SUMMARY REPORT Meeting Date: 20.11.14 Agenda Item: 8.3 Enclosure Number: 6 Meeting: Title: Author: Accountable Director: Other meetings presented to or previously agreed at: Trust Board OUR STAFF: ENSURING AND ASSURING THAT OUR SERVICES ARE DELIVERED SAFELY Steve Gregory, Director of Nursing and Operations Steve Gregory, Director of Nursing and Operations Committee Date Reviewed Key Points/Recommendation from that Committee Purpose of the report To appraise the Board on the safe deployment of staffing within our community hospitals. This is a monthly update and contains metrics pertaining to staff numbers, skills and quality indicators. Quality Metrics are included to give an overview of safety, patient eperience and clinical effectiveness. Consider for Action Approval Assurance Information Strategic Priorities this report relates to: To eceed epectations in the quality of care delivered Summary of key points in report To transform our services to offer more care closer to home more productively. To deliver wellco-ordinated effective care by working in partnership with others. What are the key issues the Board needs to consider in this report? 1. Safe staffing levels maintained 2. Leadership development 3. Thematic review regarding sickness absence To provide the best services for patients by becoming a more fleible and sustainable organisation The Board is asked to: Agree the UNIFY return Note the quality metrics Note the report only looks at nursing 1 Accountable Director: Steve Gregory, Director of Nursing and Operations
Is this report relevant to compliance with any key standards? YES OR NO CQC Yes NHSLA IG Governance Toolkit Board Assurance Framework Impacts and Implications? Yes No No YES or NO If yes, what impact or implication State specific standard or BAF risk 2 Accountable Director: Steve Gregory, Director of Nursing and Operations
OUR STAFF: ENSURING AND ASSURING THAT OUR SERVICES ARE DELIVERED SAFELY REPORT NOVEMBER 2014 1. Introduction 1.1 This month provides an overview of the staffing utilised during October. 2. Main Points to Note 2.1 Ludlow Hospital 2.1.1 In October, both wards had 12 beds open as per plan following the completion of the refurbishment work. On 24 October 2014, following a request by Shropshire Clinical Commissioning Group, an additional 5 escalation beds were opened due to the bed pressures within Shrewsbury and Telford Hospitals NHS Trust 2.1.2 Across both wards there were 5.87 WTE Registered Nurse vacancies. 1.0 WTE Band 6 Ward Sister and 0.60 WTE Band 5 Registered Nurses are both due to commence at the beginning of November. 2.1.3 There is 1.0 WTE Registered Nurse currently on maternity leave, with 2.87 WTE Registered Nurses due to go on maternity leave by the end of December. 2.1.4 Interviews which took place in September and October resulted in no candidates being successful at interview. The vacancies are currently out to advert. 2.1.5 During October, Stretton Ward had no patients requiring additional supervision. On Dinham Ward, there was 1 patient requiring additional supervision for 4 days, both on the late and the night shift. 2.1.6 There were 2 Dati reports during this period. 1 Dati related to 2 Registered Nurses and 1 Health Care Assistant on the early shift for 12 patients. This was due to sickness of a Health Care Assistant at short notice and not being able to cover. The other Dati related to 1 Health Care Assistant not turning up from ID Medical Agency due to staff sickness which left 2 Registered Nurses on a night shift for 11 patients. The escalation beds that night were not occupied. There was no harm to patients as a result of these incidents. Sickness 2.1.7 Across both wards, 455 Registered Nurse hours and 451 Health Care Assistant hours were lost due to sickness (this equates to 14.86%). The majority related to long term sickness; all individuals are under review in line with the policy. 3 Accountable Director: Steve Gregory, Director of Nursing and Operations
Bank/Agency Usage 2.1.8 Due to the high levels of vacancy and sickness, staffing was supplemented by the use of bank and agency staff. 2.1.9 Of the 186 shifts within the month, only 25 shifts were covered by 2 Registered Nurses on the same shift who were substantive staff. The remainder were covered by 1 substantive Registered Nurse and a bank or agency Registered Nurse. 2.2 Bishops Castle Hospital 2.2.1 In October, there were 16 beds open at Bishops Castle. 2.2.2 There were no vacancies. 2.2.3 No patients required additional supervision this month. 2.2.4 1 Dati was reported regarding workload on the ward. The correct numbers of staff were on duty but difficulties were eperienced due to the dependency of 2 end of life patients. There was no harm to patients as a result of these incidents. Sickness 2.2.5 150 Registered Nurse hours and 15 Health Care Assistant hours were lost due to sickness (this equates to 7.04%). Registered Nurse sickness relates to long term sickness. 2.3 Whitchurch Hospital 2.3.1 On 14 October, the Rehabilitation Ward at Whitchurch Hospital opened 4 additional escalation beds over and above the normal 32 bedded ward compliment. This followed a request by Shropshire Clinical Commissioning Group due to the bed pressures within Shrewsbury and Telford Hospitals NHS Trust. 2.3.2 2.4 WTE Band 5 Registered Nurse posts are currently vacant with 1.0 WTE due to leave at the end of November and 1.0 WTE epected to give notice imminently. There is also 1.0 WTE Band 6 Registered Nurse due to leave at the end of November. 2.3.3 Interviews for Band 5 staff in October were unsuccessful. Further interviews are planned for 19 November. 2.3.4 The interview for the Band 6 post is on 17 November. 2.3.5 Three Registered Nurse Bank staff were recruited in October. The vacant 16 hours Ward Clerk position is being interviewed on 17 November. 2.3.6 One patient required 24 hour 1:1 supervision until they were discharged on 13 October. 2.3.7 No incidents were reported. 4 Accountable Director: Steve Gregory, Director of Nursing and Operations
