Safer Staffing Report March 2015 Trust Board 26 May 2015 EXECUTIVE SUMMARY

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1 EXECUTIVE SUMMARY Report to Trust Board Date Tuesday 28 April 2015 Agenda Number 2.4a Agenda Item Safer Staffing Report March 2015 Sponsor Debbie Bennion, Interim Director of Nursing Prepared by Debbie Bennion, Interim Director of Nursing Presented by Debbie Bennion, Interim Director of Nursing 1 Purpose and Key Issues The purpose of this report is to brief the Trust Board on the actual vs. planned for the month of March 2015 in line with the requirements set out in the National Quality Board guidance. 2 Supporting Information Appendix 1 - Safer Staffing Planned versus Actual hours monthly March This spreadsheet details the percentage filled rate of planned levels. Appendix 2 - Safer Staffing Substantive versus Actual hours monthly March This spreadsheet details the percentage substantive staff versus temporary staff. Appendix 3 - Vacancies for s and Health care assistants March This table details the whole time equivalent registered nurse and health care assistant vacancies for the acute wards and emergency care directorate in North Devon District Hospital 3 Controls and Assurance A weekly report of actual vs. planned is reviewed at the Executive Directors Group meeting; actions in respect of developing trends are thus taken with the required urgency. The Senior Nurses will review rosters one week ahead in order to identify any potential gaps, and work with the ward managers in order to remedy these gaps. 4 Legal and Regulatory Implications Failure to report and/or act upon reports will have an adverse impact on the Trust s registration with regulatory bodies and could place the Trust at risk of legal claims where levels are a factor in harm. 5 Equality and Diversity Implications The Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. No adverse or positive impacts have been identified from this report. 6 Patient, Public and Staff Engagement There is a clear public expectation that information about levels will be published and accessible. Corporate Nursing Page 1 of 10

2 7 Cost Implications There are no cost implications. 8 Potential Risk to the Organisation Failure to address effectively will place the care of our patients at risk and could damage the reputation of the Trust. Failure to use/report with this methodology could result in unnecessary agency / temporary reducing continuity of care and incurring unnecessary cost. 9 Board Prompts Does the attached information and the commentary provided explain the position for the month concerned? Does the commentary sufficiently explain the actions taken to address gaps in the provision of planned levels? 10 Recommendations The Board is asked to RECEIVE this report. NOTE the potential developments in managing staff and the presentation of this report. 11 References How to ensure the right people, with the right skills, are in the right place at the right time A guide to nursing, midwifery and care capacity and capability. National Quality Board November Please also refer to: 12 Strategic Objectives The Trust s strategic objectives are reviewed by the Board on an annual basis. This paper supports the achievement of the following strategic objectives: X Highest quality X Flexible & multi-skilled workforce X Sustainable services X Efficient & effective Integrated health & social care X Local provider of choice 13 Principal Risks The Trust s principal risks have been identified through the Trust s risk management processes. They are updated as they are identified by the Risk Management Committee. This paper supports the mitigation of the following principal risks: Financial planning & management Clinical records management Strategic & business planning X Leadership & management X Workforce numbers Unsafe behaviour Workforce skills External demands Procedural management Partnership arrangements Equipment & facilities arrangements Communication Corporate Nursing Page 2 of 10

