Date of Meeting: 29 th June 2016 Report Title: Nursing and Midwifery Staffing Exception Report (for March 2016)

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1 Report to: Board of Directors Date of Meeting: 9 th June 16 Report Title: Nursing and Midwifery Staffing Exception Report (for March 16) Status: For information Discussion Assurance Approval Regulatory requirement Mark relevant box with X X X Prepared by: Lisa Dixon/Mary Armitage/ Denise Todd, Senior Matrons Executive Sponsor Rob Dearden, Director of Nursing (presenting): Appendices (list if Appendix 1: UNIFY spreadsheet applicable): Purpose of the Report This is the nursing and midwifery staffing exception report for May 16 in response to the publication of Hard Truths: Putting Patients First (Department of Health, 14). The aim of the report is to inform the Board about nursing and midwifery staffing capacity and capability in relation to agreed establishments and to provide assurance that concerns and potentially unsafe staffing levels are escalated and dealt with promptly.. Key points for discussion Each month, staffing data is collected and analysed in order to establish how the number of actual staff on duty for both registered nurses / midwives and health care support worker s (HCSW s) compares to the planned staffing level. The data is uploaded onto UNIFY by the required deadline and is displayed on NHS Choices. As described in the May 16 Board paper, following the final report from Lord Carter, Operational Productivity and Performance in English NHS Acute Hospitals : Unwarrented Variations (16), within the optimisation of clinical resources there is the recommendation that Trusts adopt a revised metric for measuring nurse staffing; Care Hours Per Patient Day (CHPPD). This is the first month of data that this pertains to. CHPPD can be used to describe both the staff required and staff available in relation to the number of patients on a ward. This is calculated by adding the of registered nurses to the of healthcare support workers and dividing the total by every 4 of in-patient admissions. The patient numbers are taken as being are the number on the ward at 3.59; for the month of May, this has been both a manual and systems count to validate the data. The Board will see 3 additional columns on the attached spreadsheet describing the CHPPD for registered staff, un-registered staff and then the combined totals. The acceptable range for each of these 3 metrics is yet to be developed and agreed, but is expected to become the principle measure of nursing and healthcare support worker deployment nationally. Page 1 of 4

2 As in previous reports, the exceptions are highlighted where the actual rates for both registered staff and HCSW s are below 9 %. To note: Health Care Support Workers (HCSW s) are referred to as Care Staff on the attached data sheet. The following wards have been highlighted for discussion. Ward 4 : Ward 4 is reporting an improvement from 69.7% to 96.8% registered nurses on night duty following a revision of their skill mix at night. RN day duty has an actual versus planned figure of 87.1%, whilst this is less than ideal, during the day there is more assistance available to support the ward than in the out of period. If RNs are not available HCSW s are booked to reduce the potential impact to the patients particularly in relation to maintaining the required amount of pressure area care. The Board will see this in the data where the actual numbers of HCSW s are over 1%. Ward 5 : Ward 5 is reporting 84.3% RNs for day duty and 81.1% HCSW s for days. The data to support the narrative in this report is not sufficiently sensitive to capture a variable bed base. The ward has had a reducing bed base over the month from 8 to 1, and on this base the staffing is judged to be appropriate, however this will continue to be closely monitored by the Matron and Senior Matron. Ward 6 : Ward 6 is reporting 89% HCSW s on days, this was due to the redeployment of an HCSW to pother wards where the patient need was greater. Ward 9 : Ward 9 is reporting 8.% RN day duty; this is due to vacancies, maternity leave and sickness, with wte currently seconded to the winter ward. The ward also reported 81.9% HCSW s due to long term sickness and 1 HCSW on a phased return. The ward has experienced a higher number of patients requiring 1:1 supervision in the last weeks of May. Matron Edwards notes there has not been any delays or risks to patient care. Ward 13 : Ward 13 is reporting 7.7% HCSW fill rate for days, Matron Edwards advises that the gaps are due to.8 wte vacancy at band 3 and 1. wte seconded to the winter ward. There does not appear to have been a notable impact emerging as a result of this. Ward 14 : Ward 14 is reporting 73.1% RN night duty. Matron Edwards advises that Ward 14 plan to have 3 RNs at night but in May this has not been achieved due to ongoing vacancies. Every effort was made to fill the shortfall using bank / agency but this was not always possible. When the ward has had 3 RNs on duty, nurses have been moved on some occasions to support other wards with a reduced skill mix. Matron Edwards suggests that the impact of the staffing deficit may potentially have put a delay into patient flow, re: timely discharge and transfer. Ward 16 : Ward 16 is reporting 89.6% RN fill rate on night duty 74.% care staff on day duty. Senior Matron Todd and Sister Lynne Moore advise that the shortfalls are mainly due to a high level of maternity leave in May (3. wte), along with the continuing secondment of an HCSW to the winter ward. There are further constraints to nurse staffing with staff currently unavailable for duty and 1. wte Band 6 currently on long term sickness. The ward has 3.8 wte registered nurse vacancies and.41 wte HCSW. One ICU bed has been closed to support safer staffing within the ward and weekly staffing AEFs are reported to Matron Logue and Senior Matron Todd, with the Deputy Director of Nursing having an organisational overview. Ward 17 : Ward 17 is reporting 78% for HCSWs day duty. The HCSW fill rate is compromised due to maternity leave and a vacancy. Matron Newman advises that the impact of the reduced number of HCSW is minimal as ward activity has been manageable however, it has limited the number of HCSWs Page of 4

