WORKFORCE Detailed PI Tracking

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1 WORKFORCE Detailed PI Tracking June 2015 Safe Staffing Level Acute s/ Areas DAY NIGHT Fill Registered midwives/nurses Fill Care Staff Fill Registered midwives/nurses Fill Care Staff BH 94.0% 99.5% 96.2% 104.3% RLH 98.1% 124.5% 103.0% 128.4% MEH 87.1% 93.4% 97.2% 122.4% WXH 97.6% 101.2% 100.3% 108.5% SBH 79.5% 53.7% 76.9% 48.1% NUH 93.2% 105.6% 94.0% 111.1% rate for all sites being above 80% for and for both care support staff and Registered Nurses. All CAGS except Cardiovascular CAG report as average fill rate above 80% for both Registered and Care Staff. Cardiovascular CAG reported the lowest and St Barts Hospital reported the lowest for both and fill rate. Total 93 red flags were reported including out areas, theatres and other non-in areas. Total 46 Red Flags in were raised in in areas compared to 43 in May on incidents related to shortage of staffing. rating was undertaken triangulating this data with the actual staffing levels and core nursing quality indicators along with CAG DON assurance statements. Areas of risk Total 6 areas reported staffing below 80% fill rate and 6 were risk assessed as red. 39 areas were risk assessed as amber. 45% in areas have a high vacancy number within the Trust. Areas where fill rates are above 45% wards are reporting above for Registered Nurses compared to 40% in May. This is predominantly for increased acuity, specials, increased use of beds than budgeted but also due to incorrect establishment. 55% wards are reporting above for HCAs for day shifts which is decreased from 75% in May. HCA specials at night have declined by 12% for night. 24 July 2015 Lead Director: Chief Nurse Organisation Aims/Objectives Meeting all national minimum performance standards and regulator requirements Providing high quality, safe and compassionate care BAF/ High Risk Rating BAFrisk no. X Related high risks (>15 at outset): 1

2 CAG WORKFORCE Detailed PI Tracking June 2015 Safe Staffing Level CAG Fill rate DAY Fill Registered midwives/nurses Fill Care Staff NIGHT Fill Registered midwives/nurses Fill Care Staff ECAM 95.9% 115.5% 100.6% 121.3% CARDIOVASCULAR 78.0% 45.4% 74.1% 36.3% SURGERY 99.0% 110.8% 103.0% 123.6% WOMEN S AND CHILDREN 92.3% 100.5% 95.7% 106.4% 24 July 2015 Lead Director: Chief Nurse 2

3 WORKFORCE CAG Level Detailed PI Tracking Safe Staffing Level cont. Adult Acute s/ Areas DETAILS 24 July 2015 Exception Reporting Rationale The (red, amber, green) traffic light rating requires professional judgement which may include the following criteria: establishment not meeting the needs around Clinical acuity Red Flag Triggers Wider workforce issues relating to vacancy and skill mix Leadership Existing Quality and safety data Risks posed to s as a result of the above Lead Director: Chief Nurse Minor Impact Fill rates above 80% establishment meets for acuity/ dependency of s No Red Flags Area meeting all requirements set out in Professional judgment criteria Staff Shortages not an endemic issue for the ward Moderate Impact Fill rate below 80% Impairment to some aspect of service delivery Establishment deficiencies however risk to s reviewed and no quality or safety issues. Routine sickness absence - infringement on safe staffing levels not impacting safety One red flag triggering concerns around safety Use of agency and back dueto vacancies within acceptable limits Requirements for staff to be redeployed Nurse in charge included in the numbers Significant Impact Fill rate below 80% Establishment deficiencies - not meeting acuity/ dependency Multiple red flags triggering concerns around safety Requirements for staff to be redeployed Nurse in charge included in the numbers Staff Shortages is an endemic issue for the ward Systemic Staffing problems (Recruitment issue, poor vacancy fill) Significant impact on service delivery/activity 3