3 SAFER STAFFING REPORT MARCH 2015 Background The spread sheet (Appendix 1) sets out the percentage of planned actually provided. The data is set out as follows: By ward and area (i.e. North Devon District Hospital, North Community Hospitals, East Community Hospitals) By day shift and night shift, and Health Care Assistant; planned hours vs hours provided By day shift and night shift, and Health Care Assistant; percentage fill rate. For the purpose of monitoring, any ward with a total equal to or less than 90% of planned will be regarded as a hotspot. The spread sheet (Appendix 2) sets out the percentage of substantive versus temporary. The data is set out as follows; By ward and area (i.e. North Devon District Hospital, North Community Hospitals, East Community Hospitals) By total temporary staff percentage, nurse temporary percentage and Health Care Assistant percentage. For the purpose of monitoring, any ward with a total equal or more than 20% temporary will be regarded as a hotspot. The table at Appendix 3 identifies the whole time equivalent registered nurse and health care assistant vacancies for the acute wards and emergency care directorate in North Devon District Hospital as of 31 st March Northern Devon Acute Planned and temporary hotspots There were five planned hotspots identified for Northern Devon acute wards in this reporting period. This represents an increase of six hot spots from February There were five temporary hotspots identified for Northern Devon acute wards in this reporting period. This represents an increase of one hot spot from February Ward Total % of planned Total % of temporary ASU 28.97% (41.07% Capener 16.39% (26.42% Action taken Permanent vs Temporary Staffing This is an increase of 3.7% overall and 5.87% Nurse on February figures. Corporate Nursing Page 3 of 10

4 Fortescue * 83.91% (81.43% and 86.39% ICU 85.88% (85.91% and 85.55% KGV 87.32% (79.03% and 98.36% MAU % (89.57% and % Staples ** 95.17% (88.71% and % Tarka 91.68% (79.74% and % Victoria 89.85% (78.23% and % 16.43% (26.42% 24.44% (40.99% 12.91% (21.90% Permanent vs Temporary Staffing This is a decrease of 4.24% overall and 4.94% of Nurse. Permanent vs Temporary Staffing Senior Nurse has confirmed was safe during this reporting period. Permanent vs Temporary Staffing This is a total decrease of 2.5% but an increase of Nurses of 0.24% on February s figures. * Fortescue ward continue to consistently have 29 beds open **Staples Ward continue to consistently have 6 beds open that had previously been the subject of an agreed temporary closure due to concerns about levels Northern and Eastern Devon Community Planned and temporary hotspots There were five planned hotspots identified for Northern Devon community hospital wards in this reporting period this represents an increase of five from February There were ten temporary hotspots identified for Northern Devon community wards in this reporting period this represents a decrease of one hot spot from February Ward Bideford Elizabeth Total % of planned Total % of temporary 21.59% (22.22% Action taken/comments A decrease from February 2015 of 0.40% total temporary Corporate Nursing Page 4 of 10

5 Bideford Willow 91.83% (86.63% and 96.97% Budlake 97.41% (84.76% and % Exmouth Doris Heard Exmouth Geoffrey Willoughby Okehampton 89.38% (89.40% and 89.37% 87.56% (92.01% and Ottery St Mary 95.77% (88.09% and % Sidmouth % (93.37% and % Honiton 88.40% (85.68% and % Tiverton Blackdown % (90.78% and % Tiverton Twyford % (91.52% and % total (27.19% 20.42% total (1.78% 35.85% total (38.25% 22.90% total (9.01% 25.12% total (21.05% 24.04% total (35.37% 47.13% total (51.97% 35.84% total (30.60% 21.80% total (25.64% and an increase of 1.14%. An increase from February 2015 of 0.50% total temporary and 4.04%. An increase from February 2015 of 0.38% total temporary and a decrease of 11.75%. An increase from February 2015 of 14.70% total temporary and 7.95% Nurse. A decrease from February 2015 of 5.02% total temporary and an increase of A decrease of 4.81% total and 3.38%. A total increase from February 2015 of 7.22% and 11.33%. A slight decrease overall from February 2015 of 4.28% and a slight increase of 1.97%. A total increase of 10.06% from February 2015 but a slight decrease of 2.13% Nurse. A total increase of 4.25% from February 2015 but a slight Corporate Nursing Page 5 of 10

