TAMESIDE HOSPITAL NHS FOUNDATION TRUST. Safe Staffing Report

Transcription

1 TAMESIDE HOSPITAL NHS FOUNDATION TRUST Report to Public Trust Board meeting of 24 th September 2015 Agenda Item Title Sponsoring Executive Director Author (s) 8b Safe Staffing Report Mrs Trish Cavanagh Director of Operations and Interim Chief Nurse Dawn Downing, E-Rostering Lead Helen Howard, Matron for Patient Experience Anita Fleming - Assistant Chief Nurse / Head of Midwifery - Surgery, Women s & Children s Services Purpose Previously considered by To note/receive n/a Executive Summary In-line with the Hard Truths Commitments regarding the publishing of Staffing Data, the Trust Board are required to review staffing data on a monthly basis. The aim of this report is to provide the monthly update on the continuing actions and developments to support safe staffing. This report also includes additional information relating to midwifery staffing levels Related Trust Objectives Risk Assurance risk impacted upon Legal implications/regulatory requirements Financial Implications 1. All patients receive harm free care through the Trust s Patient Safety Programme. 2. To improve the quality of patient care through the implementation of the Trust s agreed Quality Strategy. 3. To improve the patient experience through a personalised, responsive, compassionate and caring approach to the delivery of patient care. CR734: Nurse vacancies, leadership and Nursing staffing recruitment across medicine and the ability to provide safe care. AF3480: Failure to meet CQC registration requirements relating to staffing. AF3482: Failure to ensure adequate staffing levels to ensure patient safety and quality of services NHS England monthly requirement to publish and report Staffing Data None Has a quality impact assessment been undertaken? Yes where applicable in plans How does this report affect Sustainability? The Trust is required to ensure staffing levels are adequate to meet patient safety and quality. Action required by the Board The Trust Board are requested to receive this update and note the assertive monitoring of staffing levels that are in place for quality & safety. Page 1 of 8

2 1. Purpose In-line with the Hard Truths Commitments regarding the publishing of Staffing Data, the Trust Board are required to review staffing data on a monthly basis. The aim of this report is to provide the monthly update on the continuing actions and developments to support safe staffing. 2. Safe Staffing Update August 2015 Data Each month the data collection compares the number of staff hours Planned against the number staff hours used Actual. This is collected by ward, by shift, and is reported by calendar month as a % fill rate by day and by night: Appendix 1 Provides a summary of the August position by ward. The overall Trust position for August was RN/RM Average Fill rate Care Staff Average Fill rate 92.6% 96.3% 118% 130.8% This is the UNIFY upload of August s Staffing Data; and the information is published via NHS. This data is currently available via our public website in a specific designated section Safe Staffing : Tameside Hospital - Nurse Staffing ( 3. Monthly Submission Trend Overall, RN fill-rates remain fairly constant month on month, but Care Staff fill rates have seen an increase due to increasing levels of enhanced care (1:1 s) and additional support for RN shortfalls. Page 2 of 8

3 4. Exception Report The submission only represents monthly aggregated data and percentages, which have limited benefit. Robust conclusions cannot be deduced from this information alone. The data gives a summary and aggregated overview of how frequently the Trust met its planned requirements. England have suggested that greater scrutiny should be given to any area reporting <80% fill rates. This month only 1 area reported <80% fill rates: Critical Care Unit - Care Staff s 79% The Critical Care Unit had a 79% fill rate for Healthcare Assistants during the month of August. was due to annual leave and additionally a Healthcare Assistant who was leaving the Trust being granted leave that had been accrued due to a period of sickness. Discussion with the Matron has provided assurance that the department was not adversely affected, as the Technician for the area provided clinical support during this period of time. 5. Incident Reporting Table One below outlines the number of incident reports received in relation to staffing issues. analysis is undertaken divisionally to determine reason and impact. Table One 6. Actions to Address Shortfalls Short-term sickness and vacancy continue to be the main reasons for shortfalls in substantive staffing, with additional pressures due to escalation areas. To address these shortfalls the Trust has planned or is undertaking A further Recruitment for Registered Nurses/Midwives is planned for 17 th October Internal adverts to recruit HCA staff that have been on placement from NHSP. Ward Managers and Matrons providing increased direct support to the clinical teams. Increased HR support to ensure effective management of sickness. 7. Temporary Staffing When required; additional staff are requested through our temporary staffing provider - NHSP, to any shortfalls in RN/RM or Care Staff. Whilst reliance and temporary staffing costs remain high, the NHSP contract and use of the NHSP/HealthRoster interface is driving significant change to improve efficiency and enable greater scrutiny. A monthly dashboard has been produced and gives an overview of usage and actions being taken: (Appendix 2). Page 3 of 8

