SOMERSET PARTNERSHIP NHS FOUNDATION TRUST SAFER STAFFING REPORT: MARCH AND APRIL Report to the Trust Board 26 May 2015

Transcription

1 SOMERSET PARTNERSHIP NHS FOUNDATION TRUST SAFER STAFFING REPORT: MARCH AND APRIL 2015 Report to the Trust Board 26 May 2015 Sponsoring Director: Author: Purpose of the report: Key Issues and Recommendations: Director of Nursing and Patient Safety Director of Nursing and Patient Safety Report of the progress of implementing the new Safer Staffing establishments for all in-patient wards in January 2015 and February 2015 In May 2014 the Trust Board approved new staffing establishments which were bespoke for each in patient ward supported by significant additional investment to recruit to additional registered nurse posts By April 2015 the number of wards achieving in excess of 80% of the recommended staffing levels had increased to nineteen out of twenty four wards Recruitment remains the main challenge to achieving the recommended staffing levels All shifts are risk assessed and the staffing levels flexed based on patient acuity and dependency, and bed occupancy levels Bank and agency staff are used to fill in gaps with block contracts in place with agencies to mitigate the risk and to provide continuity The number of wards reporting both high levels of sickness and vacancies has improved with ten wards reporting via the April Early Warning Trigger Tool Actions required by the Board The Trust Board is asked to discuss the report May 2015 Public Board - 1 -

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3 SOMERSET PARTNERSHIP NHS FOUNDATION TRUST SAFER STAFFING REPORT: MARCH AND APRIL PURPOSE 11 This report explains how well the Somerset Partnership s community hospital wards and mental health inpatient wards are doing in achieving the recommended staffing levels in March and April 2015 This is known as the fill rate This is split down further in the appendices to the report, to show the fill rates for each ward, showing registered nurses and health care assistants separately, for early shifts, late shifts, and night shifts 12 In May 2014, the Trust Board approved new staffing establishments for each ward based upon guidance issued by NHS England, which shows that there is a positive link between having the right number of staff with the right skills on the ward This confirms that when you get the staffing levels right - the quality of the care delivered to patients improves Full details can be found on the Trust website 13 The new staffing levels are bespoke for each individual ward and shift, and have been developed following a detailed review of the literature and using evidence based tools This reaffirms that by having the right number of staff on duty staff have more time to care, time to talk and time to listen and this leads to better outcomes for patients 14 In line with the majority of organisations, Somerset Partnership is now actively recruiting to the additional nursing posts required to meet the new recommended staffing establishments Until such time as recruitment is complete the Trust has agreed a number of actions in order to achieve enhanced staffing levels This includes the following: use of temporary staff including bank and agency staff; completion of a risk assessment for each shift where staffing level was below 80% of the new recommended level 15 During November and December 2014 the Trust re-opened as planned, the14 transitional beds and a further twenty escalation beds These included beds as Dene Barton, West Mendip and Wincanton community hospitals Part of the agreed escalation plan included the re-designation of a ten bedded ward on Athlone ward at Wincanton hospital as a nurse led Step Down ward to take patients from Yeovil District Hospital who were awaiting domiciliary care or placement in a residential care As the care needs and dependency of these patients are less than that required by our core community hospital patients, May 2015 Public Board - 3 -

4 the ratio of registered nurses to patients has been increased accordingly 16 In order to deliver optimal flexibility for admissions, the Trust also agreed with the Clinical Commissioning Group (CCG) that, for a short time, Athlone ward at Wincanton, and Luke Ward at Dene Barton would operate as mixed sex wards both having previously been designated as male (Athlone) and female (Luke)single sex wards In practice this means that these two wards are taking small numbers of patients who would previously been cared for in a different ward Whilst not ideal the staff are ensuring that the privacy and dignity of these patients is not being compromised at any time during their stay on the ward 2 RECOMMENDED AND ACTUAL STAFFING LEVELS FOR MARCH AND APRIL 21 In March 2015 the overall fill rate for registered nurses on day shifts was 874 % (88% in February 2015) and for night shift this was 969 % (949 % in February 2015) In April 2015 the fill rate was 875 % for day shifts and 971 % for night shifts This shows a continued improvement when compared to the March 2015 figures 22 The total number of wards meeting the new recommended staffing levels further improved in March 2015 with seventeen wards (out of a total of 24) consistently having a fill rate of more than 80% and this position improved further with nineteen wards in April No wards were below the 50% compliance rate in either month A summary table detailing the fill rate for all wards for March and April 2015 is attached in Appendix 1 and 2 (March 2015) and Appendix 5 and 6 (April 2015) This information can also be found on the Trust website 24 The main reason individual wards have been unable to meet the recommended staffing levels remain problems with the recruitment of registered nurses, lack of availability of bank/agency staff and sickness Three wards have not been able to meet the recommended staffing levels for any month in the last six months These are Crewkerne; Chard; Shepton Mallet May 2015 Public Board - 4 -

