SOMERSET PARTNERSHIP NHS FOUNDATION TRUST ANNUAL REVIEW OF SAFER STAFING. Report to the Trust Board 26 May Head of General Nursing.

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1 SOMERSET PARTNERSHIP NHS FOUNDATION TRUST ANNUAL REVIEW OF SAFER STAFING Report to the Trust Board 26 May 2015 Sponsoring Director: Author: Director of Nursing and Patient Safety. Director of Nursing and Patient Safety. Head of General Nursing. Head of Mental Health Nursing. Purpose of the report: Report of the progress in implementing the recommended inpatient staffing since May Approval of revised ward establishments Key Issues and Recommendations: Following the report into the failings of the Mid Staffordshire NHS Foundation Trust, the Government issued new requirements for all Trusts in relation to the staffing levels on each of their inpatient wards; The Director of Nursing is required to recommend staffing levels for each shift on every ward, and the Board is required to review and approve the recommended staffing establishment for all wards each year On May the Trust Board approved new staffing establishments for each ward in line with national guidance together with additional investment to support the recruitment of additional nurses and health care assistants. The Trust has made significant progress in achieving the recommended staffing levels in the last twelve months. Recruitment to vacancies remains the biggest challenge to achieving this. Since January this year all ward establishments have been reviewed using Hurst s Professional Judgement Tool which has been approved by the National Quality Board. May 2015 Public Board - 1 -

2 It is recommended that the staffing establishment on Rydon Ward is strengthened to reflect the increased dependency and acuity of patients following the change of function to become an adult assessment and triage ward. It is recommended that the ward leadership in community hospitals is further strengthened to develop Band 6 Junior Ward Sister roles in four of the larger wards. It is recommended that the ward leadership structure for Pyrland Ward is confirmed and funded. It is recommended that the Trust board reaffirms its commitment to the programme to increase the supervisory status of ward sisters and to ultimately achieve 100% supervisory status for all Band 7 Ward Sisters. Actions required by the Board The Trust Board is asked to approve the recommended staffing establishments for each ward. May 2015 Public Board - 2 -

3 SOMERSET PARTNERSHIP NHS FOUNDATION TRUST ANNUAL REVIEW OF STAFFING ESTABLISHMENTS 2015 TIME TO TALK, TIME TO LISTEN, TIME TO CARE 1. PURPOSE 1.1 The purpose of this report is to update the Trust Board on progress being made with regard to meeting the national standards for safer staffing on all of our inpatient wards and to recommend the ward establishments for each ward for 2015/ BACKGROUND 2.1 In November 2013, NHS England published: 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 staffing capacity and capability (NQB Guidance). In this guide, endorsed by the National Quality Board (NQB), they set out the expectations of commissioners and providers to optimise nursing, midwifery and care staffing capacity and capability so that they can deliver high quality care and the best possible outcomes for their patients. 2.2 The NQB guidance was designed to assist providers in fulfilling the commitments made in Hard Truths the Journey to Putting Patients First, with regard to publishing nurse, midwife and care staffing levels and undertaking in-depth reviews of staffing establishments every six months using evidence based tools. NHS England confirmed that they expected all organisations to be meeting these expectations currently, or taking active steps to ensure they do so in the very near future. 2.3 The NQB guidance also indicated a clear expectation that commissioners in their engagement with providers should be assuring themselves that they have sufficient nursing, midwifery and care staffing capacity and capability to meet the outcomes and quality standards they require and use appropriate commissioning and contractual levers to bring about improvements. 2.4 On 27 May 2014, Somerset Partnership Foundation Trust board received and approved the ward establishment for each of the community hospitals and mental health wards and agreed additional investment to support the recruitment of additional registered nurses and health care assistants. The Trust has subsequently published the monthly performance for each ward for both recommended staffing levels and actual - on the public website, and regularly considers May 2015 Public Board - 3 -

