UPDATE REPORT ON ERADICATING NURSING AGENCY UTILISATION WITHIN THE HEALTH BOARD. Executive Director of Nursing

Transcription

1 AGENDA ITEM May 2011 UPDATE REPORT ON ERADICATING NURSING AGENCY UTILISATION WITHIN THE HEALTH BOARD Report of Paper prepared by Executive Director of Nursing Assistant Director of Nursing Executive Summary This report provides an update on the actions put in place to deliver the objective of eradicating nursing agency utilisation within the UHB. An update report on the progress made since February 2011against the overarching NSFG Corporate action plan is provided for the Committee within a separate report. During the last month each Division has worked on the development of a detailed plan outlining the specific Divisional activity being put in place to support the cessation of nursing agency utilisation. Three key areas of activity which will support a reduction in utilisation of nursing agencies have been identified: Recruitment against agreed establishments On-going recruitment to the UHB Nurse Bank Roll out and full implementation within Divisions of the electronic rostering system, Rosterpro Update Report on Eradicating Nursing Agency Page 1 of 37 Workforce and OD Committee

2 Agreement of a UHB Capacity Plan is also a vital step towards enabling Divisions to map staffing requirements against service delivery demands. A Capacity Plan has now been developed and Divisional staffing requirements are being worked through so that short notice additional capacity demands can be avoided thereby reducing reliance on high cost nursing agency utilisation. Whilst the general focus of NSFG continues to ensure that nursing and midwifery resources are safely and effectively deployed, renewed effort is being given to eradicating nursing agency utilisation. The end of year position for 2010/2011 demonstrates an overall reduction in expenditure on temporary staffing, a significant achievement during a year which has seen unprecedented service pressures resulting in high levels of demand for additional capacity. A high level of scrutiny continues on nursing agency and bank utilisation through a weekly review of activity by the Executive Director of Nursing and Divisional Nurses. Scrutiny against the Divisional action plans associated with eradicating agency utilisation will now take place through the recently introduced Divisional Performance Review process. Action/Decision required Link to other Board Committee (s) and subcommittees To note the progress made to date and the action proposed. The report relates to the work of the Nursing Financial Sustainability Group which reports to the Workforce and OD Committee. Update Report on Eradicating Nursing Agency Page 2 of 37 Workforce and OD Committee

3 Link to Standards for Health Services in Wales Link to Public Health Agenda Link to UHB Strategic Direction and Corporate Objectives / Legislative and Regulatory Framework The principle standard to which this work is linked is Healthcare Standard 1. Effective deployment of nursing and midwifery resources supports delivery of care, treatment and prevention approaches which underpin the delivery of the Public Health agenda. The work of the Nursing Finance Sustainability Group is aligned with the workforce and finance agendas. The development of a sustainable nursing workforce also contributes to the delivery of safe, effective and efficient quality care for patients. Link to relevant evidence base National Audit Office 2006 Good practice in managing the use of temporary nursing staff. Update Report on Eradicating Nursing Agency Page 3 of 37 Workforce and OD Committee

4 UPDATE REPORT ON ERADICATING NURSING AGENCY UTILISATION WITHIN THE HEALTH BOARD INTRODUCTION The Nursing Financial Sustainability Group (NFSG), which meets on a monthly basis, chaired by the Executive Director of Nursing, continues to review and monitor nursing workforce requirements with a particular focus on the utilisation and deployment of temporary nurse staffing. The Corporate NFSG action plan provides a work plan for the group, one objective of the action plan being the reduction on reliance on temporary staffing, in particular high cost agency utilisation whilst delivering safe, effective patient care. This report provides an update on the progress of the actions identified in relation to eradication of nursing agency utilisation and the Committee is asked to note the progress made to date and the actions proposed during the coming year. BACKGROUND At the Workforce and Organisational Development (WOD) Committee meeting in February 2011 a report was presented on the approach being led by the NFSG to support eradication of the utilisation of nursing agencies within the UHB. Following discussion at the meeting it was agreed that an update report outlining more detailed actions to achieve a position of non utilisation of nursing agencies should be presented to the May 2011 Committee meeting. It was noted that this objective may not be achievable in all areas of the UHB and that differing time frames, through phased implementation, would be required. At the last WOD meeting it was recognised that a number of factors impact upon continued reliance upon high cost temporary nurse staffing options: Ability to recruit against agreed establishments Ability to recruit sufficient numbers of appropriately skilled and qualified staff to the UHB Nurse Bank Update Report on Eradicating Nursing Agency Page 4 of 37 Workforce and OD Committee

