recruited registered nurses are waiting for their Nursing and Midwifery Council registration. Maternity escalation and innovation 16. The maternity escalation plan has resulted in 1020 midwifery hours being released to support community midwifery between December 2014 and March This is an average of 250 hours per month or 6.6 midwives released to support service. 17. During this period of 121 nights, midwives supported ladies to birth on 36 nights. There were 85 nights were no midwifery service was required. 18. During this period, 28 women were supported by midwives during the out-of-hours (on call) period (after 8pm or weekends).

5 Key achievements and messages; corporate nursing/midwifery team Successful bids and nursing/midwifery technology 19. In 2015, the senior nursing and Information Technology team submitted two successful bids for nursing technology were intrinsically linked and details of both bids are described through this section. 20. Safer Hospitals, Safer Ward bid for (48) ward packages that include an electronic whiteboard, tablet computer and wide screen monitors to support electronic monitoring of key patient safety indicators. 21. Indicators visible to clinicians at a glance include risks (e.g., falls, dementia, nutrition, pressure areas); early warning scores (an indication of acuity), allowing speedy review by the most appropriate person. 22. Nursing Tech Fund to support electronic recording of patient observations. This will produce an automatic early warning score and populate the whiteboard described above. 23. Patient observations will be available to the ward manager, matron and other key clinical staff. This will enable any anomalies or concerns to be monitored closely and appropriate and speedy action to manage patient care. 24. Observations will be uploaded onto i-pods at the bedside. There will be 14 i-pods for use on every inpatient ward. The Trust has taken delivery of 950 i-pods which will be in use following roll-out of training. 25. The senior nursing team would like to acknowledge and thank the IT / I3 team for their sterling work in making this innovation a reality. This technology will support the Trust strategic goal of reducing mortality and reducing patient harm through enabling visibility at numerous levels of patient acuity and management. Sign Up to Safety 26. The Trust nursing and governance team have worked in partnership to develop a bid for Sign Up to Safety. We were delighted to learn that the bid for 260, was successful. 27. The Trust bid focused on improving the assessment of foetal health through using antepartum cardiotocography (CTG) in order to support early appropriate interventions in the antenatal period and therefore reduce complications. 28. The bid will enable the Trust to appoint band 7 midwife CTG champions at Furness General and Royal Lancaster hospitals. Training programmes, training assessment tools and 11 CTG viewing and archiving instruments with computerised analysis facility will be purchased. 29. CTG interpretation is difficult and subjective. Misinterpretation leading to inappropriate action can result in lost lives. These CTG machines provide robust, objective CTG analysis to improve quality of care and outcomes. 30. The first three months will involve employing midwives and setting up the infrastructure and governance to deliver the project.

6 31. It is anticipated that the new CTG machines will be purchased and installed by month 6. Impact on patient care and outcomes will be monitored closely. 32. The senior nursing team would like to thank the head of patient safety and effectiveness for the significant contribution he has made to support the team in achieving this outcome. Patient observations; the importance of touch 33. The senior nursing team have led a project to install a manual sphygmomanometer at the bedside. The rationale for this decision is that electronic observation machines cannot detect key clinical data that can be assessed by human touch. These include regularity of pulse and clammy skin. Both of these are important indicators of deterioration. The nursing team believe that human touch not only provides a more meaningful clinical assessment but also provides reassurance to patients. 34. The first 75 sphygmomanometers have been received in the Trust and will be introduced along with training of staff in their use. 35. This innovation aims to support improved monitoring of patients, further reducing opportunity for deterioration. 36. The Trust has reduced trend in patients who suffer cardiac arrest over recent months, however we believe that this can be reduced further. Regional benchmark data for cardiac arrests can be seen below. Data is from Lancashire and South Cumbria Critical Care Network. % Arrest Calls of Total Inpatients 0.90% 0.80% 0.70% 0.60% 0.50% 0.40% 0.30% 0.20% 0.10% 0.00% Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Blackpool 0.20% 0.19% 0.15% 0.20% 0.17% 0.17% 0.23% 0.12% 0.21% 0.17% 0.16% 0.20% 0.24% East Lancs 0.08% 0.13% 0.13% 0.07% 0.11% 0.09% 0.00% 0.07% 0.08% 0.10% 0.13% 0.18% 0.08% Preston 0.29% 0.23% 0.24% 0.27% 0.26% 0.20% 0.22% 0.16% 0.22% 0.29% 0.31% 0.29% 0.33% Chorley 0.50% 0.19% 0.20% 0.20% 0.33% 0.10% 0.59% 0.13% 0.15% 0.14% 0.47% 0.60% 0.48% Furness 0.27% 0.12% 0.23% 0.20% 0.19% 0.14% 0.25% 0.03% 0.10% 0.19% 0.18% 0.12% 0.04% Lancaster 0.17% 0.18% 0.08% 0.29% 0.31% 0.26% 0.24% 0.09% 0.06% 0.15% 0.20% 0.18% 0.09% Target 0.38% 0.38% 0.38% 0.38% 0.38% 0.38% 0.38% 0.38% 0.38% 0.38% 0.38% 0.38% 0.38%