4 trends, reasons for any gaps and actions taken to address these at the public Trust board meeting 2.5 In October 2014 a six monthly review was undertaken with minor amendments to the staffing establishments approved. 2.6 All NHS organisations are now publishing ward level staffing information, at Trust level and on NHS Choices; in 2014 the National Institute for Health and Care Excellence (NICE) published a guideline to support safe staffing for nursing in adult in-patient wards in acute hospitals and endorsed the first nurse staffing tool. NICE has since also launched a national consultation on safe staffing guidance in maternity settings, and further consultations will follow for mental health inpatient settings this summer. 3. RATING TRUSTS FOR SAFER STAFFING PERFORMANCE 3.1 At the beginning of 2015 NHS England confirmed their intention to publish nursing safer staffing indicators, which will provide an overall RAG rating for each Trust. These indicators will support the patient safety information already published on NHS Choices and provide comparable information for Trusts to use and for patients and service users to enable them to make an informed choice of care provider. It will also be used by the regulatory bodies as part of their Trust assurance process. 4. SAFER STAFFING INDICATORS 4.1 This data is taken from a range of published workforce information, already available and currently used for workforce planning, assurance and intelligent monitoring. NHS England is working with the Health and Social Care Information Centre (HSCIC) and the NHS ESR Central Team to use existing information to minimise the burden of reporting. 4.2 The indicators that make up the initial composite measure include: staff sickness rate, taken from the ESR (published by HSCIC); the proportion of mandatory training completed, taken from the National staff survey measure; completion of a Performance Development Review (PDR) in the last 12 months, taken from the National staff survey measure; May 2015 Public Board - 4 -

5 staff views on staffing, taken from the National staff survey measure; and patient views on staffing, taken from the National patient survey measure. 4.3 The first national rating was issued in March 2015 and the Trust was rated as within the expected range. 5. SAFER STAFFING CONTACT TIME 5.1 Staffing levels impact upon the ability of nursing and midwifery staff to provide high quality care (NHS England 2015). The focus on delivering safe staffing has been in response to reports that suggest nurses and midwives are not visible enough and are often too busy with administrative tasks to deliver direct care to patients. NICE guidelines recommend monitoring and action to ensure patients are receiving the nursing care and contact time they need with the emphasis on safe patient care, not the number of available staff. 5.2 It is acknowledged that safe staffing is much more than just looking at the number of staff on wards. The measurement and understanding of care contact time can be used to drive local improvement, support the determinant of a robust nursing establishments and the effective deployment of staff. The appropriate balance of nursing activities will vary according to the specialty of a ward or unit, the dependency and acuity of its patients, as well as other factors. 5.3 It is important to note that whilst a significant element of nursing staff time should be spent providing direct care, such as patient medications and clinical interventions, this needs to be balanced with indirect patient care. For example, attendance at multi-disciplinary ward rounds or liaising with families to plan discharge, as well as other activities, such as supporting and mentoring students and newly qualified nurses, supervision, audits, appraisals and training - all of which are critical components in the delivery of safe care. 5.4 NHS England published the Care Contact Time Guide in November 2014 and recommended that Trusts should check their patient contact time using a consistent methodology to assess any changes in contact time and consider any impact this may have on patient care by the summer of This will be built into regulatory and commissioning pathways for assurance that it has been completed. 5.5 The Trust has completed initial pilots of models to measure contact time in both mental health and community hospital wards using the Productive Series Releasing Time to Care Toolkit. We plan to complete the initial baseline review by August This will then be May 2015 Public Board - 5 -

6 shared with the Trust board with a view to informing the October review of the staffing establishments. 5.6 The data collected on a ward by ward basis will be considered alongside other indicators to include planned versus actual staff numbers, Friends and Family Test (patient and staff) and other key quality and patient safety indicators and will form part of the ward dashboard. 5.7 Temperature checks of contact time can be undertaken using a consistent methodology to assess any changes in contact time and consider any impact this may have on patient care. It is proposed that they will be undertaken in the following circumstances - where quality indicators are falling, if the care model is changed, if there is a change in skill mix, or introduction of new technology. 6. NATIONAL WORKFORCE POSITION 6.1 Nationally the nursing workforce is fragile with safer staffing requirements leading to a national drive to recruit to additional ward based roles at a time when Trusts were trying to deliver cost efficiency savings. Excluding Health Visitors and School Nurses full time positions nationally have only increased by 1,470 but with a national headcount reduction of 1,845 nurses- this means fewer nurses carrying out more care for a record number of patients (HSCIC data). 6.2 Nationally 45% of the nursing workforce is over the age of 45 years with the profile for mental health nurses even more worrying with 32.3% of the mental health workforce (nationally) above the age of 50 years in comparison to 28.7% in other settings. 6.3 Correspondingly the number of nurse training places fell by 2,210 between 2010 and Whilst the number of student nurse training places is improving, last year the number of places at 21,205 was still below the 2009 level. There continues to be a year on year increase in the number of nurses applying for nurse training with 30,000 potential nurses turned away from universities because of a lack of training places (Frontline First 2015). 6.4 The Trust is actively engaged with programmes to support return to practice students but the numbers are low. There is also hope that a new widening access programme for higher level health care assistants may lead to more of our unregistered staff being able to access a shorter degree programme in the future. May 2015 Public Board - 6 -