4 8. Midwifery Staffing Calculation. There is recently published NICE guidance for Safe Midwifery Staffing for Maternity Settings (NICE, 2015). A review of midwifery staffing numbers has been undertaken using BirthRate Plus criteria. Birthrate Plus is the national tool available for calculating midwifery staffing levels and is endorsed by the Royal College of Midwives. The methodology is based on an assessment of clinical risk and the needs of women and their babies during labour, delivery and the immediate post-delivery period, utilising the accepted standard of 1 midwife to 1 women, in order to determine the total midwife hours, and therefore staffing required, to deliver midwifery care to women across the whole maternity pathway. At its simplest Birthrate Plus can provide any given service with a recommended ratio of clinical midwives to births in order to ensure safe staffing levels. It is expressed as a ratio of midwives to births. The ratio recommended is 1:28 Using this methodology the ratio at THFT is 1:27.8 suggesting that the current establishment exceeds requirements. The midwifery staffing ratios need to be monitored and are reported (through the maternity dashboard) on a monthly basis, and this calculation needs to be based on midwifery staff in post at the end of each month and birth numbers for the previous 12 month period. This will fluctuate each month and will enable trends to be identified. The new NICE guidance also requires predicted staffing levels to be calculated using numbers of predicted births in the following six months. Based on bookings for July to December 2015, 1137 births are predicted, which is a further reduction and ultimately impacts on the staffing levels that may be required in the future. The monthly reporting of the midwife:birth ratios on the dashboard will enable ongoing monitoring. 9. Midwifery Red Flags The Safe Midwifery Staffing NICE guidance identifies midwifery staffing red flags, detailed below, which need to be monitored and reported in a way that enables actions to be taken to address in a timely manner. It is proposed that the incident reporting trigger list is reviewed to ensure all the red flags are included. The red flags are: Delayed or cancelled time critical activity. Missed or delayed care (for example, delay of 60 minutes or more in washing and suturing). Missed medication during an admission to hospital or midwifery-led unit (for example, diabetes medication). Delay of more than 30 minutes in providing pain relief. Delay of 30 minutes or more between presentation and triage. Full clinical examination not carried out when presenting in labour. Delay of 2 hours or more between admission for induction and beginning of process. Delayed recognition of and action on abnormal vital signs (for example, sepsis or urine output). Any occasion when 1 midwife is not able to provide continuous one-to-one care and support to a woman during established labour. The Division have developed a range of actions to ensure that both staffing ratios and incidents are monitored effectively and this are outlined in Table Two below Page 4 of 8

5 Table Two Action required Lead Date To obtain monthly midwifery staff in post numbers to enable accurate calculation of midwifery staff required and monthly midwife:birth ratio. To review staffing requirements for each individual area to ensure that staffing is distributed appropriately across the service. Develop and implement plans to increase obstetric market share. Review maternity trigger list to ensure all midwifery staffing red flags are included. Anita Fleming & Sarah Hadfield Anita Fleming, Anne Haggerty & managers for each area Anita Fleming, Judy Coombes and Fiona New. Anita Fleming & Anne Haggerty Ratio to be reported on maternity dashboard from August 15 1/10/15 30/9/15 30/9/15 Summary Getting the correct numbers of Nurses, Midwives and Healthcare Assistants in place is essential for the delivery of safe and effective patient care. This paper demonstrates that the Executive Nurse is providing scrutiny, leadership and oversight of this essential area of quality and safety. Recommendations The Trust Board are requested to receive this update and note the assertive monitoring of Nurse/Midwifery staffing that is in place. Page 5 of 8

6 APPENDIX 1. August - 15 WARD SPECIALTY SHIFT Planned Orthopaedic Unit ENT & Orthopaedics Planned Staff Vs Actual % Registered Staff Care Staff Comments Surgical Unit Surgery Emergency Orthopaedic Unit Trauma & Orthopaedics Critical Care Critical Care A Healthcare Assistant was granted accrued Annual Leave 95.3 N/A prior to leaving the Trust. Heart Care Centre Cardiology Gen Acute Cardiology Unit Cardiology Gen AMU Ward Ward Page 6 of 8

7 APPENDIX 1 continued August - 15 WARD SPECIALTY SHIFT Ward 42 Ward 43 Ward 44 Ward 45 Ward 46 Maternity Ward 27 Women s Health Unit NICU Children s Ward Obstetrics Gynaecology Obstetrics Paediatrics Planned Staff Vs Actual % Registered Staff Care Staff N/A N/A N/A Comments Trust Average Fill Rates RN/RM Average Fill rate Care Staff Average Fill rate Page 7 of 8

8 APPENDIX 2 Page 8 of 8