Nursing Staff Levels Board Report 2014/2015 Month 3

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1 Nursing Staff Levels Board Report 2014/2015 Month 3 Item Page Background 2 Monthly Summary 3 s 4-16

2 Background Introduction Following the publication of the Francis Report (2013) and the Berwick Report (2013), there is a NHS England requirement for Trusts to display publically in ward areas the number of nurses working each shift against the funded nursing template. The Trust has implemented this requirement across all inpatient areas with effect from 1 st April Subsequently there has been a directive from NHS England for Trusts to report to their Trust Public Boards Inpatient Nursing Staffing Levels NHS England Process On the 16 th May 2014, All Chief Executives and Directors of Nursing of Trusts with inpatient areas were written to outlining the requirement to publish monthly staffing data on the NHS Choices website. The data collection period is first to the last day of each with a requirement to report hours worked against template hours, split by Qualified/Unqualified and Day/Night, with a submission date to UNIFY of 10 th of each month. This report will be produced monthly. NHS Choices Website Each month data on staffing fill rates for nurses, midwives and care staff will be published on the NHS Choices website. The aim is that patients and the public will be able to see how hospitals are performing on meeting inpatient safe nursing levels in an easy and accessible way. As well as submitting the May staffing data via UNIFY, all Trusts are also required to publish their actual versus planned staff fill rates on a ward by ward basis on their Trust website. CHUFT Process In May a project group was set up which included the Director of Nursing, Deputy Director of Nursing, Deputy Director of HR and Head Workforce Systems and e-roster Workforce Manager, to design the data collection process, the areas to be included and the subsequent reporting timescales. 26 Inpatients wards were identified for data collection. The data will be extracted from the Trust s e-rostering system and from NHSP/Agency records. 2

3 Monthly Summary Nursing Staffing Levels Fill Rate versus Template Jun-14 Template Actual Fill Rate Ward Name QU Day QU Night UQ Day UQ Night QU Day QU Night UQ Day UQ Night QU Day QU Night UQ Day UQ Night 432 CS&C Jefferson Ward 1, , % 100.5% 65.1% 76.7% 432 CS&C Rhys-Lewis Ward 1, % 101.3% 74.0% 60.0% 432 MED Birch Ward 3, , , , % 98.1% 79.6% 68.3% 432 MED D Arcy Ward 2, , , , % 92.1% 112.2% 93.3% 432 MED Dedham Ward 1, , , % 95.8% 76.2% 88.9% 432 MED Emergency Assessment Unit 5,295 3,105 2,250 1,725 4,845 2,589 1, % 83.4% 73.9% 50.7% 432 MED Isolation Unit % 110.0% 65.4% 80.0% 432 MED Langham Ward 2, , % 75.6% 74.4% 93.5% 432 MED Layer Marney Ward 3,158 1,140 1, ,358 1,149 1, % 100.8% 75.0% 100.2% 432 MED Nayland Ward 3, , , % 93.6% 56.3% 96.7% 432 MED Peldon Ward 2, , , , % 104.6% 104.7% 82.1% 432 MED Stroke Unit 3,833 1,350 1, ,057 1,768 1, % 131.0% 84.8% 107.7% 432 MED Tiptree Ward 2, , , % 101.3% 88.7% 82.1% 432 SURG Aldham Ward 1, ,915 1,016 1, % 118.8% 134.0% 119.3% 432 SURG Brightlingsea Ward 2, , , % 100.0% 57.9% 68.3% 432 SURG Critical Care 3,960 3,795 1, ,668 3, % 91.6% 50.7% 59.6% 432 SURG Fordham Ward 2, , , , % 98.9% 93.8% 76.5% 432 SURG Great Tey Ward 2, , , % 91.8% 57.0% 90.0% 432 SURG Mersea Ward 2, , , % 101.0% 85.7% 43.3% 432 SURG Wivenhoe Ward 2, , , % 92.2% 92.3% 100.0% 432 W&C Childrens Acute Referral Unit 1, % 93.3% 0.0% 0.0% 432 W&C Childrens Ward 1,890 1, ,811 1, % 99.2% 37.2% 46.7% 432 W&C Juno Suite % 75.0% 0.0% 0.0% 432 W&C Lexden Ward 1, ,991 1,027 1, % 123.7% 145.6% 132.2% 432 W&C Neonatal Unit 1,890 1, ,815 1, % 108.8% 74.0% 68.3% 432 W&C Stanway Ward , % 84.3% 24.6% 26.7% 3