7 7. DEVELOPING RECOMMENDED STAFFING LEVELS FOR EACH WARD 7.1 Both mental health and community hospital ward teams utilised an adapted model of the Dr Keith Hurst s Professional Judgement Tools (2002) which was one of the key models for community and mental health wards identified in the National Quality Board paper. 7.2 These local reviews were then considered against the national recommendations Royal College of Nursing Guidance on Safe Nurse Staffing Levels in the UK (2010) and Safe Staffing for Older People s Wards (2012). Individual ward bespoke establishments were agreed for each of the wards and shared with Somerset Clinical Commissioning Group. 7.3 Approval of the funded establishments by the Trust board in May 2014 to support the recommended staffing levels included the adoption of the following key principles in order that care is not compromised - the threshold for registered nurses to patients should not drop below one nurse to seven patients during the day and one to ten at night. (1:6 for stroke patients); the ratio of registered to unregistered staff should be 50:50 as a minimum; a move to a standard 7.5 hour and 6 hour day shift and the ceasing of all 12 hour day shifts; any increase/decrease in the individual acuity and dependency of patients could include amendments to the staffing levels on a shift by shift basis as required; additional weighting would be adopted where the ward design limited visibility; standardisation of ward sister/charge nurse supervisory hours and a commitment to increase these in 2015; enough staff would be employed to cover the headroom for training, annual leave and sickness. For community hospital wards this would be 22%, and for mental health wards 23% to recognise the additional training requirements. 7.4 These principles were reaffirmed by the Trust board at the six monthly review in October 2014.Progress to date: May 2015 Public Board - 7 -

8 all wards moved to the new recommended staffing levels for each shift from Monday 9 June 2014; E rostering has been rolled out to all community hospital wards having already been in place in mental health wards; all wards have now adopted the Trust shift pattern with twelve hour shifts ceasing apart from staff on formal flexible working agreements; temporary staffing has been reviewed with agreement to recruit a Nurse Bank Manager and to fund mandatory training for all bank staff; a review of recruitment branding was completed and the development of a Trust recruitment video completed; enhanced pay schemes were successfully utilised for key wards to support winter pressures; an enhanced preceptorship programme for newly qualified staff has been implemented % 95.0% Progress to date is detailed in the table below -: Somerset Partnership NHS Foundation Trust Safer Staffing Compliance Rates Registered Nursing Total Between 1 June 2014 to 30 April 2015 Da Nig 90.0% 85.0% 80.0% 75.0% Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May 2015 Public Board - 8 -

9 8. REVIEW OF ESTABLISHMENTS NOVEMBER AND RECOMMENDATIONS 8.1 In line with the previous reviews of the establishments, all wards have been reviewed using the Keith Hurst Professional Judgement Tool and clinical care indicators. This process has been led by the Heads of General Nursing and Mental Health Nursing working closely with ward sisters/ward managers from each ward and operational managers. From these, ward profiles have been developed and recommended actions. Key issues for consideration 8.2 Recruitment Recruitment to vacant registered nurse posts remains the key concern for ward staff. Specific challenges remain in South Somerset where there are a large number of hospitals - four community hospitals, one acute Trust (Yeovil District Hospital) with another just over the border in Dorset (Dorchester) within a small geographical area. Pyrland ward in Taunton also continues to struggle to recruit RMN s Additional investment in District Nursing and the re-opening of Wessex House has meant that a larger than expected number of staff have moved internally within Trust teams in the last year. This has caused additional staffing gaps in key areas such as Rydon and Holford wards and the community hospitals, which is being addressed Focussed recruitment schemes have significantly improved the staffing position in areas such as Frome and Williton which no longer have significant vacancies. Learning from this is being shared across the Trust. 8.3 Temporary Staffing The last six months has seen a significant increase in the use of agency staff specifically in Wincanton, West Mendip and Dene Barton hospitals where escalation beds have been opened. Wherever possible the challenges presented by using staff who are not Trust employees has been negated through the agreement of block contracts with nursing agencies. The additional burden on Trust staff to regularly provide local induction on a shift by shift basis, setting up RiO access and the provision of local information has put an additional strain on our own staff resources but now appears to be easing. May 2015 Public Board - 9 -

