Compassion in Practice Action Area Five. Pauline Milne, Head of Clinical Workforce Planning and Development, Health Education East of England

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1 Compassion in Practice Action Area Five Pauline Milne, Head of Clinical Workforce Planning and Development, Health Education East of England 5 th December 2013

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3 Our Vision developing the culture of compassionate care The actions set out in this vision and strategy will change the way we work, transform the care of our patients and ensure we deliver a culture of compassionate care Jane Cummings, Chief Nursing Officer for England

4 Our values and behaviours are at the heart of the vision and all we do 6 Cs Care Competence Courage Compassion Communication Commitment

5 Six Areas for Action Helping people to stay independent, maximising well-being and improving health outcomes Working with people to provide a positive experience of care Delivering high quality care and measuring impact Building and strengthening leadership Ensuring we have the right staff, with the right skills in the right place Supporting positive staff experience

6 Action at all levels 1. National Actions a range of initiatives that will be led by national bodies and regulators such as CQC, NMC, NTDA and Monitor. These will also be supported by key stakeholders such as Health Education England, the RCN and the RCM. 2. Local Actions a range of initiatives to be led by local organisations and be supported by national bodies, creating the environment, providing leadership and giving the highest priority to achieving the culture of compassionate care. There are many examples of excellent practice in the Midlands & East region. 3. Call to Action the overarching focus for organisations and individuals specific to each area of action.

7 Action Area 5: ensuring we have the right staff, with the right skills in the right place

8 Wider Policy Context

9 Francis Recommendations Evidence to the inquiry suggested that the Trust did not have reliable nursing establishment figures 23 NICE to develop evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix 195 Nurse ward managers should operate in supervisory capacity, visible to patients and staff, role model and mentor 205 Seek and record the advice of Nursing Director on quality and safety on major change

10 The Keogh Review Issues related to nurse staffing in some organisations identified by reviewers: dissonance between nursing establishments, staff in post and staff available on each shift inadequate staffing levels on night shifts and weekends poor skill mix links to Compassion in Practice Action Area Five Workstream

11 Berwick Recommendations Government, Health Education England and NHS England should assure that sufficient staff are available to meet the NHS s needs now and in the future. Healthcare organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are well-supported. Boards and leaders of provider organisations should take responsibility for ensuring that clinical areas are adequately staffed in ways that take account of varying levels of patient acuity and dependency, and that are in accord with scientific evidence about adequate staffing. Reference to NICE work and to staffing ratios

12 Key Objectives of Action Area Five Directors of Nursing to agree appropriate staffing levels through the application of evidence based tools All nursing and midwifery staffing levels and quality experience metrics should be discussed at a public board meeting Boards to sign off and publish evidence based staffing levels at least every six months, providing assurance regarding the impact on quality of care and patient experience Monitoring of compliance (CQC, NTDA, Monitor, Contracts) Work with NICE to establish adequate and appropriate staffing levels for all care settings

13 Key Objectives of Action Area Five Develop Good Practice Guidance with National Quality Board Undertake an assessment of ward or community nurse / midwifery leaders having a supervisory role Directors of Nursing to undertake a review of options for each patient being allocated a named key nurse responsible for coordinating care HEE leading the on values / HCSW workstreams (linked to Cavendish Review)

14 Workforce Planning Tools Tools for Acute Care: Safer Nursing Care Tool Guidance and Multipliers Updated in July Available at: Work in progress to develop Safer Nursing Care Tool for AMUs / A&E / Children s In-Patients IPAD-APP in development to record SNCT acuity and dependency scores at the bedside and generate local reports proof of concept stage

15 Workforce Planning Tools Tools for Maternity: Birthrate Plus - RCM published updated guidance in autumn Tools for Community (by April 2014): QNI strategic partners in this work - three workshop sessions have been held QNI are undertaking a review of existing tools (due for completion in January 2014)

16 Workforce Planning Tools Tools for Mental Health (by April 2014): Two workshop sessions held Pilots of Dr Keith Hurst and NHSScotland tools in progress Literature review commissioned Tools for Learning Disabilities (by September 2014): Sub group established in September Literature review undertaken Working with MH group on tools for in-patient settings (pilot as above) Focus on tools for community settings

17 National Quality Board Guidance Available at:

18 Good Practice Guidance National Quality Board guidance published on 19/11/13 Includes ten expectations and twenty case studies Six themes Accountability and responsibility Evidence-based decision making Supporting and fostering a professional environment Openness and transparency Planning for future workforce requirements Role of commissioning Work in progress with CQC regarding the monitoring of implementation of the expectations

19 Accountability and Responsibility 1. Boards take full responsibility for the quality of care provided to patients, and as a key determinant of quality, take full and collective responsibility for nursing, midwifery and care staffing capacity and capability. 2. Processes are in place to enable staffing establishments to be met on a shift-to-shift basis.

20 Evidence-Based Decision Making 3. Evidence-based tools are used to inform nursing, midwifery and care staffing capacity and capability.

21 Supporting and Fostering a Professional Environment 4. Clinical and managerial leaders foster a culture of professionalism and responsiveness, where staff feel able to raise concerns. 5. A multi-professional approach is taken when setting nursing, midwifery and care staffing establishments. 6. Nurses, midwives and care staff have sufficient time to fulfil responsibilities that are additional to their direct caring duties.

22 Openness and Transparency 7. Boards receive monthly updates on workforce information, and staffing capacity and capability is discussed at a public Board meeting at least every six months on the basis of a full nursing and midwifery establishment review. 8. NHS providers clearly display information about the nurses, midwives and care staff present on each ward, clinical setting, department or service on each shift.

23 Planning for Future Workforce Requirements 9. Providers of NHS services take an active role in securing staff in line with their workforce requirements.

24 The Role of Commissioning 10. Commissioners actively seek assurance that the right people, with the right skills, are in the right place at the right time within the providers with whom they contract.

25 Future Work Work with NICE to establish adequate and appropriate staffing levels for all care settings NICE have joined Steering Group and are scoping options for the work programme Scoping work around supervisory status of senior sisters / charge nurse / team leaders NNRU review of impact of 12 hour shift patterns due to commence in December 2013 Week of action (6c s live) 9 th December

26 Implications Focus on nursing staffing and links to patient safety / quality of care Consistency of policy findings Opportunity for increased engagement in workforce planning and education commissioning processes Common approaches will support more effective benchmarking Involvement of key stakeholders nationally Opportunities for UK wide collaboration

27 Thank you Contact details: