Deirdre Fowler Director of Nursing, Midwifery and Quality. Debbie Stewart Lead nurse Nursing Workforce

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1 Report of: Responsible Officer Accountable Officer Author of Report: Deirdre Fowler Director of Nursing, Midwifery and Quality Debbie Stewart Lead nurse Nursing Workforce Subject/Title Background papers (if relevant) Nurse Staffing Establishments Inpatient Services How to ensure the right people with the right skill are in the right place at the right time, Chief Nursing Officer for England & National Quality Board November Purpose of Paper Purpose of the paper is to provide the board an overview and assurance on monthly nursing / mw safer staffing Action/Decision required Mitigates Risk: On Corporate Risk Register The Executive Board is asked to note the content of the report. Safe staffing levels will minimise adverse clinical incidents and ensure our patients are cared for in a safe environment This assessment has considered and takes account of the Francis, Keogh, Berwick and Cavendish reports. Link to Care Quality Commission Safe, Effective, Caring, Responsive, Well Led Link to: Trust s 16 point plan Patient Experience Engaged Staff Value for Money Clinical outcomes Legal implications - (identify) No legal implications Impact on quality Alignment with quality improvement plan Resource impact Financial 1

2 1. INTRODUCTION This report provides an update to the board on monthly RN and HCA staffing levels and provides the planned verses actual nurse fill rates for May The reasons for gaps and the actions taken to support nursing and midwifery staffing, and the impact on quality and safety outcome measures drawn from the nursing handover report are outlined in the paper. Appendix 1 shows the full staffing UNIFY data submitted in May 2015 Appendix 2 shows the staffing compliance, vacancy factor and the quality metrics by ward. 2. OVERVIEW Four wards are using the SafeCare module on erostering to give us patient acuity information at 0800 and 2000 daily. This will allow visibility of staffing needs and safe movement of staff within the hospital. The Allocate customer adoption team for SafeCare will be supporting the erostering team to implement this across all wards. The next meeting is on 24 th July 2015 and the erostering team have requested analysis data for 30 th March to 26 th April 15 on the four pilot wards for review. The customer adoption team support the roll out and ensure that all project team utilise Saf Care functionality and requirements, including specialised wards/ units. As part of this roll out of SafeCare module implementation the Trust will have the functionality to report on the red flag shifts in our quality metrics in appendix 2. Due to the reduction in Staff within the bank and erostering team and the on-going review of the team structure the focus for erostering and the bank team at present is to support the wards to maintain their Healthroster and to continue to fill the vacant shifts through bank and agency The erostering and bank team have a band 6 Team Lead starting on 13 th July and a Band 3 erostering administrator starting on 20 th July There are also 2.5wte administrators who are awaiting start dates. This will enable us to continue the erostering implementation across the trust including the safer staffing module. 2.1 Professional Standards The acute ward areas in the Trust have an RN ratio of 1:6 patients in line with the recommendations from the safer care review. The unavailability of staff in each area is reviewed during the capacity meeting three times daily and by the site managers out of hours. In the event that the ratio reduces below 1:6 there is an escalation policy in place. During the capacity meeting the staff levels are reviewed and staff redeployed as clinically safe to ensure safe care in all our ward areas. This information is reported on the capacity report which is shared with ward matrons and 2

3 senior on call staff. Information of the RAG ratings for each ward areas staffing is provided on this document. Going forward this will form one of the red flags. 3. ANALYSIS 3.1 Percentage compliance Overall the HCA compliance was higher due to the need for 1:1 specials for patients requiring 1:1 care Patients are assessed as requiring 1:1 care for a number of reasons, most commonly due to acute/ chronic confusion causing the patient to be at increased risk of harming themselves or on occasions others. All specials are reviewed daily by the ward matrons. The over fill rate for RN on Reablement centre is due to an increase in RN numbers due to an increased acuity of the patient group. Apple Tree ward and Cherry tree ward have increased their HCA staffing by one to 2 on each shift for specials. Cherry Tree Ward are currently completing an SI investigation and as part of risk mitigation during the investigation process bed capacity has been reduced to 20 beds to ensure safe staffing and reduce percentage of temporary staff. The key factor for the Cherry Tree ward amber compliance for RN day shifts is short term sickness and percentage of vacancies. Reablement Centre has a high percentage of HCA staff unavailability due to sickness and other leave. Birch ward flex their staffing to their elective activity and so the unfilled shifts were not escalated to bank as the ward capacity did not indicate a need to flex upwards. The method of capturing the data for this ward will be reviewed this month. Juniper Ward has increased levels of sickness within both registered and HCA staffing. Several shifts were not escalated for bank cover as the ward review the staffing levels and skill mix and staff appropriately to ensure patient safety. ATSU noncompliance with RN and HCA staff is due to parenting and short term sickness and vacancy levels Critical care unit have Amber and Red for compliance levels for HCA s and Amber for the RN day shifts. Critical care flexes their staffing to demand and so the unfilled shifts are not escalated to bank as the unit capacity did not indicate a need to flex upwards. The method of capturing the data for this ward will be reviewed this month. AAU noncompliance for RN staff is due to other leave and supernummery status of staff. AAU have a high vacancy rate. 3