5 25 The full details of wards not reaching 80% of the staffing levels are detailed in the table below Wards which have not reached 80% of the recommended staffing levels Ward Nov Dec Jan Feb Mar Apr Comment Ash New staff recruited now Bridgwater New vacancies and sickness continues Bur On Sea Resolved Chard Ongoing vacancies and sickness Block agency contract in place Crewkerne Ongoing vacancies and sickness Block agency contract in place Frome No vacancies currently Rowan Rydon New vacancies due to staff Shepton Mallet South Petherton movement within the Trust Continues to be managed through ESD beds and reduced bed occupancy May 2015 Public Board Managed through bank staff and agency contract Deteriorated in March 2015 but improvement in April 2015 Williton Improving due to bank agency use Willow Improving Wessex Recruitment still challenging House Wincanton New vacancies Recruitment 26 Recruitment to vacancies remains one of the main reasons for shortfall in staffing levels with 38 RGN vacancies in community hospitals and 35 RMN vacancies in mental health wards as at 8 May The underlying position in terms of registered nurse recruitment is varied across the Trust and is mitigated in terms of safer staffing levels if there is a good level of bank and agency nursing staff available to fill the gaps in the rotas This is particularly evident at South Petherton where the level of vacancies remains high but they are able to absorb some of gaps in capacity through the use of bank staff and a block contract with the agency 28 In terms of actual vacant posts there is an improving picture at Williton, West Mendip, Frome, Ash and South Petherton There is however no

6 realisable improvement in recruitment to vacancies for Chard or Crewkerne Community Hospitals or Magnolia and Pyrland 29 Additional future pressures with recruiting to RMN vacancies have been identified due to additional funding for crisis services It is likely that this will cause additional internal movement of staff 210 The Trust is further reviewing and updating its recruitment campaign and recruitment process to attract additional registered nurses Additional actions agreed include: the establishment of a new bank and agency office with a Nurse Bank Manager and dedicated training programme for bank staff; enhanced preceptorship programme; pre reg nurses recruitment day; local advertising; overseas recruitment feasibility review 3 QUALITY EFFECTIVENESS AND SAFETY TRIGGER TOOL Key findings for March The self-assessed Quality Effectiveness and Safety Trigger Tool scores attributable to ward, against each of the criteria for March 2015, are summarised in Appendix 3 32 A summary of the comments submitted by individual wards, as part of their March 2015 report, is included as Appendix 4 33 The key points of note for the month of March 2015 are: the highest score reported by any ward was 9pts, the same as recorded in February 2015; no wards reached the trigger level of 12pts, signifying that the hospital will be required to submit an action plan covering the concerns highlighted by their reporting template; the average score of 44pts per ward was a decrease on the average of 49pts recorded in February 2015; the number of wards reporting both a high vacancy rate and a high sickness absence rate in March 2015 was eleven, a decrease on fourteen reported in February 2015 May 2015 Public Board - 6 -

7 34 The wards reporting the highest scores in March 2015 were: Wincanton, Hadspen ward: Wessex House: Bridgwater: Pyrland ward: Chard: 9pts (9pts in February); 8pts (4 pts in February); 7pts (7pts in February); 7pts (7pts in February); 7pts (5 points in February) 35 The highest scoring criteria across all wards in March 2015 were: vacancy rate higher than 3% average of 20pts (same as reported in February 2015) sickness absence rate higher than 35% average of 15pts (down from 17pts as reported in February 2015) unfilled shifts is higher than 6% average of 03pts (up from 02pts as reported in February 2015) new or no line manager in post (within last 6 months) average of 02pts (same as reported in February 2015) 36 Of the 24 wards submitting a return in March 2015: 18 reported a sickness absence rate higher than 35% (down from 20 reported in February 2015); 16 reported a vacancy rate higher than 3% (same as reported in February 2015); 11 reported both a high sickness absence rate and also a high vacancy rate (down from fourteen reported in February 2015) Key Findings for April The self-assessed Quality Effectiveness and Safety Trigger Tool scores attributable to ward, against each of the criteria for April 2015, are summarised in Appendix 7 38 A summary of the comments submitted by individual wards, as part of their monthly reports, is included as Appendix 8 39 The key points of note for the month of April 2015 are: the highest score reported by any ward was 9pts, the same as recorded in March 2015; May 2015 Public Board - 7 -

8 no wards reached the trigger level of 12pts, signifying that the hospital will be required to submit an action plan covering the concerns highlighted by their reporting template; the average score of 48pts per ward was an increase on the average of 44pts recorded in March 2015; the number of wards reporting both a high vacancy rate and a high sickness absence rate in April 2015 was ten, a decrease on eleven reported in March Figure 1 below illustrates the trend for the average and highest monthly total scores per ward, from April 2014 to April 2015: 311 The wards reporting the highest scores in April 2015 were: Wincanton, Hadspen ward: Chard: Rydon ward: Wessex House: Bridgwater: Magnolia ward: 9pts (9pts in March); 8pts (7 points in March) 8pts (6 pts in March); 7pts (8 pts in March); 7pts (7pts in March); 7pts (5pts in March) May 2015 Public Board - 8 -

9 312 Dene Barton, Luke ward for the third consecutive month recorded a score of zero points 313 Figure 2 below shows the average monthly score reported by each ward, over the six month period ending 30 April Figure 2 shows that the average score per ward during the reporting period ranged from 00pts at Dene Barton Lydeard ward (currently closed), to 87pts at Wincanton Hadspen ward, with an average over the last six months of 47pts, an increase on the average of 46pts recorded in March Figure 3 below illustrates the trend for the four currently highest scoring issues across all wards, in each month since April 2014 May 2015 Public Board - 9 -