10 8.4 Ward leadership / Supervisory Status Senior nurses play a crucial role in the care and treatment of patients and are often called upon to make important and critical clinical judgements and decisions and support junior and less experienced staff. An absence of ward leadership and time to lead can often lead to delayed decision making and/or risk adverse behaviours by junior staff The importance of good ward leadership has been acknowledged for some time. In 2010 the national standard as detailed in the Guidance on Safe Nurse Staffing Levels in the UK ) was clear that ward sisters/ward managers should be 100% supervisory and not included in the shift roster. This recognises the value of good leadership and the measurable improvement in outcomes for patients and staff when this is in place In response to the Francis report the national document Hard Truths required all trusts to consider the role of the ward sister/charge nurse and have in place plans to move to full supervisory status. This allows the ward sister time to focus on leading her team, to be visible on the ward, to undertake teaching and observations of junior staff, time to meet relatives and to ensure that the clinical quality of the care being provided in as high as possible All wards sisters/charge nurses in community hospitals wards currently have two days as supernumerary and in mental health wards the majority have two days with some wards more. In May 2014 the Trust board agreed that consideration would be given to increase the number of supervisory days in May 2015 to a minimum of three days per week. Shortfalls in substantive staffing and increased use of temporary staff has been identified by ward sister/ managers as having a impact on their leadership role with less time for proactive discharge planning, family meetings, staff supervision and assessment of clinical competencies as they work more clinical shifts. Feedback following the week of Breaking the Cycle supported the view that focussed attention on non- patient facing time activity by ward sisters/managers will lead to improved performance and better patient outcomes The Trust is fully committed to ensuring that all ward sisters/charge nurses have dedicated time and are empowered to lead their wards and in the next year will prioritise actions to further increase supervisory time and to reach the optimal standard of 100% supervisory time for all Band 7 ward sisters. In the interim it is recognised that the ward sister/charge nurse role is significantly supported by Community Hospital Matrons and Ward managers. May 2015 Public Board

11 8.5 Job Titles Currently there is a difference in the job title of staff undertaking similar roles across the Mental Health Wards and Community Hospitals. This difference can and does cause significant confusion for staff and patients and undermines the integration agenda With Integration Phase 2 it would be timely to ensure that there is continuity of job title across inpatient wards within the organisation. It is recommended that the following titles and grades are adopted across the Mental Health Wards. Grade Current Job Title on MH Proposed Job Tile Wards Band 8 A Ward Manager Matron Band 7 Deputy Ward Manager Charge Nurse/Ward Sister Band 6 Clinical Lead Junior Charge Nurse/Junior Ward Sister /Clinical Lead 8.6 Community Hospital Wards Community hospital wards are reporting an increase in the complexity of patients being seen and patients often being transferred from the acute Trust earlier in the patient pathway. This has been specifically reported at Bridgwater and Dene Barton Hospitals where the medical care is provided by the acute trust. A lack of recognition by acute trusts that community hospital wards have minimal medical input in hours, and reduced access to medical support out of hours, has been raised as a concern by the majority of community hospitals although this is not coupled with an associated request for additional medical input There is a lack of career structure for community hospital ward sisters with a very small number of Band 6 junior ward sisters and lack of parity with mental health wards the majority of which have Band 6 clinical leads. Feedback from staff indicates that this is not helping with staff recruitment as there is a perceived lack of support on the wards, particularly for junior staff. In terms of retention, it has been identified that a small number of Band 5 staff nurses are leaving the Trust to gain junior ward sister roles in acute Trusts. It is proposed that for the larger wards (with beds in excess of 24 beds) a band 5 post is converted into a Band 6 junior ward sister/clinical lead post. Wards affected include South Petherton, Bridgwater, and Frome (already in place in West Mendip). All of these posts will be 100% clinical and report to a Ward Sister Band All community hospital wards report an increase in the number of patients with dementia plus other co-morbidities a number of whom require one to one supervision to maintain their safety. Ward sisters/managers raise concerns regarding the requirements of the May 2015 Public Board