Sickness 2.3.8 137.5 Registered Nurse hours were lost due to sickness, of which 130 hours related to long term sickness. 15 Health Care Assistant hours were lost due to short term sickness (this equates to 3.06%) Bank/Agency Usage 2.3.9 Safe staffing was maintained with the use of bank and agency staff. 2.4 Bridgnorth Hospital 2.4.1 There were 25 beds open on the ward. 2.4.2 A vacancy for 1.00 WTE Registered Nurse is currently being advertised. A further 0.51 WTE Registered Nurse vacancy is epected due to member of staff who is leaving to take up a post in the community. 2.4.3 There are now 3.80 WTE Health Care Assistants in post and a 0.6 WTE vacancy is being advertised. 2.4.4 There were no patients requiring additional supervision this month. 2.4.5 There were 8 staffing incidents during October as follows:- 1. Poor infection prevention and control practice by an Agency Nurse. This was addressed by staff on duty at the time of the incident and also with ID Medical. 2. Failure to book Agency. This was an error on duty when the need for additional Bank/ Agency had not been highlighted and therefore not covered. The Sister apologised to staff on duty. This left 3 staff on night duty. 3. A Registered Nurse who was booked via ID Medical failed to turn up for the night shift and this left 3 staff on duty. The reason for non-attendance was due to the fact that the Registered Nurse had been involved in a car accident and the Agency had not been communicated with regarding this. 4. Reduced staffing on night duty (3 staff on duty) due to Agency not turning up and unable to get replacement. 5. HCA booked via ID medical did not turn up for duty. ID Medical were contacted and asked to establish why the individual had not turned up and to source replacement. No replacement was found. 6. Staff reported that, due to the high workload on night duty, they were unable to allocate time to check Controlled Drugs and handed this over to the net shift. The Ward Manager has been requested to have a discussion with the team. 7. There were only 3 staff on night duty which resulted in issues regarding checking Controlled Drugs due to reduced numbers of staff. This was handed over to the net shift to complete. The Ward Manager will be having further discussions with the team. 5 Accountable Director: Steve Gregory, Director of Nursing and Operations
8. Registered Nurses on a night shift did not take a break due to the ward being very busy and due to the dependency of the patients. Health Care Assistants were able to take a break. 2.4.6 The Ward Manager is currently reviewing all the incidents and providing feedback to staff on any actions taken and will be discussing issues regarding workload that have been highlighted. 2.4.7 There was no harm to patients as a result of the incidents. Sickness 2.4.8 There were 145.25 Registered Nurse hours lost due to sickness. This related to long term sickness for 1 member of staff who is due to return in November and 1 member of staff who had short term sickness (this equates to 7.05%). 3. Key Actions Leadership development and team building. of Registered Mental Health Nurses to support people with Dementia. Sickness absence and promoting well-being work to be more proactive. Internal quality metrics continue to have no reds. 4. Conclusion 4.1 Staffing levels are maintained to safe levels. There needs to be continued work on recruitment and creating a healthy workplace (reducing sickness absence). 5. Recommendations Agree the UNIFY return Note the quality metrics Note the report only looks at nursing 6 Accountable Director: Steve Gregory, Director of Nursing and Operations
APPENDIX 1 Org: R1D Shropshire Community Health NHS Trust Period: October 2014-15 Fill rate indicator return Staffing: Nursing, midwifery and care staff Hospital Site Details Main 2 Specialties on each ward Ward name Hospital Site name Specialty 1 Registered midwives/nurses Total Total monthly monthly planned actual staff staff hours hours Day Night Day Night Registered Care Staff Care Staff Average fill Average fill midwives/nurses rate - rate - Total Total Total Total Total Total Average fill registered registered monthly monthly monthly monthly monthly monthly rate - care nurses / nurses / planned actual planned actual planned actual staff (%) midwives midwives staff staff staff staff staff staff (%) (%) hours hours hours hours hours hours Average fill rate - care staff (%) R1D25 BISHOPS CASTLE Stonehouse Ward 314 - REHABILITATION 864.5 994.3 866 984 620 620 0 0 115.0% 113.6% 100.0% - R1D21 LUDLOW Dinham 314 - REHABILITATION 855.3 812.5 631.5 685 620 620 0 110 95.0% 108.5% 100.0% - R1D21 LUDLOW Stretton 314 - REHABILITATION 912 903 675.3 687.5 620 620 80 230 99.0% 101.8% 100.0% 287.5% R1D34 Whitchurch Hospital Whitchurch Rehab 314 - REHABILITATION 2325 2536.5 930 1297.5 930 1090 310 460 109.1% 139.5% 117.2% 148.4% Ward R1D22 BRIDGNORTH Agnes Campbell 314 - REHABILITATION 1395 1209 930 1154.5 880.5 589 294.5 560.5 86.7% 124.1% 66.9% 190.3% 6351.8 6455.3 4032.8 4808.5 3670.5 3539 684.5 1360.5 101.6% 119.2% 96.4% 198.8% Overall day/night/registered/care) 109.7% 7 Accountable Director: Steve Gregory, Director of Nursing and Operations