10 Average Score per Ward G Figure 3 - Somerset Partnership NHS Foundation Trust - Quality, Effectiveness and Safety Trigger Tool: Trend for the four Highest Scoring Categories in the Current Month across all Wards Vacancy rate higher than 3% Sickness absence rate higher than 35% Ongoing investigation or disciplinary investigation (including RCAs) New or no line manager in post (within last 6 months) 316 The highest scoring criteria across all wards in April 2015 were: vacancy rate higher than 3% average of 21pts (up from 20pts reported in March 2015) sickness absence rate higher than 35% ongoing investigation or disciplinary investigation (including RCA's & infection control RCA's) new or no line manager in post (within last 6 months) average of 13pts (down from 15pts as reported in March 2015) average of 05pts (up from 01pts as reported in March 2015) average of 03pts (up from 02pts reported in March 2015) 317 Of the 24 wards submitting a return in April 2015: 15 reported a sickness absence rate higher than 35% (down from 18 reported in March 2015); 17 reported a vacancy rate higher than 3% (up from 16 reported in March 2015); May 2015 Public Board

11 ten reported both a high sickness absence rate and also a high vacancy rate (down from eleven reported in March 2015) 318 Figure 4 shows the monthly number of wards in reporting both a high vacancy rate and also a high sickness absence rate 16 Figure 4 - Somerset Partnership NHS Foundation Trust - Quality, Effectiveness and Safety Trigger Tool: Number of Wards reporting both a High Sickness Rate and a High Vacancy Rate Figure 5 shows the average score per issue, reported for month of April 2015 May 2015 Public Board

12 Figure 5 - Somerset Partnership NHS Foundation Trust - Quality, Effectiveness and Safety Trigger Tool: Average Score Per Issue for the Reporting Month No formal feedback obtained from patients during the month (eg questionnaires or surveys) 01 2 or more formal complaints in a month (wards) or 3 or more (A&E or OPD) or 1 or more (CCU & ICU) 01 Unusual demands on service exceeding capacity to deliver (eg national targets, outbreak) 02 Unfilled shifts is higher than 6% 03 New or no line manager in post (within last 6 months) 03 Ongoing investigation or disciplinary investigation (including RCA's & infection control RCA's) 05 Sickness absence rate higher than 35% 13 Vacancy rate higher than 3% SUMMARY AND RECOMMENDATION 41 The performance against the recommended staffing levels continues to improve with nineteen out of twenty four wards having an average rill rate of 80% or more in April Maintaining recommended staffing levels is being increasingly achieved through the use of bank and agency staff, however this supply route is becoming increasingly unstable 43 The underlying recruitment to vacancies continues to be significant challenge in some areas with hospitals in South Somerset (both community hospitals and mental health wards) particularly struggling to attract applicants The risk has been partially mitigated through the implementation of an additional number of block agency contracts 44 There is an improvement in the number of wards reporting both a high vacancy rate and a high sickness rate with the number dropping from a peak of 14 wards in February 2015, to 11 wards in March 2015 and down to ten wards in April The Board is asked to note the report and to: consider any risks associated with staffing issues; May 2015 Public Board

13 confirm that it has assurance that plans are in place to: o o o prevent shortfalls wherever possible; take any necessary actions; report any incidents which happen because of gaps in staffing; confirm that it has assurance that the Trust s Executive Team is supported to take action so that patients receive and experience safe, high quality care DIRECTOR OF NURSING AND PATIENT SAFETY May 2015 Public Board

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15 Safer Staffing APPENDIX 1 1 March until 31 March 2015 Nurse Staff Cover HCA Staff Cover Reason Action Impact Comments Day Night Day Night Ash Ward 597% 1839% Improved - February (589% RMN nights) Rydon 803% 1052% Improved - February (796% RMN day) Chard Hospital 742% 1048% 359 WTE RGN vacancies Crewkerne Hospital 737% 100 WTE RGN seconded to another role 1231% 511 WTE RGN vacancies 10 WTE RGN maternity leave Bank and agency workforce utilised Risk assessed each shift Bank and agency workforce utilised Risk assessed each shift Reduced access to RGN and reduced time to care Minimised due to temporary workforce Reduced access to RGN No significant concerns raised Improved - February (732% RGN day) Recruited 3 bank HCA Deteriorated - February (744% RGN day) Improvement in HCA Frome Community Hospital 774% 1242% 617 WTE RGN vacancies 10 wte RGN mat leave Bank and agency workforce utilised Reduced access to RGN No significant concerns raised Improved - February (710% RGN day) 59 wte RGN to start 0 wte Shepton Mallet Hospital 742% South Petherton 726% 935% 167 WTE RGN vacancies plus 28 WTE maternity leave 1280% RGN HCA Reduced number of stroke patients Reduced access to RGN Minimised due to temporary workforce Improved - February (685% RGN day) Deteriorated - February (833% RGN day) Appointed Wincanton (Hadspen Ward) 688% 914% Increased empty beds Risk Assessed Clarifying with wards as the hospital flexes staff across both wards Deteriorated February (84% RGN day) May 2015 Public Board

16 Nurse Staff Cover HCA Staff Cover Reason Action Impact Comments Day Night Day Night Matron and Ward Sister worked clinically where there were shortfalls May 2015 Public Board