6 Seaton 86.51% (91.54% and 82.66% Holsworthy 89.17% (89.98% and 88.27% decrease of 3.13% Nurse. All community hospitals remained staffed to the new agreed in principle levels, which will appear over-established until the new establishment is set. The table below demonstrates the incidence of a number of key Nurse Sensitive Indicators (Hospital acquired pressure ulcer grade 3 (HAPU 3) and grade 4 (HAPU 4), and Falls with harm). Where the incidence of the Nurse Sensitive Indicators is linked to a Hotspot ward the ward name will be listed in orange. Nursing sensitive indicators incidence. Ward HAPU G3 HAPU G4 Falls with Comments harm Fortescue 1 Fractured Neck of Femur; SEA underway. Twyford 1 Fractured Neck of Femur; SEA underway. Seaton 1 Fractured Neck of Femur; SEA underway. South Molton 1* This was not reported by South Molton but was reported by KGV, when the patient was transferred into NDDH. SEA underway. Staples 1 72 hour report completed. Exec review, no further action. Capener 1 72 hour report underway. Bideford Willow 1 72 hour report underway. Vacancies at North Devon District Hospital Acute Wards and Emergency Care At end of March 2015, vacancies were wte. This represented a slight decrease on the February 2015 vacancy rate of 1.81 wte, despite recruiting 15 wte EU Nurses. The wards are over established by 5.33 wte in order to support high number of RN vacancies. The medical division continues to have the highest number of vacancies at wte; this is an increased vacancy rate of 5.12 wte on February Corporate Nursing Page 6 of 10

7 During March 2015, nine of the EU nurses that were recruited in 2013 left the Trust. Many were offered positions in a Bristol NHS Trust. Update on SafeCare Mobile SafeCare has now been rolled out to all acute wards in North Devon District Hospital and all wards in North and Eastern Community Hospitals SafeCare Mobile was implemented in the acute wards during February and March The planned roll out for community sites will now commence in April Community Nursing Staffing Developments Since 2010, community nursing services have been developing their methodologies for measuring and working too safe and effective. The following have been developed; A prioritization tool (the prioritization pyramid), which clarifies how clinical teams decision make and share their priorities. The tool invites scrutiny from all key stakeholders and explains how caseloads are assessed objectively and work planned against the referrals which arrive for any team, at any given moment. The tool has been shared with commissioners and is based on the patient s condition and/or required interventions. Visits have a red, amber or green status associated with the urgency of the situation; An acuity and capacity assessment tool (AscTool) for community nursing has been developed in house, based on the Bristol model. The AscTool has been developed and tested through small tests of change. The AscTool collates the current capacity of a team, against the visit windows and travel time needed to achieve safe and effective care. It uses the caseload information to determine if teams are close to, below or above their current capacity to deliver safe and effective care and gives this as an under or over 100% figure. To date we have used the AscTool as required, to understand when teams may be under pressure or have capacity to help others; and The next steps would be to report this capacity and safety, in triangulation with workload information and the community nursing safety and quality dashboard information. Recommendations for further action 1. Overview Risk assessment of Community Hospital to be followed up via Executive Directors Group meeting. 2. A deep dive review of the recent increase in falls and grade 3 pressure ulcers covering the period November 2014 January 2015 inclusive has been concluded and the report presented to the Safer Care Delivery Committee. A meeting has been arranged for the 8 th May 2015 for the Head of Quality and Safety to meet with the acute Senior Nurses and Ward Managers, to discuss the report. Future planned developments of this report 1. Data and charts from the Safe-Care function in Health-roster was planned to provide improved graphical reports by ward by April 2015; this has now been postponed until June Summary of reported incidents in respect of concerns. 3. Vacancy rate for community hospital sites to be included in the report. 4. Monthly recruitment update in tandem with vacancy rate to provide a projected view. Corporate Nursing Page 7 of 10

8 APPENDIX 1 Corporate Nursing Page 8 of 10

9 APPENDIX 2 Corporate Nursing Page 9 of 10

10 APPENDIX 3 North Devon District Hospital Acute Wards and Emergency Care vacancies at 31 st March 2015 excludes ambulatory care. RN HCA Total Medicine Over established by Surgery 7.64 Over established by ED Over established by MAU 2.32 Over established by 3.94 Over established by 1.62 Total: Over established by Corporate Nursing Page 10 of 10

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