3 that can be released for training. The vacancy is being advertised and recruitment is expected to be successful, therefore the training will be addressed during the forthcoming months. Neonatal Unit : NNU is reporting 86% for registered nurse night duty. This was managed due to a (coincidental) reduced level of activity. Recruitment is in progress to fill the vacancies. Labour Ward : Labour Ward is reporting a fill rate for HCSWs during the day of 87.8%, this is an improvement as the maternity bank now has a number of healthcare support workers trained and picking up shifts on the unit. The shifts that have remained unfilled are supported by other areas minimising the potential impact. Escalation of Staffing Deficits : The escalation of any staffing deficits or concerns are made known to the Bed Manager via the bleep holders from 7.3 8am who, in turn, informs a Matron from 8am. The Medical and Surgical bleep holders are likely to have resolved initial staffing issues internally. Further escalation takes place via the three daily bed meetings, and are further articulated, in the form of low to high risk on an associated SBARR paper that is received by the Director of Operations, the Director and Deputy Director of Nursing. These risks have associated actions that are assigned to individuals to complete. Where no resolution is forthcoming the senior team are involved to agree the necessary actions. Recruitment : Nursing and midwifery have had 9 adverts in the national arena, either through NHS Jobs (an electronic site) or through professional journals in May. These have yielded a number of responses as described below: please note this is the position on 3 rd June 16 : Posts Offered : 18 students offered positions - due to start in September 5 qualified covering medicine & surgery Posts at Shortlisting Stage 8 posts in total (4 x surgery & 4 x medicine) Posts Advertised but not yet closed 8 Staff Nurse adverts currently out (1 x bank) Contacts from Last Recruitment Fairs 4 contacts from RCN Congress contacts from RCN Jobs Fair Manchester Following the Board approval to recruit a further 5 international nurses, Skype interviews have been held and candidates have been offered positions. Of these, 3 are in possession of an NMC PIN, and the remaining 17 have to meet the revised requirements of the NMC, namely, they must pass the International English Language Testing System (IELTS) to the expected standard. Further interviews are scheduled for the end of June, with a face to face recruitment trip taking place in early July. The Board will be provided with the progress of these candidates through the process in future papers. Page 3 of 4

4 Roster Construction & Management : Proactive rostering by the ward managers ensures that the night and weekend duties are covered by substantive staff (on the whole), with the exception of short notice absences. This may create shortfalls or deficits during the day which are placed to Nurse Bank / Agency to cover. It is recognised that during the weekdays there are a number of areas that can provide support to wards, which is not an option out of. The Ward Sisters meet on a weekly basis to share off duty, and move staff around where able, prior to seeking external assistance. Capturing this on the electronic rostering system is time consuming and ways are being sought to reduce this and thereby ensure that off duties reflect all the help that has been provided to wards both for whole and part shifts. Recommendations The Board is asked to note the key points set out in this paper and the actions in place to mitigate any risks to the quality of patient care. Page 4 of 4