4 Safe Staffing Level cont. Acute s Mile End Hospital name GerryBennet Jubilee Older People s Older People s registere d care nurses/ midwive s nurses/mi staff dwives 83.46% 91.11% 98.89% % 90.50% 96.77% 95.60% 95.72% FFT % s recommendi ng wards (response 4 80% 10 acquired pressure (moderate/se vere) Red Flags Vacancy Bank Fill Fill % 20.4% 1.9% % 16.2% 3.5% Manager is off sick currently. 44 unfilled shifts for the month.in the absence of ward manager, no supernumery for nurse incharge. High vacancy rate. safely staffed. 4

5 Safe Staffing Level cont. Acute s Newham General Hospital name Beckton Gynaecology Delivery Suite Midwifery Led unit CCU East Ham Heather NUH ICU Obstetrics Obstetrics Cardiology Stroke wives care staff wives care staff 95.66% % % % % 89.03% 98.01% 93.20% 87.70% 86.60% 78.80% % 94.21% % % 0% 97.62% % % % 89.59% % % % Critical Care 82.18% 65.53% 87.05% 27.59% FFT % s recommending wards (response 88% No data available 75% 4 82% acquired pressure Red Flags Vacancy Bank Fill (moderat e/severe) Fill % 21.0% 6.2% % 7.0% 0.0% % 14.0% 0.0% Safely staffed. However, high vacancy rate. Recent establishment review increasedslightly. Ambulatory bay is still unfunded and is under cost pressure list. Safely staffed. 11 unfilled shifts at night for RM, sent out to bank but not filled. High vacancy rate., recruitment campaign in place. 26 new midwives started since march. 16 Student midwives offered posts and due to start in September incidents reported had an adverse impact on care % 13.8% 8.1% Safely staffed. HCAs not required in the night % 26.8% 8.7% % 18.7% 0.6% Additional surge capacity requiringmore staff than budgeted. Hence, > fill rate and high bank/agency use. 20 unfilled RN shifts for the month. Additional staff booked to cover the 13 additional beds used as part of surge response. Safely Staffed. Not measured % 3.8% 1.9% Safely staffed. HCA not counted in numbers Larch Maternity Obstetrics % 98.52% 96.77% 95.97% 93% % 17.4% 0.1% Safely staffed. Higher acuity leading to high bank usage. Maple % 19.5% 1.0% Additional surge capacity requiringmore staff than budgeted. Hence, > fill rate and high bank usage % 99.09% % % *Not Applicable in critical care units and Children's areas 5

6 name nurses/mi dwives wives Safe Staffing Level cont. Acute s Newham General Hospital FFT% of recommending ward (response acquired pressure Red Flags Vacancy Bank Fill (moderate/s evere) Fill Neonatal Unit Neonatology 80.13% 95.00% 84.03% % NA % 6.0% 3.7% Higher acuity at night leading to > fill rate. Plashet- Med Gastro % % % % 89% % 17.7% 2.2% Higher acuity and confused s requiring specials than budgeted resulting in >fill rate and high temporary staff usage.. Rainbow - NUHT Paediatrics 87.50% 80.52% 82.12% NA 50% % 16.0% 10.7% HCA not established at night. Included in establishment review.hcas are not included in safety numbers as they act as runners to help release direct care contact time for RNs. Silvertown General 94.41% % % % 94% % 28.4% 4.8% Higher bank usage due to higheracuity. safely staffed Stratford General % 76.37% % 87.63% 98% % 26.7% 5.0% Higher acuity and tracheostomy s resulting in > fill rate as policy requires 1:1 nursing and high temporary staff usage. Tayberry Older People s % 21.1% 9.5% safely staffed. Higher vacancy rate leading to high bank usage. Recruitment campaign in place % 94.20% % % Thistle Older People s 75% % 16.1% 4.1% Higher acuity and confused s requiring specials than budgeted resulting in > fill rate and high temporary staff usage % 93.09% % % 6