4 CS&C Jefferson Ward Qualified Day Fill Rate 101.0% 110.8% Qualified Night Fill Rate 92.9% 100.5% Unqualified Day Fill Rate 84.3% 65.1% Unqualified Night Fill Rate 98.3% 76.7% Overall Fill Rate 94.4% 92.4% Reasons for gap: Bed occupancy is sometimes less than 100%. Staffing for Jefferson and Rhys Lewis is managed as a whole with staff moved flexibly between the wards. Impact: None Actions being taken: Shortfall l of unqualified is often mitigated by qualified but this is decided on a shift by shift basis, taking into consideration that wards at Essex County do not have the same emergency backup as the wards at CGH. A consultation process will be taking place shortly regarding the relocation of the two oncology wards to CGH. For this reason further recruitment into vacancies on these wards has been temporarily delayed. CS&C Rhys Lewis Ward Qualified Day Fill Rate 90.5% 89.3% Qualified Night Fill Rate 106.7% 101.3% Unqualified Day Fill Rate 88.7% 74.0% Unqualified Night Fill Rate106.5% 60.0% Overall Fill Rate 95.5% 84.6% Reasons for gap: Bed occupancy is sometimes less than 100%. Staffing for Jefferson and Rhys Lewis is managed as a whole with staff moved flexibly between the wards. Impact: None Actions being taken: Shortfall l of unqualified is often mitigated by additional qualified staff but this is decided on a shift by shift basis, taking into consideration that wards at Essex County do not have the same emergency backup as the wards at CGH. A consultation process will be taking place shortly regarding the relocation of the two oncology wards to CGH. For this reason further recruitment into vacancies on these wards has been temporarily delayed. 4

5 MED Birch Ward Qualified Day Fill Rate 72.5% 69.1% Qualified Night Fill Rate 88.5% 98.1% Unqualified Day Fill Rate 116.1% 79.6% Unqualified Night Fill Rate 97.8% 68.3% Overall Fill Rate 88.1% 75.8% Reasons for gap: Difficulty recruiting to Care of the Elderly wards. Higher than average attrition rate. Impact: Significant clinical risk. Actions being taken: A risk assessment has been carried out and beds were temporarily closed to maintain patient and staff safety but were reopened shortly afterwards. The ward has currently 10 RN vacancies and staff on long term sickness. Agency staff are being utilised. The Matron for Specialist Medicine is reviewing risk on a daily basis and trying to avoid the use of 5 beds. This is the preferred option rather than the cost of using agency staff. Currently being added to risk register following risk assessment MED Darcy Ward Qualified Day Fill Rate 85.1% 80.4% Qualified Night Fill Rate 102.7% 92.1% Unqualified Day Fill Rate 126.1% 112.2% Unqualified Night Fill Rate 99.2% 93.3% Overall Fill Rate 99.0% 91.1% Reasons for gap: Difficulty recruiting to Care of the Elderly wards. Higher than average attrition rate. Vacancies: 7.57 WTE RN and 0.8WTE unqualified. No maternity leave and 1 RN on long term sickness returning 07/07/2014. Impact: Clinical risk Actions being taken: Use of unqualified to make up for low qualified numbers on some shifts. D arcy is undertaking its own recruitment drive. D arcy to go on the Risk Register and reduction in bed base is being considered. Overall fill rate has dropped. 5

6 MED Dedham Ward Qualified Day Fill Rate 94.3% 91.4% Qualified Night Fill Rate 102.5% 95.8% Unqualified Day Fill Rate 82.7% 76.2% Unqualified Night Fill Rate 98.4% 88.9% Overall Fill Rate 93.2% 88.1% Reasons for gap: Vacancy, sickness and unfilled bank. I RN on long term sick leave. 1 member of staff on light duties. Vacancies: 0.96WTE Band 6. Is being advertised for the 3 rd time as no suitable applicants previously. 1 WTE Band 5. Impact: Daily risk assessment. Actions being taken: Daily risk assessment. Risk to clinical area assessed daily. Requested urgent reaudit of acuity as staffing template appears to be wrong. Utilisation of specialist nurses. Overall fill rate has dropped. Currently on risk register 1046 MED Emergency Assessment Unit Qualified Day Fill Rate 92.0% 91.5% Qualified Night Fill Rate 86.2% 83.4% Unqualified Day Fill Rate 85.0% 73.9% Unqualified Night Fill Rate 74.6% 50.7% Overall Fill Rate 86.8% 80.6% Reasons for gap: Vacancy and long term sickness. 3 staff on long term sickness (2 HCA and 1 AHP). 3 staff on light duties. Vacancies: 6 WTE RN posts, 1 Band 4 AHP post, 1 unqualified HCA post. In total of 20.1% of the workforce unavailable. Impact: Clinical risk. Actions being taken: EAU has not had an acuity audit as yet as the AUKUH model used for general wards does not fit the EAU though the AUKUH and BEST tools have been amalgamated to provide a basis for calculating acuity. There is a daily review by the Matron and her team looking at the rota to move staff flexibly. Currently on risk register 735 6