5 Y Fill rate indicator return Org: RCF Airedale NHS Foundation Trust Staffing: Nursing, midwifery and care staff Period: May_16-17 Please provide the URL to the page on your trust website where your staffing information is available (Please can you ensure that the URL you attach to the spreadsheet is correct and links to the correct web page and include ' in your URL) Comments Only complete sites your organisation is accountable for Day Night Day Night Care Hours Per Patient Day (CHPPD) Hospital Site Details Main Specialties on each ward Registered midwives/nurses Care Staff Registered midwives/nurses Care Staff Cumulative Average fill Average fill count over the Site code *The Site rate - Average fill rate - Average fill Registered month of code is Ward name registered rate - care staff registered rate - care midwives/ patients at automatically actual planned actual nurses/midwiv (%) nurses/midwiv staff (%) nurses Hospital Site name Specialty 1 Specialty planned staff planned staff planned staff 3:59 each populated when a staff staff staff actual staff actual staff es (%) es (%) day Validation alerts (see Site name is Care Staff Overall control panel) selected RCF AIREDALE GENERAL HOSPITAL - RCF Labour Suite 51 - OBSTETRICS 51 - OBSTETRICS % 87.8% 96.3% 9.3% RCF AIREDALE GENERAL HOSPITAL - RCF Neonatal Unit 4 - PAEDIATRICS 4 - PAEDIATRICS % 1.% 86.4% 1.% RCF AIREDALE GENERAL HOSPITAL - RCF Ward GERIATRIC 3 - GENERAL % 131.1% 1.% 1.3% RCF AIREDALE GENERAL HOSPITAL - RCF Ward - AMU 36 - ACUTE INTERNAL 36 - ACUTE INTERNAL % 16.% 94.6% 15.8% 1, RCF AIREDALE GENERAL HOSPITAL - RCF Ward GERIATRIC 3 - GENERAL % 13.3% 96.8% 14.% RCF AIREDALE GENERAL HOSPITAL - RCF Ward GENERAL REHABILITATION % 81.1% 1.% 94.6% RCF AIREDALE GENERAL HOSPITAL - RCF Ward GERIATRIC 3 - GENERAL % 89.% 1.% 11.% RCF AIREDALE GENERAL HOSPITAL - RCF Ward GENERAL 43 - GERIATRIC % 9.3% 14.5% 93.% TRAUMA & 11 - TRAUMA & RCF AIREDALE GENERAL HOSPITAL - RCF Ward % 81.9% 1.% 18.7% RCF AIREDALE GENERAL HOSPITAL - RCF Ward GENERAL SURGERY 5 - GYNAECOLOGY % 7.7% 1.% 1.% RCF AIREDALE GENERAL HOSPITAL - RCF Ward GENERAL SURGERY 11 - UROLOGY % 95.5% 73.1% 97.% RCF AIREDALE GENERAL HOSPITAL - RCF Ward GENERAL 43 - GERIATRIC % 74.% 89.6% RCF AIREDALE GENERAL HOSPITAL - RCF Ward PAEDIATRICS 4 - PAEDIATRICS % 78.% 98.9% TRAUMA & 11 - TRAUMA & RCF AIREDALE GENERAL HOSPITAL - RCF Ward % 93.3% 1.% 9.9% CLINICAL 11 - TRAUMA & RCF AIREDALE GENERAL HOSPITAL - RCF Ward 19 HAEMATOLOGY % 98.8% 8.4% 15.% RCF AIREDALE GENERAL HOSPITAL - RCF Ward OBSTETRICS 4 - PAEDIATRICS % 93.9% 1.% 96.8% RCF3 CASTLEBERG HOSPITAL - RCF3 Harden Ward 3 - GENERAL REHABILITATION % 86.1% 1.% 7.5% RCF AIREDALE GENERAL HOSPITAL - RCF Winter Ward 3 - GENERAL 43 - GERIATRIC % 9.1% 95.% 1.% Total 5, , , , , , , , ,716