17 APPENDIX 2 SOMERSET PARTNERSHIP NHS Foundation trust Safer Staffing Compliance Rates Reporting Period 1 to 31 March 2015 Per DOH Submission Standards Site Name Day Average fill rate - registered nurses/midwives (%) Average fill rate - care staff (%) Night Average fill rate - registered nurses/midwives (%) Average fill rate - care staff (%) Ash Ward 984% 1037% 597% 1839% Bridgwater 826% 985% 989% 1086% Burnham-on-Sea 914% 991% 1000% 1000% Chard 742% 1048% 968% 984% Crewkerne 737% 1231% 968% 1016% Dene Barton - Luke 962% 889% 1048% 952% Frome 774% 1242% 849% 1419% Holford 1097% 1242% 1000% 1054% Magnolia 855% 1044% 952% 1081% Minehead 1000% 987% 1000% 1000% Pyrland Ward % 1124% 1000% 2161% Pyrland Ward % 1520% 1000% 2065% Rowan 898% 892% 1016% 1016% Rydon 803% 1052% 806% 1250% Shepton Mallet 742% 935% 1000% 1000% South Petherton 726% 1280% 1016% 1016% St Andrews 1008% 1113% 1000% 1086% Wellington 887% 1097% 1000% 1000% Wessex House 1024% 1153% 968% 2129% West Mendip 939% 971% 1290% 989% Williton 895% 891% 968% 903% Willow 856% 1720% 1000% 1081% Wincanton - Athlone 1000% 1008% 1032% 565% Wincanton - Hadspen 688% 914% 919% 1081% TRUSTWIDE 874% 1082% 969% 1135% 100%+ >=80% and <100% <80% May 2015 Public Board

18 Ash, Bridgwater Bridgwater Waverley Burnham on Sea Chard Crewkerne Dene Barton Luke Dene Barton Lydeard Frome Holford, Taunton Magnolia, Yeovil Minehead Exmoor Pyrland, Taunton Rowan, Yeovil Rydon, Taunton Shepton Mallet St Andrews, Wells South Petherton Wellington Wessex House, Bridgwater West Mendip Abbey West Mendip Cathedral Williton Willow, Bridgwater Wincanton Athlone Wincanton Hadspen Average February 2015 Score January 2015 Score December 2014 Score November 2014 Score October 2014 Score Av Monthly Score for last Six Months G SOMERSET PARTNERSHIP NHS FOUNDATION TRUST APPENDIX 3 QUALITY, EFFECTIVENESS AND SAFETY TRIGGER TOOL: WARD SUMMARY FOR MARCH 2015 Criterion New or no line manager in post (within last 6 months) Vacancy rate higher than 3% Unfilled shifts is higher than 6% Sickness absence rate higher than 35% No monthly review of key quality indicators by peers (eg peer review or governance team meetings) Planned annual appraisals not performed No involvement in Trust-wide multi-disciplinary meetings No formal feedback obtained from patients during the month (eg questionnaires or surveys) or more formal complaints in a month (wards) or 3 or more (A&E or OPD) or 1 or more (CCU & ICU) No evidence of resolution to recurring themes May 2015 Public Board

19 Unusual demands on service exceeding capacity to deliver (eg national targets, outbreak) Hand hygiene audits not performed or compliance level below 95% Cleanliness audits not performed or compliance level below 95% Ward/department appears cluttered and untidy No evidence of effective multidisciplinary/multi-professional team working Ongoing investigation or disciplinary investigation (including RCA's & infection control RCA's) TOTAL February 2015 Score January 2015 Score 0 December 2014 Score November 2014 Score October 2014 Score Average Monthly Score for the last Six Months Denotes wards with a total score of 12 or more Denotes the highest scoring wards and issues May 2015 Public Board

20 APPENDIX 4 QUALITY, EFFECTIVENESS AND SAFETY TRIGGER TOOL COMMENTS ON RETURNS RECEIVED FROM WARDS FOR MARCH 2015 Ward Ash Bridgwater Waverley Burnham on Sea Chard Crewkerne Dene Barton Luke Dene Barton Comments New members of the team have recently started; this will help support the Safer Staffing There continues to be some short term sickness along with long term sickness Band 5 vacancies WTE 715, Band 2 vacancies WTE 381 Appointed WTE 20 Band 5 to commence July 2015 and one Band 5 preceptorship to commence end May 2015 Out to advertisement for Band 5 vacancies and in process of interviewing for Band 2 Sickness rate remains high due to recent Norovirus resulting in staff being off sick Our sickness absence rate is 83% with long term sickness We have 359 RGN vacancies plus 2X 375 RGNs who are on secondments We are interviewing on 2 April 2015 for RGNs We have recently recruited three HCAs and are now up to full establishment We have not been able to meet our Safer Staffing of three RGNs for all early and late shifts, but have managed to achieve two RGNs on all shifts with HCAs backfilling the shortfalls to support the RGNs to ensure patient safety, risk assessments in place Due to our high number of vacancies, long term sick and secondments we have had a high use of agency to achieve two RGNs on all shifts, especially for night cover We have RGN vacancies of 471 WTE and one WTE on maternity leave, these shifts are being covered by a mixture of excess hours, bank and agency Recruitment is ongoing We also have a 032 WTE HCA on maternity leave and we covering their shifts with bank Overall staff sickness is 887%, this is split between RGNs 1451% and HCAs 04% Safer Staffing levels have generally been met by the use of bank staff, there has been very minimal use of agency Sickness for clinical staff is below 35% but higher for other staff Currently closed May 2015 Public Board