7 MED Isolation Unit Qualified Day Fill Rate 81.3% 85.7% Qualified Night Fill Rate 119.4% 110.0% Unqualified Day Fill Rate 109.6% 65.4% Unqualified Night Fill Rate154.0% 80.0% Overall Fill Rate 103.7% 83.8% Reasons for gap: The ward often has empty beds therefore the department is staffed according to clinical need. Vacancies: None Actions being taken: Use of unqualified to make up for low qualified numbers on some shifts Impact: Low clinical risk MED Langham Ward Qualified Day Fill Rate 78.8% 75.5% Qualified Night Fill Rate 83.9% 75.6% Unqualified Day Fill Rate 89.6% 74.4% Unqualified Night Fill Rate 93.8% 93.5% Overall Fill Rate 83.9% 77.6% Reasons for gap: 4 RN on maternity leave. HCA sickness is high. Vacancies: 6.62 WTE RN posts Actions being taken: Active specialist recruitment. Risk assessed use of bank and agency. Many shifts unfilled due to agency only taking long day bookings not early or late shifts. Impact: Managed risk. This is being added to the Risk Register. 7

8 MED Layer Marney Ward Qualified Day Fill Rate 89.8% 74.7% Qualified Night Fill Rate 98.8% 100.8% Unqualified Day Fill Rate 109.2% 75.0% Unqualified Night Fill Rate110.0% 100.2% Overall Fill Rate 97.9% 81.6% Reasons for gap: Vacancy, high HCA sickness levels. Vacancies: 0.6 WTE Band WTE Band 5 RN. Actions being taken: Risk assessed use of bank and agency. Many shifts unfilled due to agency only taking long day bookings not early or late shifts. Use of unqualified to make up for low qualified numbers on some shifts Impact: Risk being managed with balance between clinical risk and managing budget. MED Nayland Ward Qualified Day Fill Rate 91.2% 84.1% Qualified Night Fill Rate 104.4% 93.6% Unqualified Day Fill Rate 68.8% 56.3% Unqualified Night Fill Rate108.1% 96.7% Overall Fill Rate 89.4% 80.0% Reasons for gap: Vacancy and sickness. High levels of HCA sickness. 1.6% HCA vacancy. Total RN deficit of 36%. Vacancies: 10 + RN vacancies Actions being taken: Risk assessment. Lines of work on agency. Plans to move to Easthorpe ward and reduce bed base, but maintaining current staffing plan. No plans for reduction in staffing template until acuity review in September. Impact: Managed clinical risk. On Risk Register no

9 MED Peldon Ward Qualified Day Fill Rate 93.2% 86.4% Qualified Night Fill Rate 107.8% 104.6% Unqualified Day Fill Rate 136.6% 104.7% Unqualified Night Fill Rate113.7% 82.1% Overall Fill Rate 107.8% 93.1% Reasons for gap: RN vacancy. Vacancies: 2.0 WTE RN vacancy. Actions being taken: Use of unqualified to make up for low qualified numbers on some shifts. Impact: None MED Stroke Unit Qualified Day Fill Rate 78.8% 79.8% Qualified Night Fill Rate 127.2% 131.0% Unqualified Day Fill Rate 93.1% 84.8% Unqualified Night Fill Rate126.9% 107.7% Overall Fill Rate 94.0% 92.0% Reasons for gap: Vacancy, maternity leave and staff sickness Vacancies: 11.4 WTE Band 5 RN vacancies. 0.4 band 6 RN vacancy. 1 Band 6 seconded to Retrospective review team. 3.4 WTE Band 5 seconded to other areas. HCA over established (from last acuity review). 1 WTE RN on maternity leave and 0.5 WTE HCA on maternity leave. 2.0 HCA WTE on long term sickness. 3.1 WTE HCA on light duties and 1.0 WTE RN on light duties. Action being taken: Generic and local recruitment. Recent interviews for RNs. The Band 7 is currently working on a new shift system to reduce the bank and agency spend. Impact: General standard of care, attention to detail and tidiness of the ward have suffered. The NPSA and Infection Control audits demonstrate this. It has also been very challenging to induct lots of new Staff nurses when the ward is under template, this will have a long term detrimental effect. Many new Band 6 nurses that require development are not getting the input from the Band 7 they require due to the staffing numbers. This will be further impacted as the Band 8 Lead Nurse has just left. Currently on Risk Register