7 Safe Staffing Level cont. Acute s St. Bartholomew s Hospital name wives care staff wives care staff FFT% of recommendi ngward (response acquired pressure (moderat e/severe ) Red Flags Vacancy Bank Fill Fill Bodley Scott 1 (5C) Clinical Haematology 97.35% % 96.77% % 1 response % 22.7% 12.8% HCAs act as runners in this unit and do notwork nights. High vacancy rate. Garrod Endocrinology 90.27% 88.33% 98.86% % % 6.8% 3.8% Safely Staffed. High vacancy rate KGV 5A Medical Oncology 94.02% 81.45% % % % 19.2% 2.2% High vacancy rate 1 C 1 E (ICU SBH) Cardiothoracic 66.0% 3.0% 60.6% 1.6% Not measured % 16.0% 3.4% High number of agency staff. 5 Red Flags reported. Service notfully established. BodleyS 2 (5D) Clinical Oncology 93.55% 98.39% % % 0% 0 returned % 2.0% 9.7% safely staffed. High vacancy rate. KGV 5B (Rahere) Vicary Clinical Oncology 87.25% 96.77% 93.55% 0% 11 0 Cardiology 91.37% 71.62% 68.55% % % 15.2% 21.1% % 14.5% 7.8% safely staffed. High vacancy rate Higher acuity leading to > fill rate. RN shifts at night below threshold. Not all beds opened so ratio maintained WG Grace Cardiology 83.96% % 69.35% 95.70% % 16.4% 2.5% Safely Staffed. Not all beds openedto ensure safe staffing. High vacancy rateand recruitment underway. 7

8 Safe Staffing Level cont. Acute s St. Bartholomew s Hospital name nurses/mi dwives registere d nurses/m idwives rate Care staff % FFT% of recommending ward (response acquired pressure Red Flags Vacancy Bank Fill Fill (moderate /severe) 4 D (Caplin) Respiratory % 10.2% 9.7% Establishmentreviews were done recently and had an HCA increase at night % 87.89% 97.50% 55.00% 4 B (Leander) Cardiothoracic 0% % 1.4% 0.0% Use of band 7 during the day to ensure staff numbers are maintained % % 87.10% 93.55% 4 B HDU Cardiothoracic 1 response % 2.0% 9.7% 94.89% % 96.48% 0% Radcliffe ward Thoracic % 13.4% 4.4% High vacancyrate. Staff redeployed from other wards. Recruitment in progress 90.4% 74.2% 80.7% 75.8% 8

9 name wives wives Safe Staffing Level cont. Acute s The Royal London Hospital FFT% of recommending ward (response acquire d pressur (moderat e e/severe) Red Flags Vacancy Bankfill rate Fill 3D Short Stay % 96.84% % 93.87% 97% % 19.4% 8.8% safely staffed. High vacancy rate 3E Stroke 96.79% 98.26% % 66.67% 96% % 16.3% 12.9% Bank not filling the area and routine requesting of agency on lines being made. High vacancy rate. No adverse impact on care. 3F Short Stay % % % % 90% % 14.9% 7.4% safelystaffed. Higher acuity and increased work load leading to > fill rate 4E/F Critical Care 94.67% 93.33% 98.87% % Not measured % 6.0% 8.6% safely staffed. 6C Paediatrics 95.77% NA 96.77% NA % 4.7% 1.7% HCA is a housekeeper, doing the stock keeping and topping up facilitating clinical staff to concentrate on direct care. 6E & F Obstetrics 82.15% 95.56% 80.76% % 96% % 13.8% 0.0% safely staffed. High vacancy rate. 7D 7 ENorth (7 C (b)) Paediatric Paediatrics % 96.77% 96.77% 96.77% % % % 0% 89% 9 1 response % 6.8% 5.4% % 9.3% 14.0% safely staffed. safelystaffed. No HCA at night. High vacancy rate. 7E Paediatrics 97.89% % 94.62% 93.55% 1 response % 6.0% 0.9% Higher acuity leading to > due to tracheostomy specials. safely staffed. 7 C (previous 7E PASSU) 7F Paediatrics PAEDIATRICS % % % 90.00% Not measured % 0.5% 8.5% % 24.4% 7.6% safely staffed. > and higher bank and agency fill rate due to additional sleep study and video telemetry regular activity % % % % 9