21 Ward Comments Lydeard Frome Marshfield Holford Fully recruited to RGN vacancies (not yet in post) Fully recruited to HCA vacancies (not yet in post) [1] Vacancies: All HCA/Activity Support Workers appointed now started Some long term sickness leaving only 1 WTE of 34 WTE establishment for service assistants Agency block booking for three weeks agreed by Head of Service (HOD) Effectively five RMN vacancies now RMN advertisement kept rolling as no applicants arrived for interview out of five shortlisted Six shortlisted for next interviews in end of April 2015 Due to shortage of RMNs risk assessment tool developed for managing against Safer Staffing figures With recent further reduction we have agreed with HOD and Head of Mental Health Nursing to block book two agency RMNs to ensure we have two RMNs at night meeting Safer Staffing requirements and maintain consistency [2] Increase in sickness this month with a rolling 12 month cumulative rate of 598% at the end of January 2015 Magnolia Staffing and recruitment remain the biggest challenge during the month of March 2015 The ward establishment for Band 5 is 1023 WTE, current vacancies 35 WTE Despite numerous rounds of advertisements and shortlisting uptake of interview offers has been poor Two Band 5 interviews are scheduled for 8 April 2015 The impact of this shortfall of RMNs is being covered by the Deputy Manager working more clinical shifts than usual, the Ward Manager covering some clinical shifts and use of agency RMNs who cover particularly night shifts Safer Staffing risk assessment completed with Head of Mental Health and forwarded as a potential corporate risk Block agency contract has been negotiated for RMN cover which will help support the ward in the interim Over recruiting into Band 3 posts has also been agreed and is being sought Other Band 5's are picking up additional shifts on bank but this needs to be carefully managed to ensure these staff do not become burnt out/overtired due to the extra hours worked Sickness remains way above 35% There has been a significant amount of short term sickness during the month Multidisciplinary team working continues and patient May 2015 Public Board

22 Ward Comments feedback is received through the Have Your Say Meetings and also via the Friends and Family Test 100% of respondents of the Friends and Family Test said they were extremely likely to recommend Magnolia ward Minehead Exmoor Pyrland Rowan Rydon Shepton Mallet Total 1425 RGN hours vacant and out to advertisement No response from rolling advert that has been out since September 2014 One interview planned but candidate did not turn up HCA returned from long term sick back on staged return Using bank and agency to cover all shifts Vacancy rate for RMN remains high and recruitment is slow All vacant shifts are being covered by either bank or agency There are no HCA vacancies The recruitment advertisement has been reviewed and plans to recruit locally as well as on NHS Jobs The ward staff will be attending student day to promote Pyrland in May 2015 Sickness has increased and being closely monitored by the ward manager and HR The HR sickness rate report for March 2015 is awaited We currently have no one on long term sick and general use of bank would suggest that this remains low We had our PLACE inspection during this month and the initial feedback from the Governors was excellent in particular around out recruitment, retention and positive fulfilled staff All audits have been completed to a satisfactory level Training rates remain very good and we were reported as having 98% staff up to date with mandatory training in February 2015 The ward continues to have nine WTE vacancies across both wards However have successfully appointed two HCA, with anticipated start dates of early May 2015The Ward continues to shortlist for RMN vacancies via the Trust recruitment campaign Sickness absence remains above 35%, Long term sickness absence has increased Acting Ward Sister in post covering maternity leave RGNs on maternity leave due to return September 2015, and other vacancies including extra required for core staffing requirements Due to the Early Supported Discharge (ESD) project temporary ring-fencing of beds has meant staffing was risk assessed as OK The pressure on bed occupancy has eased over the past few weeks and bed occupancy on the stroke unit has May 2015 Public Board

23 Ward Comments reduced during March 2015 South Petherton Registered Nurse vacancy 52 WTE with 08 starting 22 June 2015 and 20 WTE starting 1 October 2015 Actual hours down currently 300 per week Bank and agency used daily to make up shortfall Staff Nurse interviews due to be held 9 April 2015 We are managing a minimum of two on all shifts with bank and agency usage Acting Sister appointed until 12 April 2015 The ongoing situation with staffing/recruitment is discussed regularly with the Deputy Head of Division and closely monitored Length of stay has improved slightly 15 WTE HCA vacancy; interviews 8 April 2015 St Andrews Wellington Wessex House West Mendip Abbey West Mendip Cathedral Ongoing work with HR to manage sickness in the team I currently have band 5 vacancies of 395 WTE, this is due to the Safer staffing increases, I have VRF approval for these hours and they will be going out to advertisement These hours are currently being filled with bank/agency and staff from Dene Barton Community Hospital There is no long term sick within the nursing staff Sickness rate has increased over the past month However, this is mostly down to physical health problems such as broken limbs We are currently reviewing questionnaires and information given out to young people and their family/carers on admission, discharge and throughout admission to make sure that feedback aimed at improving the service we offer is received back Senior Sister on Cathedral acting up to cover until new Matron starts Band 6 covering both wards with support from Acting Matron, small amounts of long term sick currently Due to extra beds being opened on Cathedral, high number of bank/agency staff to ensure Safer Staffing but having impact on substantive staff All RGN VRFs approved, two WTE RGNs appointed but unable to start until June 2015 Refer to further comments within Cathedral ward section Senior Sister on Cathedral acting up to cover until new Matron starts Band 6 covering both wards with support from Acting Matron Due to extra beds being opened on Cathedral, high number of bank/agency staff to ensure Safer Staffing but having impact on substantive staff All RGN VRFs approved, advertisements out but very little May 2015 Public Board