10 MED Tiptree Ward Qualified Day Fill Rate 84.5% 78.8% Qualified Night Fill Rate 101.6% 101.3% Unqualified Day Fill Rate 101.8% 88.7% Unqualified Night Fill Rate100.1% 82.1% Overall Fill Rate 93.2% 85.4% Reasons for gap: Vacancy and long term sickness. 1.6 RN on long term sickness. 0.6 WTE RN maternity leave. 0.6WTE on light duties. Vacancies: 1.9 WTE RN posts. Impact: Low clinical impact. Actions being taken: Use of unqualified to make up for low qualified numbers on some shifts. SURG Aldham Ward Qualified Day Fill Rate 94.7% 97.2% Qualified Night Fill Rate 108.3% 118.8% Unqualified Day Fill Rate 184.5% 134.0% Unqualified Night Fill Rate240.6% 119.3% Overall Fill Rate 128.2% 111.6% Reasons for gap: Use of unqualified to make up for low qualified numbers on some shifts. The staffing template is thought to be incorrect. I member of staff being performance managed who cannot administer medication. Many patients who require log rolling requiring 5 staff. Currently on risk register 1048 for review of acuity. This may affect the stafing numbers going forwards Vacancies: None Action being taken: N/A Impact: Low clinical risk 10

11 SURG Brightlingsea Ward Qualified Day Fill Rate 84.7% 80.2% Qualified Night Fill Rate 107.8% 100.0% Unqualified Day Fill Rate 101.6% 57.9% Unqualified Night Fill Rate105.6% 68.3% Overall Fill Rate 94.4% 76.9% Reasons for gap: Vacancy, unfilled bank, maternity leave and sickness. Dramatic drop in June 2014 in unqualified day and night fill rate. Unable to fill HCA shifts in June. Vacancies: 3.65 WTE RN posts and 3 unqualified posts. 1.0 WTE RN and 1.0 HCA maternity leave. Action being taken: CHUFT generic recruitment. Impact: Increase in verbal complaints. Being added to risk register SURG Critical Care Qualified Day Fill Rate 88.9% 92.6% Qualified Night Fill Rate 88.5% 91.6% Unqualified Day Fill Rate 59.1% 50.7% Unqualified Night Fill Rate 83.9% 59.6% Overall Fill Rate 85.2% 86.2% Reasons for gap: Vacancy and maternity leave. Vacancies: 5 WTE RN posts and 1.44WTE unqualified. 5 WTE RN on maternity leave. Impact: Moderate clinical risk Action being taken: Review of establishment. On Risk Register no

12 SURG Fordham Ward Qualified Day Fill Rate 96.6% 97.5% Qualified Night Fill Rate 104.4% 98.9% Unqualified Day Fill Rate 114.3% 93.8% Unqualified Night Fill Rate117.6% 76.5% Overall Fill Rate 104.4% 94.5% Reasons for gap: Vacancies and maternity leave (2.4 WTE). Vacancies: 5.40 RN post, 2.0 WTE HCA posts. Action being taken: Use of bank to fill shifts. Ward being added to Risk Register for vacancy and high dependency levels. Impact: Experienced Band 5 deficit due to retirement etc. Currently on risk register 1080 SURG Great Tey Ward Qualified Day Fill Rate 84.9% 85.4% Qualified Night Fill Rate 100.1% 91.8% Unqualified Day Fill Rate 68.1% 57.0% Unqualified Night Fill Rate103.3% 90.0% Overall Fill Rate 84.1% 79.2% Reasons for gap: Fill rates do not equate to a significant clinical risk as Gt Tey and Copford are managed together as elective orthopaedic wards. Many patients are day case and only a very small number are transferred to the main ward overnight. For this reason the staffing for both wards is managed according to clinical need. The ward has 0.8 WTE RN on maternity leave. Vacancies: 0.8 WTE RN and 4.16 WTE unqualified posts. Action being taken: CHUFT generic recruitment. Impact: Low clinical risk. 12