12 Care Act and their capacity to undertake assessments and gain access to specialist mental health advice from the community mental health teams. Additional training has been made available as well as promoting access to specialist support and guidance Last year saw an increase in the number of patients reported as delayed discharges across community hospitals. As a result of this and ongoing winter pressures the Trust agreed to open a nurse led step down ward at Wincanton hospital to take patients who no longer had an ongoing need for inpatient care. The staffing establishment for this nurse led ward was developed specifically to reflect the reduced acuity and dependency of these patients. Ongoing - consideration should be given to cohorting groups of these patients in designated wards with a bespoke establishment in the future Access to rehabilitation staff in community hospitals remains a persistent issue with ILT staff being community based rather than being perceived to be part of the multidisciplinary team in the ward. Timely access and continuity of care by ILT teams has been identified as a cause for concern in a number of community hospitals There are no community hospital wards where the recommended staffing levels for registered nurses or health care assistants are deemed to be inadequate. All wards are using their professional judgement to increase their staffing levels by shift should the dependency/acuity of patients indicate that this is appropriate Where wards are consistently meeting the recommended staffing levels the outcomes for patients for patients appear to be improved and the staff satisfaction levels are reported to be higher. 8.7 Mental Health Wards In the last six months there has been a review of the local management arrangements for Holford and Rydon Wards 1 & 2, all three wards now being managed by one overarching Band 8A with a Band 7 on each of the three wards Where patients are on level 3 and 4 observations staffing continues to be altered accordingly following a full risk assessment. In exceptional circumstances when there may be a patient on 2:1 (or above) observation, additional staff are likely to be required and the nurse in charge will risk assess and amend the staffing levels accordingly; In the last year Rydon wards 1 and 2 have moved to become an acute admission and triage ward for adult patients leading to an increase in the number of acutely unwell patients in the ward. As a result it is May 2015 Public Board

13 recommended that the ward establishment and skill mix is strengthened The provision of staff for the running of the ECT suite on the Rydon Ward site is not included in the safer staffing figures; for those patients receiving ECT who require a two nurse escort from their host ward which cannot be absorbed into the above numbers, a risk assessment at shift level may lead to a requirement for additional staff. This continues to be managed locally and does not affect the core ward establishments Pyrland ward (1 and 2) continues to have acting arrangements for the Band 7 and 6 roles with a Band 8a providing senior level management. It is recommended that the ward leadership structure is finalised and substantively recruited to. It is recommended that Ward 1 is managed on a day to day basis by a Band 7 (increase of 0.3) supported by a Band 6 (increase of 0.4), Ward 2 is managed by a Band 6 (no change) supported by the Band 8a (no change) Wessex House has re-opened since the first review of ward establishments in May It opened with 4 beds in October 2014, increasing to 10 beds before finally working at 12 beds once all posts are recruited. The ward establishments have been agreed with NHS England as the commissioner and are detailed in the appendix The Trust continues to benchmark the staffing levels of mental health wards in anticipation of the new NICE guidance for mental health wards. Specific work to benchmark Holford Ward (PICU) against other similar wards is underway. In the interim, the shift leader continues to use their professional judgement and will increase the staffing levels should the acuity of patients indicate that extra staff are required There are no mental health wards apart from Rydon Ward where the recommended staffing levels for registered nurses or health care assistants are deemed to be inadequate. All wards are using their professional judgement to increase their staffing levels by shift should the dependency/acuity of patients indicate that this is appropriate Where wards are consistently meeting the recommended staffing levels the outcomes for patients for patients appear to be improved and the staff satisfaction levels are reported to be higher 8.8 Mental Health Wards In the last six months there has been a review of the local management arrangements for Holford and Rydon Wards 1 & 2, all three wards now being managed by one overarching Band 8A with a Band 7 on each of the three wards. May 2015 Public Board

14 8.8.2 Where patients are on level 3 and 4 observations staffing continues to be altered accordingly following a full risk assessment. In exceptional circumstances when there may be a patient on 2:1 (or above) observation, additional staff are likely to be required and the nurse in charge will risk assess and amend the staffing levels accordingly; In the last year Rydon wards 1 and 2 have moved to become an acute admission and triage ward for adult patients leading to an increase in the number of acutely unwell patients in the ward. As a result it is recommended that the ward establishment and skill mix is strengthened The provision of staff for the running of the ECT suite on the Rydon Ward site is not included in the safer staffing figures; for those patients receiving ECT who require a two nurse escort from their host ward which cannot be absorbed into the above numbers, a risk assessment at shift level may lead to a requirement for additional staff. This continues to be managed locally and does not affect the core ward establishments Pyrland ward (1 and 2) continues to have acting arrangements for the Band 7 and 6 roles with a Band 8a providing senior level management. It is recommended that the ward leadership structure is finalised and substantively recruited to. It is recommended that Ward 1 is managed on a day to day basis by a Band 7 (increase of 0.3) supported by a Band 6 (increase of 0.4), Ward 2 is managed by a Band 6 (no change) supported by the Band 8a (no change) Wessex House has re-opened since the first review of ward establishments in May It opened with 4 beds in October 2014, increasing to 10 beds before finally working at 12 beds once all posts are recruited. The ward establishments have been agreed with NHS England as the commissioner and are detailed in the appendix The Trust continues to benchmark the staffing levels of mental health wards in anticipation of the new NICE guidance for mental health wards. Specific work to benchmark Holford Ward (PICU) against other similar wards is underway. In the interim, the shift leader continues to use their professional judgement and will increase the staffing levels should the acuity of patients indicate that extra staff are required There are no mental health wards apart from Rydon Ward where the recommended staffing levels for registered nurses or health care assistants are deemed to be inadequate. All wards are using their professional judgement to increase their staffing levels by shift should the dependency/acuity of patients indicate that this is appropriate. May 2015 Public Board