24 Ward Comments applications Concerned for RN staffing levels from April 2015 onwards if extra beds remain open as will not have enough RGNs to cover shifts across both wards due to high vacancy factor We have Staff Nurses leaving, some due to retirement One RGN appointed recently from a Nursing Home background, is now leaving as offered a higher salary to return to previous employer Unable to compete against this New matron starting on 20th April 2015 Williton 36 WTE Band 5 staff started March 2015 A further 06 WTE recruited and starting 27 April 2015 Rolling recruitment advertisement o going for remaining 262 WTE vacancies Unfilled shifts covered throughout March 2015 by staff bank, excess hours or agency, to assist staffing to reach Safer Staffing requirements Escalation plan in place if the need to open further beds is required Willow Sickness rate is at 57% for March WTE Staff Nurse vacancies One has been filled from recent interview but they are awaiting their pin, so are currently not in post Wincanton Athlone See Hadspen for vacancy position Higher bed occupancy and demand remained throughout month and set to continue Wincanton Hadspen Ward remains a 16 bedded unit in line with increased demand, seven beds filled at time of writing Using bank and agency on a daily basis to achieve Safer Staffing Current vacancies - 28 WTE Band 5 06 WTE HCA out to advertisements Daily board rounds continue, sometimes without rehab staff May 2015 Public Board

25 Safer Staffing APPENDIX 5 1 April until 30 April 2015 Nurse Staff Cover HCA Staff Cover Reason Action Impact Comments Day Night Day Night Ash Ward 867% 1333% Improved March (597% RMN nights) Rydon 797% 1171% Previously above 80% Chard Hospital 783% 1156% 359 WTE RGN vacancies Crewkerne Hospital 717% Frome Community Hospital Shepton Mallet Hospital 800% 744% South Petherton 806% Wincanton (Hadspen Ward) 100 WTE RGN seconded to another role 1283% 471 WTE RGN vacancies 10 WTE RGN maternity leave Bank and agency workforce utilised Risk assessed each shift Bank and agency workforce utilised Reduced access to RGN and reduced time to care Minimised due to temporary workforce Reduced access to RGN No significant concerns raised Improved - March (742% RGN day) Deteriorated - March (737% RGN day) Risk assessed each shift 1190% Improved - March (774% RGN day) 1017% 34 WTE RGN vacancies plus 20 WTE maternity leave Reduced number of stroke patients Reduced access to RGN Improved - March (742% RGN day) Minimised due to temporary workforce 1317% Improved - March (726% RGN day) 733% 1317% 54 WTE RGN vacancies Number of empty beds during reporting period Risk Assessed each shift Reduced access to RGN Matron and Ward Sister worked clinically where there were shortfalls Improved March (688% RGN day) May 2015 Public Board

26 Staff worked flexibly across both wards May 2015 Public Board

27 APPENDIX 6 SOMERSET PARTNERSHIP NHS Foundation trust Safer Staffing Compliance Rates Reporting Period 1 to 30 April 2015 Per DOH Submission Standards Site Name Day Average fill rate - registered nurses/midwives (%) Average fill rate - care staff (%) Night Average fill rate - registered nurses/midwives (%) Average fill rate - care staff (%) Ash Ward 983% 1062% 867% 1333% Bridgwater 820% 1039% 1000% 1078% Burnham-on-Sea 894% 1029% 1000% 1000% Chard 783% 1156% 1000% 1017% Crewkerne 717% 1283% 983% 1017% Dene Barton - Luke 989% 876% 1067% 903% Frome 800% 1192% 933% 1200% Holford 873% 1128% 1000% 1056% Magnolia 958% 958% 1017% 1000% Minehead 1000% 993% 933% 983% Pyrland Ward % 1044% 1000% 2067% Pyrland Ward 2 992% 1408% 1000% 1683% Rowan 872% 972% 983% 1017% Rydon 797% 1171% 833% 1317% Shepton Mallet 744% 1017% 1000% 1000% South Petherton 806% 1317% 1000% 1000% St Andrews 992% 1106% 1000% 1033% Wellington 983% 967% 1000% 983% Wessex House 937% 856% 915% 958% West Mendip 947% 993% 1200% 1033% Williton 867% 1004% 967% 922% Willow 845% 1533% 1000% 1000% Wincanton - Athlone 1017% 1000% 967% 583% Wincanton - Hadspen 733% 1317% 717% 1533% TRUSTWIDE 875% 1088% 971% 1081% 100%+ >=80% and <100% <80% May 2015 Public Board

28 Ash, Bridgwater Bridgwater Waverley Burnham on Sea Chard Crewkerne Dene Barton Luke Dene Barton Lydeard Frome Holford, Taunton Magnolia, Yeovil Minehead Exmoor Pyrland, Taunton Rowan, Yeovil Rydon, Taunton Shepton Mallet St Andrews, Wells South Petherton Wellington Wessex House, Bridgwater West Mendip Abbey West Mendip Cathedral Williton Willow, Bridgwater Wincanton Athlone Wincanton Hadspen Average March 2015 Score February 2015 Score January 2015 Score December 2014 Score November 2014 Score Av Monthly Score for last Six Months G SOMERSET PARTNERSHIP NHS FOUNDATION TRUST QUALITY, EFFECTIVENESS AND SAFETY TRIGGER TOOL: WARD SUMMARY FOR APRIL 2015 APPENDIX 7 Criterion New or no line manager in post (within last 6 months) Vacancy rate higher than 3% Unfilled shifts is higher than 6% Sickness absence rate higher than 35% No monthly review of key quality indicators by peers (eg peer review or governance team meetings) Planned annual appraisals not performed No involvement in Trust-wide multidisciplinary meetings No formal feedback obtained from patients during the month (eg questionnaires or surveys) 2 or more formal complaints in a month (wards) or 3 or more (A&E or OPD) or 1 or more (CCU & ICU) No evidence of resolution to recurring themes May 2015 Public Board