13 SURG Mersea Ward Qualified Day Fill Rate 87.6% 106.1% Qualified Night Fill Rate 96.9% 101.0% Unqualified Day Fill Rate 89.0% 85.7% Unqualified Night Fill Rate119.7% 43.3% Overall Fill Rate 91.9% 95.4% Reasons for gap: 2 HCA on long term sickness. Vacancies: 2 RN posts, No unqualified posts. Action being taken: Generic CHUFT recruitment. Impact: Increased clinical risk partly due to increased number of emergency patients has increased number of falls. SURG Wivenhoe Ward Qualified Day Fill Rate 87.7% 86.4% Qualified Night Fill Rate 96.2% 92.2% Unqualified Day Fill Rate 96.6% 92.3% Unqualified Night Fill Rate100.0% 100.0% Overall Fill Rate 92.4% 90.2% Reasons for gap: Vacancy and maternity leave. Vacancies: 3.0 WTE RN vacancies WTE on maternity leave. Action being taken: Bed base reducing from 07/07/2014 from 34 to 28 beds. Impact: Managed clinical risk. It is predicted that from 27/07/2014 that due to a large number of resignations and also taking into consideration the reduction in bed base the ward will have WTE RN vacancies. This is being added to the Risk Register. 13

14 W&C Childrens Acute Referral Unit Qualified Day Fill Rate 82.6% 73.8% Qualified Night Fill Rate 93.5% 93.3% Unqualified Day Fill Rate 0.0% 0.0% Unqualified Night Fill Rate 0.0% 0.0% Overall Fill Rate 86.1% 79.5% Reasons for gap: Vacancy and maternity leave. Vacancies: 0.49 RCN band 6 vacancy. Action being taken: Staff are flexed between CARU and children's ward according to clinical need. Impact: On Risk Register no W&C Childrens Ward Qualified Day Fill Rate 102.9% 95.8% Qualified Night Fill Rate 103.4% 99.2% Unqualified Day Fill Rate 29.0% 37.2% Unqualified Night Fill Rate 48.4% 46.7% Overall Fill Rate 86.8% 83.6% Reasons for gap: Vacancies. Vacancies: 2.65 WTE Band 5 posts. Action being taken: Staff are flexed between CARU and children s ward according to clinical need. Impact: On Risk Register no

15 W&C Juno Suite Qualified Day Fill Rate 81.9% 103.0% Qualified Night Fill Rate 64.9% 75.0% Unqualified Day Fill Rate 0.0% 0.0% Unqualified Night Fill Rate 0.0% 0.0% Overall Fill Rate 75.4% 92.4% Reasons for gap: Vacancies: Action being taken: The maternity department in managed as a whole and staff are moved around each clinical area according to clinical need. RM vacancies recently filled, new RM will commence once PIN arrived. Impact: Low clinical risk. W&C Lexden Ward Qualified Day Fill Rate 110.8% 110.6% Qualified Night Fill Rate 122.9% 123.7% Unqualified Day Fill Rate 153.8% 145.6% Unqualified Night Fill Rate152.2% 132.2% Overall Fill Rate 126.6% 123.3% Reasons for gap: Vacancies: RM vacancies filled at interview recently, will commence once PIN arrived. No HCA vacancies. Action being taken: The maternity department in managed as a whole and staff are moved around each clinical area according to clinical need. impact: None 15

16 W&C Neonatal Unit Qualified Day Fill Rate 106.1% 96.0% Qualified Night Fill Rate 118.1% 108.8% Unqualified Day Fill Rate 73.5% 74.0% Unqualified Night Fill Rate 62.9% 68.3% Overall Fill Rate 98.4% 92.4% The unit is staffed as closely as possible to 5 RN and 2 unqualified based on the BAPM national guidelines. Dependency scores are entered onto a regional database (Badger) which is monitored by the regional neonatal group and this also acts as an additional red flag for staffing. Reasons for gap: The uplift indicated from the acuity work was not financed. Vacancies: None. Low staff attrition. Action being taken: Staffing requirement differ greatly according to the dependency of the babies. The Ward Sister is able to flex her staff accordingly and they are willing to change shifts at very short notice to ensure safe staffing. No bank or agency is required because of this. Impact: W&C Stanway Ward Qualified Day Fill Rate 115.1% 118.4% Qualified Night Fill Rate 78.6% 84.3% Unqualified Day Fill Rate 44.0% 24.6% Unqualified Night Fill Rate 81.7% 26.7% Overall Fill Rate 87.5% 79.0% Reasons for gap: Vacancy, sickness and maternity leave. Vacancies: 1.0 WTE RN vacancy. 1 RN on sick leave. Action being taken: Generic recruitment. Impact: Managed clinical risk. On Risk Register no

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