Nursing within Lord Carter s report: Operational productivity and performance in English NHS acute hospitals: Unwarranted variations

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1 Nursing within Lord Carter s report: Operational productivity and performance in English NHS acute hospitals: Unwarranted variations Lyn McIntyre MBE Senior Nurse Advisor Workforce Efficiency 1

2 Introduction 1. Background 2. Overview of the report 3. Nursing recommendations 4. Next steps 2 Unwarranted Variations: final report summary, February 2016

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4 Interim report Interim report June bn opportunity tighter grip of resources Workforce is the biggest cost = biggest opportunity for improving productivity Variances between trusts the NHS can be up with the world s best but inconsistency and a need for relentless attention to costs Greater savings to be had in improving workflow within and in and out of hospitals Advocated ATI now termed Adjusted Treatment Cost (ATC). This metric could be applied to any combination of inputs to enable both comparison between trusts and to create baselines for future improvement Detailed analysis with 22 trusts Advocated a model hospital to allow trusts to compare themselves against best practice Final report by the end of the calendar year 4

5 Overview of the final report 15 recommendations across: Optimising clinical resources, including nursing Optimising non-clinical resources Quality and efficiency across the patient pathway Implementation and engagement with trusts 5 Unwarranted Variations: final report summary, February 2016

6 Background Deep dives with 32 and wider engagement across 104 non-specialist acute trusts (136 trusts in total) This chart shows the pay and non-pay split of spend for the 136 non specialist acute trusts, with a breakdown of pay 6 Unwarranted Variations: final report summary, February 2016

7 Optimising nursing resources To increase nurse and healthcare support worker productivity by: implementing robust e-rostering systems, taking a collaborative improvement approach, developing enhanced care guides, and setting appropriate benchmarks against which trusts should plan staffing resources to ensure safe and productive levels of staffing through Care Hours per Patient Day (CHPPD) so that the right teams are in the right place at the right time, collaborating to deliver high quality, efficient patient care by the end of Unwarranted Variations: final report summary, February 2016

8 Rostering Trusts should use an e-rostering system and implement the follow practices: An effective approval process by publishing rosters six weeks in advance and review them against trust key performance indicators such as proportion of staff on leave, training and appropriate use of contracted hours; A formal process to tackle areas that require improvement, with escalation paths, action plans and improvement tracking; and, Cultural change and communication plans to resolve any underlying policy or process issues. 8 Unwarranted Variations: final report summary, February 2016

9 Collaborative improvement approach Developed by the Institute of Healthcare Improvement We invited 26 directors of nursing, along with their trust colleagues, regulatory bodies and Royal College of Nursing representatives to form a nursing workforce efficiency improvement collaborative This collaborative approach proved very effective as a means of mobilising the range depth of experience and expertise across the NHS Highlighted an overreliance on external consultancies. 9 Unwarranted Variations: final report summary, February 2016

10 10 Workforce Efficiency Improvement Collaborative

11 Examples of projects Reduction of sickness by 0.5% on each ward area 500k Improved roster grip avoidance of overstaffing 300k Decrease in specialling by implementing Safety Support Worker role 330k Underused hours 350k Rosters moved to 13 week approval Specialling pool, uplift, generic worker 11

12 Specialling (Enhanced Care) 9 Trusts chose Specialling as their improvement goal Review of policies, risk assessment, working with carers and patients TDA also ran a 90 day rapid improvement collaborative Reviewing learning from both with the aim of setting up a national programme - tackling variation in specialling across the service. Good Practice Guidance including replacing the term specialling with enhanced care to better reflect this management practice and patient intervention. Acute trusts implement the enhanced care guide by 1st October

13 Care Hours per Patient Day (CHPPD) CHPPD is a simple calculation by dividing the number of nursing hours available by the numbers of patients CHPPD looks at the number of registered nurses and the number of healthcare support workers (HSWs) over the total number of inpatients It provides a measurement that enables units of a similar size and patient group to be benchmarked The CHPPD metric will form one part of the Model Hospital Nursing Dashboard, that will allow comparison with quality, financial and staffing metrics. 13 Unwarranted Variations: final report summary, February 2016

14 14 Unwarranted Variations: final report summary, February 2016

15 Single approach to reporting Data validation Performance comparisons What good looks like in comparable organisations Currently under development by a Steering Group Being tested in acute Trusts in March 2016 Evaluated and reviewed April The design and metrics for inclusion on the Nursing dashboard of the model hospital are under review. These metrics are for illustration purposes only. 15 Unwarranted Variations: final report summary, February 2016

16 Next steps Continued engagement with trusts Working closely with our partners Moving towards NHS Improvement Getting the model hospital nursing dashboard and right Mental Health and community trust involvement Allied Health Professionals and Clinicians 16 Unwarranted Variations: final report summary, February 2016

17 Lyn McIntyre MBE Senior Nurse Advisor Workforce Efficiency Productivity and Efficiency Division Department of Health Unwarranted 17 Variations: final report summary, February 2016