7 New-born hearing screening 37. New-born hearing screening is the name given to a type of screening test that assesses hearing of new born babies in the first weeks of life. 38. An innovative new-born screening programme has been introduced with the Trust being the first Trust in the country to introduce a hybrid model of hearing screening for new-born babies. 39. Changes in funding for this service resulted in a need to consider how the service could be delivered differently. 40. Screening is undertaken by band 3 clinical maternity support workers who have undertaken intensive training to become proficient in new-born hearing screening. 41. The Trust is the first in the country to provide a mix of hospital and community screening meet the needs of the service user who are not required to travel to have the screen done. It is practice elsewhere for this screening to be provided either in the community or in hospital but not in both. 42. The Trust presented this innovative new service at the National Hearing Screening Conference in London on March Documentation 43. The CQC report published in 2014 described concerns regarding quality of patient documentation. 44. A task and finish group was established and established that there was no standardised documentation in use across the Trust. There were different documents and varying standards in use across the organisation. 45. The group worked with clinicians from across the Trust to agree a standard solution to documentation that could be introduced across all areas from 1 st April The documentation is currently being rolled out across inpatient areas and includes multidisciplinary contemporaneous documentation. 47. A nursing care plan using a structured nursing model has been agreed to ensure consistency and quality of documentation. All clinical staff (medical, nursing and allied health professionals) will use contemporaneous entries that support a clear story of the patients journey and treatment for each episode of care. 48. General Medical Council and Nursing and Midwifery Council registration number stamps have been ordered for all clinical staff in order to support clear identification of each entry. 49. The change to the patient record will support clinical decision making, investigation of clinical incidents and identification of clinical staff. 50. Audits of the new documentation will commence in June 2015 and results will be reported through the quality assurance committee aligned to the CQC improvement plan update.

8 Quality Assurance Matron 51. The recent appointment of a quality assurance matron will support the implementation of the Nursing Assessment and Accreditation System (NAAS) programme that is being imported from Salford. 52. The Board of Directors have received a previous report relating to NAAS. Successful assessment is dependent upon objective assessment of standards. 53. The quality assurance matron is also undertaking training in use of the Safer Nursing Care Tool so that they can provide quality assurance when ward staff are assessing patient acuity and dependency on inpatient wards. 54. There is a regional programme to develop Advanced Improvement Practitioners who will be able to lead and influence improvement in healthcare. The quality assurance matron has been nominated for this programme. Once the programme has been completed, she will, through the improvement hub, support clinical teams to develop skills to lead clinical improvement as part of their everyday role. Patient identification boards 55. A recent Healthwatch report recommended that patient identification boards would be helpful to patients, relatives and visitors. The senior strategic nursing and midwifery group commissioned a piece of work to involve patients and staff in procuring a product. 56. Patients, ward staff, infection prevention and control staff, the Trust engagement manager, facilities staff and an equality and inclusion lead were involved in reviewing and choosing a product for use across the Trust. 57. The information boards will include the patient (preferred) name; the name of their consultant and nurse; and magnets to identify key information to clinical staff to alert them to check care plans and safety bundles to ensure that they meet specific clinical needs e.g. special diet; communication needs etc. 58. Taking a Trust-wide approach to procuring the boards has resulted in a saving of 4,000 against the total cost. This has been achieved by purchasing the boards in a single corporate order and recharging the divisions. 59. It is anticipated that the boards will be received within 6 weeks from the date of the order. Nurses engaging in procurement 60. Trust nurses are actively engaged in procurement through the nursing supplies group. They work alongside the procurement team to ensure that products procured for patient care are high quality and that variability is minimised across the Trust. 61. An example of the support that the nursing team receive from the procurement team links to concerns raised by band 6 and 7 nurses at a development day off site. The nurses expressed dissatisfaction with the toiletry packs in use across inpatient wards. Razors were ineffective and numerous packs needed opening to achieve a reasonable shave for male patients.

9 62. A phone call to the head of procurement resulted in him joining the nurses within 30 minutes of the call to listen to their concerns. As a result, the product was changed and waste was reduced. 63. Over the last year, this team has delivered 100,000 in efficiency savings whilst ensuring procurement is clinically led and evidence based. 64. The senior nursing team would like to acknowledge the significant impact that this team, consisting of front line nurses and library and knowledge staff, led by the procurement team have on delivery of cost efficiency as a by-product of best practice. Recommendation 65. The Board of Directors is asked to note the content of this paper and to commend the wide range of work that nurses, midwives and allied health professionals are leading on and engaged with across the healthcare economy.