29 Unusual demands on service exceeding capacity to deliver (eg national targets, outbreak) Hand hygiene audits not performed or compliance level below 95% Cleanliness audits not performed or compliance level below 95% Ward/department appears cluttered and untidy No evidence of effective multidisciplinary/multi-professional team working Ongoing investigation or disciplinary investigation (including RCA's & infection control RCA's) TOTAL March 2015 Score # February 2015 Score # January 2015 Score # December 2014 Score # November 2014 Score # Average Monthly Score for the last Six Months # Denotes wards with a total score of 12 or more Denotes the highest scoring wards and issues ## # # # # # # # # # # # # # # # # # # # # # # # # # May 2015 Public Board

30 APPENDIX 8 QUALITY, EFFECTIVENESS AND SAFETY TRIGGER TOOL COMMENTS ON RETURNS RECEIVED FROM WARDS FOR APRIL 2015 Ward Ash Bridgwater Waverley Burnham on Sea Chard Crewkerne Dene Barton Luke Dene Barton Lydeard Comments Both short term and long term sickness continue Band 5 vacancies 667 WTE with one preceptorship nurse starting June 2015 However, a further 18 WTE leaving at the end of June 2015 Rolling advertisement out on NHS jobs Also vacancies of 50 WTE Band 2, with interview planned Senior Sister previously on secondment now recruited substantively 28WTE Band 5 vacancies Sickness rate was at 655% Our sickness absence rate is 103% To meet our Safer Staffing levels we have 359 RGN vacancies plus 2X 375 RGNs who are on secondments Recently we have recruited three HCAs and are now up to full establishment We have not been able to meet our Safer Staffing of three RGNs for all early and late shifts but have managed to achieve two RGNs on all shifts with HCAs backfilling the shortfalls to support the RGNs to ensure patient safety, risk assessments in place Due to our high number of vacancies, long term sick and secondments we have had a high use of agency to achieve two RGNs on all shifts, especially for night cover RGN vacancies have increased to 479 WTE due to long term sick and a RGN leaving Recruitment is ongoing for these vacancies with bank, agency and overtime hours being used to cover Additionally 10 WTE RGN is on maternity leave due to return December 2015 HCA vacancy remains 032 WTE Overall staff sickness is 730%, Luke ward remained fully open with 19 inpatients during the month of April 2015 Safer Staffing levels have generally been met by the use of bank staff; there has been very minimal agency usage As reported in March 2015 sickness for clinical staff is below 35% Currently closed May 2015 Public Board

31 Ward Frome Marshfield Holford Magnolia Minehead Exmoor Comments Fully recruited to RGN vacancies although not yet in post [1] Vacancies: 50WTE RMN vacancies This will increase to 60WTE with a Band 6 RMN wishing to retire on 31 July 2015 RMN advertisement to keep rolling No short listed applicants arrived for two sets of RMN interviews One RMN appointed who is transferring from Ash ward Due to shortage of RMNs risk assessment tool developed for managing against Safer Staffing figures We have agreed with Head of Division (HOD)and Head of Mental Health Nursing to block book two agency RMNs to ensure we have two RMNs at night meeting Safer Staffing requirements and maintain consistency Meeting with HOD to investigate options to manage current staffing [2] Increase in sickness this month with a Rolling 12 month cumulative rate of 919% at the end of March 2015 Staffing and recruitment remain the biggest challenge during the month of April 2015 There ward establishment for Band 5 is 1023 WTE current vacancies 45 WTE This means there is a 44% shortfall in Band 5 nurses on the ward This is despite proactive recruitment on going since June 2014, with numerous rounds of advertisement Shortlisting uptake of interview offers has been poor One WTE Band 5 post has been recruited into and 06 WTE Band 5 will return on 8 June 2015 after retiring from a full time post at the end of April 2015 The impact of this shortfall of RMNs is being covered by the Deputy Manager working more clinical shifts than usual, the Ward Manager covering some clinical shifts and use of agency RMNs who cover particularly night shifts Safer Staffing risk assessment complete Block agency contract has been negotiated for RMN cover which will help support the ward in the interim Over recruiting into Band 3 posts has also been agreed, with interviews planned for 6 May 2015 Multidisciplinary team working continues and patient feedback is received through the Have Your Say meetings and also via the Friends and Family Test 100% of respondents of the Friends and Family Test said they were extremely likely to recommend Magnolia ward Total 1425 RGN hours vacant and out to advertisement No response from rolling advertisement that has been out since September 2014, new advert produced and posted to encourage interest 30 hour HCA vacancy waiting May 2015 Public Board