10 Safe Staffing Level cont. Acute s The Royal London Hospital name wives care staff wives care staff FFT% of recommending ward hospit al falls acquir with ed pressu(modera re te/sever e) Red Flags Vacancy Bank Fill Fill 8B (8C) Gynaecology 88.4% 190.0% 158.3% 193.3% % 15.0% 15.4% safely staffed. High vacancy rate 8D 8F 9E 9E HDU Neonatology Obstetrics Urology/Renal Urology/Renal 96.17% % % % 94.35% 96.77% 96.77% 96.77% 96.02% % 80.67% 76.67% % % % 0% NA % 7.1% 5.9% 6 93% % 13.6% 0.0% % 17.4% 2.5% NA % 14.1% 2.6% Unit reached more than full capacity leading to fill rate > dueto acuity and capacity. High vacancy rate High sickness rate during the day for nurses.this is being currently managed with HR support. Manager lost supervisory hours to maintain safety SafelyStaffed. Higher acuity leading to > fill rate. High vacancy rate. No adverse impact on care. SafelyStaffed. Higher acuity leading to > fill rate 9F 10E 10F 11C Urology/Renal OlderPeople s General 90.64% % 98.30% % 96.89% % % % 95.22% % % % % % % % 96% % % 17.7% 1.7% safely Staffed % 19.3% 12.9% % 19.7% 0.3% % 14.3% 9.9% SafelyStaffed. Higher acuity leading to > fill rate and higher bank and agency fill rate. High vacancy rate. SafelyStaffed. Higher acuity leading to > fill rate and higher bank and agency fill rate. High vacancy rate SafelyStaffed. Higher acuity leading to > fill rate and higher bank and agency fill rate. 11E AAU General 94.80% % 91.37% % 93% % 15.6% 8.6% SafelyStaffed. Higher acuity leading to > fill rate and higher bank and agency fill rate. High vacancy rate 10

11 Safe Staffing Level cont. Acute s The Royal London Hospital name nurses/mi dwives nurses/mi dwives care staff FFT% of recommend ingward (response hospit al acquir ed pressu re (moderat e/severe) Red Flags Vacancy Bank Fill Fill 12C 12D 12E 12F 13C 13D 13E Trauma and Orthopedics Trauma Neurosurgery Neurosurgery General General Cardiac % % % % % % % % 91.01% % % % % % % % 99.23% % % % % 96.45% % % 94.73% % 96.77% 96.77% % % 13 97% % 38.0% 5.2% % 21.5% 2.9% % 24.7% 6.5% % 19.7% 14.7% % 10.7% 11.1% % 11.2% 5.1% % 10.6% 1.7% Higher acuity and s requiring close supervision leading > fill rate. High vacancy rate. Higher acuity and s requiring close supervision leading > fill rate. High vacancy rate. Higher acuity and s requiring close supervision leading > fill rate. High vacancy rate. Higher acuity and s requiring close supervision leading > fill rate. High vacancy rate. Higher acuity and s requiring close supervision leading > fill rate. Higher acuity and s requiring close supervision leading > fill rate. High vacancy rate Higher acuity and s requiring close supervision leading > fill rate. High vacancy rate 13F 14E 14F Respiratory Older People s % % 97.58% 93.55% 95.22% % 96.77% % Gastroenterology % % % % 97% % 8.1% 5.0% % 12.9% 2.1% % 26.0% 3.2% Higher acuity s in side rooms requiring closer observation. > fill rate due to higher acuity. High vacancy rate. > fill rate due to higher acuity. 11

12 name wives care staff wives Safe Staffing Level cont. Acute s Whipps Cross Hospital FFT% of recommendi ngward (response acquired pressure (moderat e/severe) Red Flags Vacancy Bank Fill Fill AAU Acute admissions % % 91.94% 90.32% Part of ED returns % 11.4% 12.7% safely staffed. High vacancy rate currently able to fill by bank and agency staff. Acacia Acorn Unit Infectious Diseases Paediatrics 92.59% % % 95.00% 85.84% 92.75% % 40.00% 91% 11 92% % 12.0% 5.8% % 5.8% 28.9% safely staffed High vacancy rate. Recruitment due to take place in September. Mitigation Is regular agency staff who are trained and supported on the ward. HCA not required at night. Minimal impact on safety. B3 Winter Pressure 77.90% 85.85% % 95.00% 88% NA 10.8% 5.7% Staff recruited from overseas awaiting for pin numbers. Birch Blackthorn Cedar Older People s Older People s Older People s 94.22% 94.93% 97.73% % 71.24% % 95.56% % % % 95.46% % % % 8.4% 1.5% safely staffed % 6.8% 1.9% % 12.6% 1.4% manager post vacant. Redeployment from other ward areas on the days staffing was short. Higher acuity leading to > fill rate. safelystaffed. Higher acuity leading to > fill rate. High vacancy rate. Chestnut Older People s 96.02% 93.72% 99.93% 97.30% 91% % 22.6% 1.3% safelystaffed. Higher acuity leading to > fill rate. High vacancy rate. Conifer Gastroenterology % 98.89% % % 93% % 10.8% 1.6% safelystaffed. Higher acuity leading to > fill rate. High vacancy rate. Curie Respiratory % 93.43% % % 91% % 14.1% 8.0% 12 safelystaffed. Higher acuity leading to > fill rate. High vacancy rate.