4 Medical Short Stay Unit have amber compliance for RN day shifts due to maternity leave, short term sickness, other leave and vacancy rates. Walnut ward have an amber compliance for HCA staff due to Maternity leave and other leave. Their overstaffing for RN s is due to a short period of supernummery status for new starters. Within Maternity services sickness levels are improving. Active recruitment is ongoing and successful. A recruitment trajectory will see the Division fully recruited by October Ward Management Leadership Days (supervisory status) The ward leadership days are recognised as vital to providing to providing optimum levels of high levels of care. There is some variability across the trust with the percentage taken. The variability is due to short term sickness and vacancy rates. The Ward matron supervisory days do not show in the staffing levels in appendix Vacancies The Divisional Heads of Nursing and midwifery across the trust are continuing to proactively monitor and recruit to vacancies in all areas. It is well recognised that the reducing numbers of registered nurses nationally causes a challenge and therefore as a Trust are implementing the plan to recruit additional overseas nurses and attract newly qualified nurses from the UK. 3.4 Recruitment plan The Trust have 15wte Vacancies at present however we are looking long term and taking turnover into account need to recruit 55 nurses over the next 18 months which will take us approx. 5% above RN establishment. The Trust has recruited 78 new staff undergoing pre-employment checks. They are 40 Registered nurses, 7 Midwives and 31 Health care assistants. Nine newly qualified nurses from the UK starting in the summer, including four of our own students. 12 European nurses recruited from Rome in May. They will be joining us in two groups, on 20 th July and 3 rd August. The recruitment team in HR are updating their recruitment material to help attract the best nurses to join Hinchingbrooke The recruitment team plan to recruit 45 nurses from the Philippines over the next year. There is a UK event in September to attract next year s newly qualified nurses, offering our own final year students places here 4

5 Commence a return to practice campaign after the summer the next 12 months. (50 RNs from overseas and QUALITY METRICS 4.1. Falls No Harm Low Harm Moderate Harm Severe Harm Death April The no harm and low harm falls are due to patients in their recovery who fall due to their physical and/ or mental ability. These are often one patient with multiple falls. The one moderate fall was on Cherry ward. An internal investigation has been completed and staffing levels were not identified as a contributory factor in this incident. All patients have a falls risk assessment and appropriate care plans are put in place. The falls committee has been working closely with ward matrons to ensure that falls prevention remains a high priority and results in a sustained reduction in harm. The number of falls in the trust have reduced have reduced since last month 4.2 Pressure Ulcers Pressure Ulcers Cat 1 Cat 2 Cat 3 Cat 4 Trust Acquired The category 1 and 2 pressure ulcers may be due to the patient s physical and mental status. A pressure ulcer incident form is completed and reviewed with the ward matron and the tissue viability team. The one category 1pressure ulcer on Juniper and the one category 2 pressure ulcer on Walnut are not identified as relating to staffing in those areas. 4.3 Family and Friends Four wards have a satisfaction scores below 95% which is our internal target. These wards were Cherry Tree ward, Juniper Ward, Reablement unit and MSSU, however on analysis the response rate on these wards was low and so the actual numbers of patients who would recommend us is low for each ward. The Divisional heads of nursing are supporting these areas to increase both response rate and recommendation levels. 7. RECOMMENDATION The trust board is asked to note the report 5

6 6

7 Appendix 1 Staffing Levels May 2015 Compliance Days Nights Ward RN/RM HCA RN/RM HCA Required Actual % Filled Required Actual % Filled Required Actual % Filled Required Actual % Filled Apple Cherry Tree Reablement Birch Juniper ATSU Critical Care AAU Short Stay Unit Walnut Ward Delivery Unit Lilac Ward Trust Totals Key staffing Levels above 95% Staffing levels between % staffing levels below 90% 7

8 Appendix 2 WARD RAG rated and Score RN average fill rate HCA average fill (Day and Night rate (Day and Night Combined %) Combined %) Vacant Posts (WTE) Actions Taken to Ensure Safe Care Falls Pressure Damage Trust Friends and Family Test Recommendation % Apple Cherry Tree Active recruitment into RN posts however remains problematic Reablement Birch Birch flex their staff to elective surgery activity Juniper Rolling programme of 5 beds closed for decorating ATSU Critical Care Flex staffing to bed occupancy 0 NA AAU MSSU Walnut RM average fill rate (Day and Night Combined %) MCA average fill rate (Day and Night Combined %) Vacant Posts (WTE) Actions Taken to Ensure Safe Care Number of Shifts that 1:1 care in Labour NOT Provided Unable to provide until June % of Spontaneous Vaginal Births Friends and Family Test Response recommendation Labour Ward Staff moved to support to Lilac and Labour ward areas Unable to depending on clinical need and activity. Birth rate plus paper has been presented to board and full review of staffing has provide at present Lilac been undertaken to review the number of midwives working clinically at present which indicates a ratio of 1:35 when sickness and maternity leave taken into account 93 8

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