15 8.8.9 Where wards are consistently meeting the recommended staffing levels the outcomes for patients for patients appear to be improved and the staff satisfaction levels are reported to be higher. 8.9 Summary of Recommendations RN to patient core level May 2014 Should not drop below 1:7 November 2014 No change May 2015 No change Skill Mix Ratio 50:50 No change No change Supervisory Hours for ward sisters 2 days per week with a commitment to reach 100% supervisory Headroom CH 22% MH 23% No change but under review with a view to increasing in 2015 No change Planned review of leadership roles at ward/matron level this year to fund and increase supervisory hours No change Staffing for 136 suites Rydon Ward Included in ward establishment for Rydon and Rowan wards No change - remains under review No change -remains under review Increase health care assistants by one per shift, for ward1and 2. Pyrland Ward Interim structure No change Confirm and fund ward leadership structure at Band 6 and 7. Band 6 junior sister roles in community hospitals No change No change Create 3 additional community hospital junior sister posts by uplifting registered nurse posts from Band 5 to 6 9. FUNDING REQUIRED 9.1 Rydon Ward 144,000 Pyrland management uplift 52,000 Junior Ward Sister uplift x3 26,000 May 2015 Public Board

16 10. SUMMARY 10.1 The Board are asked to approve the changes to Rydon ward and Pyrland ward establishments and the creation of three junior ward sister roles in community hospitals The revised ward establishments to reflect these changes are attached in appendix Three. The Board is asked to approve the ward establishments for each ward. DIRECTOR OF NURSING AND PATIENT SAFETY May 2015 Public Board

17 Community Hospitals Safer Staffing Establishment Review April 2015 May 2015 Public Board

18 Mental Health Wards Establishment Review April 2015 SAFER STAFFING REVIEW April 2015 POSITION MAY 2014 PROPOSAL MAY 2015 Beds EARLY 9-5 LATE TWILIGHT NIGHT Beds EARLY 9-5 LATE TWILIGHT NIGHT RMN HCA RMN / HCA RMN HCA RMN HCA RMN HCA RN HCA RMN / HCA RN HCA RMN HCA RN HCA Ash / / Holford / / Magnolia Pyrland Pyrland Rowan Rydon St Andrews Willow / / Wessex House / TOTAL BEDS May 2015 Public Board

19 Links to Strategic Themes: Identify to which of the Somerset Partnership NHS Foundation Trust strategic themes this report relates by including a cross behind the relevant theme(s) Quality and Safety X Innovation Viability and Growth Integration Service Delivery X Culture and People X Links to the Assurance Framework: Links to the NHS Constitution and Trust Values: Links to CQC Domains: Annual Objective Six Implementing a rolling review of inpatient nurse establishments to continuously improve the ratios of staffing levels on each ward by shift. Working together for X Compassion X patients Respect and dignity X Improving lives Commitment to quality of care X Everyone counts [Identify which of the CQC domains are covered by this report by including a cross behind the relevant domain(s)] X Is it safe? X Is it caring? X Is it well-led? X Is it effective? Is it responsive to people s needs? Legal or statutory implications/ requirements: How to ensure you have the right people with the right skills are in the right place at the right time A Guide to Nursing, Midwifery and Care Staffing Capacity and Capability. NHS England 2013 Public/Staff Involvement History: Previous Consideration: ward staff are actively involved in submitting daily shift performance data together with assessing the impact and risk of any shortfalls. the Trust Board approved the Safer Staffing Establishments at the May 2014 Trust board meeting. May 2015 Public Board

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