13 name nurses/mi dwives care staff wiv es Safe Staffing Level cont. Acute s Whipps Cross Hospital care staff FFT% of recommendi ngward (response a hospita l acquire d (moderat pressure/severe) e Red Flags Vacancy Bank Fill Fill Delivery Suite Elizabeth Obstetrics Cardiology 89.81% 87.35% 85.66% 95.16% 98.33% % 97.78% 0% 67% 3 98% % 7.9% 1.0% safely staffed % 13.7% 1.2% Higher acuity and s requiringclose observations resulting in > fill rate and higher bank usage. No HCA at night. Faraday Respiratory 99.41% 91.64% % % 86% % 12.3% 0.9% Higher acuity leading to> fill rate in the night. ingale Respiratory % % 99.97% % 97% % 12.3% 0.9% Higher acuity leading to> fill rate in the night. WX -ICU Critical Care 98.35% 70.00% 88.89% 61.67% NA % 4.0% 1.9% HCAnot counted in numbers. They are utilised as runners to help release direct care contact time for Margaret Centre Palliative 98.84% 80.30% % % NA % 18.9% 6.2% Higher acuityleading to > fill rate. safely staffed. High vacancy rate for HCAs. Mulberry Obstetrics 89.80% % 87.90% % % 11.1% 0.6% Higher acuityleading to > fill rate. safely staffed. Neonatal Unit Neonatology NA % 7.5% 15.5% HCAs at night due to higher acuity. Vacancy rate high, awaiting for new nurses to start % 81.91% % 56.67%

14 name wives care staff nurses/mi dwives care staff Safe Staffing Level cont. Acute s Whipps Cross Hospital FFT% of recommendin gward (response acquired pressure (moderate/se vere) Red Flags Vacancy Bank Fill Fill Peace Stroke % % % % 71% % 18.9% 1.6% safely staffed. > fill rate due to higher acuity. Poplar General % 88.32% % % % 16.8% 9.5% safely staffed.. > fill rate due to higher acuity. High vacancy rate. Primrose General % % % % 59% % 17.8% 15.8% Safely Staffed. >fill rate due to higher acuity. High vacancy rate Rowan Gynaecology % 91.89% % % 38% % 17.5% 15.2% Safely Staffed. >fill rate due to higher acuity. High vacancy rate Sage Sycamore Syringa Victory Trauma & Orthopaedics Trauma & Orthopaedics Geriatric Geriatric % % 99.31% % 94.25% 88.71% 83.87% % % % 96.77% 92.47% % % % % 58% 26 67% 6 94% 48 92% % 24.0% 21.8% % 14.2% 16.7% % 15.6% 1.1% % 9.3% 0.9% Safely Staffed. >fill rate due to higher acuity. High vacancy rate. 1 bed closed due to the lay out of the ward. Safely Staffed. >fill rate due to higher acuity. High vacancy rate. Beds closed to 15 to manage staffing deficiencies > fill rate due to higher acuity. Higher bank usage for specials. Vacancy high at 11.0% > fill rate due to higher acuity. Higher bank usage for specials. Wavell Winter Pressure 97.85% % 96.77% 96.77% 95% % 10.7% 0.6% > fill rate due to higher acuity. Higher bank usage for specials 14