32 Ward Comments VRF approval Using bank and agency to cover all shifts Pyrland Rowan Rydon Shepton Mallet South Petherton Vacancy rate for RN remains high Recently appointed two RGN However, have received notice from one Staff Nurse who is due to leave in June 2015 to join the local Community Mental Health Team Working with bank/agency co-coordinator and have arranged block contract with local agency From 1 May 2015 both wards are now reporting Safer Staffing levels at original agree levels and not interim levels Sickness has reduced to 327% which is a substantial reduction The sickness rate for March 2015 was 377% with a cumulative rate of 392% over a 12 month rolling period There are currently no members of staff on long term sick We will interview for one of our Band 6 posts in early May 2015 and have filled our Staff Nurse posts with two newly qualified nurses who start in August Although new Manager in post on ward 2 the previous Deputy Manager continues to work on ward 1 2 The ward continues to have RMN vacancies and the ward continue to shortlist for vacancies via the Trust s recruitment campaign Two HCAs recruited and due to start by 1 June 2015, locum OT now in place until start date of newly qualified OT recruited Acting Ward Sister in post covering maternity leave Registered Nurse staffing remains a challenge, two WTE RGN on maternity leave due to return September 2015, and other vacancies including extra required for core staffing requirements Due to the Early Supported Discharge (ESD) project temporary ring-fencing of beds has meant staffing was risk assessed as OK 24 WTE Registered Nurses are starting within the next few weeks Registered Nurse vacancy 52 WTE with 08 WTE starting 22 June 2015 and 20 WTE starting October 2015 Actual hours down currently 300 per week Bank and agency used daily to make up shortfall Staff Nurse interviews in April 2015, two candidates wanted bank only For Safer Staffing levels we require three trained staff on each early and late shifts and we are managing a minimum of two on all shifts with bank and agency usage Acting Band 6 Sister extended until 30 September 2015 The ongoing situation with staffing/recruitment is discussed regularly with the Deputy Head of Division and closely monitored Length of stay has improved slightly May 2015 Public Board

33 Ward Comments 15 WTE HCA vacancy; interviews in April 2015 only wanted bank St Andrews Sickness level has dropped from 745% to 588% Ongoing work with HR to manage sickness in the team in order to improve it below 35% Wellington Wessex House West Mendip Abbey West Mendip Cathedral Williton Willow Wincanton Athlone There are currently vacancies of 495 WTE, due to Safer Staffing, this has gone out to advertisement and I am currently shortlisting for these posts I continue to rely on bank and agency to fill vacant posts I have had one Band 6 Staff Nurse leave at the end of March 2015, another who intends to hand in their notice beginning of May 2015 and another Band 6 Staff Nurse has accepted an offer of another post There is also one Band 5 Staff Nurse who is expected to hand in their notice Other nurses have stated that they are looking for other post as they are unable to get a work life balance with doing eight hour shifts and working five days All staff vacancies that have been identified have been recruited to (1WTE Band 5 and 28 WTE Band 2) New Matron started 20 April 2015 Bed occupancy currently remains at 20 beds Deescalation planned and dates for occurrence being reviewed All staff vacancies that have been identified have been recruited to (1WTE Band 5 and 28WTE Band 2) New Matron started 20 April 2015 A further 08 WTE appointed during April 2015 leaving 16 WTE Band 5 vacancies A final year student has expressed a wish to commence employment with the Trust and this is currently being addressed but will be dependent on passing their final assessment Increased sickness this month Sickness rate is currently at 78% 20 WTE Staff Nurse vacancies 18 WTE have been filled from interview but they are awaiting their PIN so are currently not in post See Hadspen for vacancy position Higher bed occupancy and demand remained throughout month Commencing de-escalation at beginning of March 2015, starting with re-aligning the male/female wards Athlone has ten available beds, eight filled at time of completing EWTT May 2015 Public Board

34 Ward Wincanton Hadspen Comments Ward remains a 16 bedded unit in line with increased demand, Currently 16 beds in use Using bank and agency on a daily basis to achieve Safer Staffing on current bed numbers Current vacancies of 28 WTE Band 5 and 06 WTE HCA Currently out to advertisement currently, recruitment continues Daily board rounds continue, rehab involvement remains sporadic upon the ward, which hinders discharge plans Wards realigned to male/ female split May 2015 Public Board

35 Links to Strategic Themes: [Identify to which of the Somerset Partnership NHS Foundation Trust strategic themes this report relates by including a cross behind the relevant theme(s)] Quality and Safety Viability and Growth Service Delivery Innovation Integration Culture and People Links to the Assurance Framework: Links to the NHS Constitution and Trust Values: Links to CQC Domains: Annual Objective Six Implementing a rolling review of inpatient nurse establishments to continuously improve the ratios of staffing levels on each ward by shift Working together for patients Respect and dignity Commitment to quality of care Compassion Improving lives Everyone counts [Identify which of the CQC domains are covered by this report by including a cross behind the relevant domain(s)] Is it safe? Is it well-led? Is it caring? Is it effective? Is it responsive to people s needs? Legal or statutory implications/ requirements: How to ensure you have the right people with the right skills are in the right place at the right time A Guide to Nursing, Midwifery and Care Staffing Capacity and Capability NHS England 2013 Public/Staff Involvement History: Previous Consideration: Ward staff are actively involved in submitting daily shift performance data together with assessing the impact and risk of any shortfalls The Trust board approved the Safer Staffing Establishments at the May 2014 Trust board meeting May 2015 Public Board