5 Roll out and full implementation within Divisions of the electronic rostering system, Rosterpro Levels of activity associated with specialling for patients requiring additional nursing support due to their clinical condition Level of additional capacity requirements within the UHB to meet need It was also recognised by the WOD Committee that patient care and safety must remain paramount in all decisions associated with nurse staffing arrangements. ACTIONS PROGRESSED TO DATE The NFSG has continued to meet monthly since the last report to the Committee in February Renewed focus has been given to the actions which will support the cessation of nursing agency utilisation and as such Divisions have been tasked with producing action plans detailing the steps to be taken to achieve this objective. The Divisional action plans are attached as appendix 1. In line with the influencing factors on agency utilisation identified above the following activity has taken place during the last two months: Vacancy scrutiny and recruitment to agreed establishment levels is being progressed and monitored. Further work is required to finalise community nursing establishments and this will be undertaken in line with the All-Wales Community Nursing Strategy although it should be noted that with the exception of one individual care package agency is not utilised within the community nursing setting. Recruitment to the UHB Nurse bank continues to grow supporting reduced reliance on high cost agencies. Since February a total of 378 staff have been recruited to the Bank Department in addition to the existing bank register: a further 161 unregistered (Healthcare Support Workers) and an additional 217 registered nurses. Of the 378 staff recruited 78 have been external applicants and 300 internal UHB staff. Steps have also been taken to enable newly registered nurses who have yet to secure a contract of employment to join the UHB Nurse Update Report on Eradicating Nursing Agency Page 5 of 37 Workforce and OD Committee

6 Bank. This has required the identification of a sponsor ward and establishment of an alternative approach to preceptorship arrangements. Whilst this provides valuable work opportunities for individual registered nurses it also supports the overall approach of increasing capacity within the Nurse Bank. To date a total of 5 sponsor placements have been identified for the 5 newly registered nurses that have enrolled on the UHB Nurse Bank. Bank fill rates and agency utilisation continues to be scrutinised on a weekly basis as well as daily reporting to Divisions of any breaches of utilisation of non-contract nursing agencies (Thornbury). Table 1 below identifies the last three months noncontract agency utilisation (Thornbury) which demonstrates a significant reduction in utilisation in April 2011, the date at which the Divisional action plans came into effect. Table 1: Thornbury Nursing Agency Utilisation February April 2011 DIVISION FEB 2011 MARCH 2011 APRIL 2011 Medicine Surgery Specialist Services Mental Health Children & Women Primary, Community & OPAIC Individual Patient Package TOTAL Table 2a, below identifies the impact of opening additional capacity on temporary staffing requirements during February and March April 2011 figures are not yet validated. Update Report on Eradicating Nursing Agency Page 6 of 37 Workforce and OD Committee

7 Table 2: Staffing Associated with Additional Capacity - February and March 2011 Temporary Staffing Type Number of Shifts Feb Number of Shifts March Hours worked Feb Hours Worked March WTE Feb WTE March Bank Nurse Contracted Agency Nurse Thornbury Nurse TOTAL Rosterpro continues to be rolled out within wards across the UHB and a business case has been developed to support a system upgrade which will maximise opportunities for effective rostering. Upgrade and implementation of this system is a key enabler to achieving effective deployment of nurse staffing across the UHB and must therefore be seen as an integral part of the actions required to reduce reliance on high cost agency utilisation. The Rosterpro team has reported that good progress is being made on roll out of the system in line with the implementation plan with 4134 staff currently being rostered via Rosterpro at the end of March The Nurse Bank Department also uses Rosterpro to record and pay staff: in March 840 bank nurses were paid for a total of 4,319 shifts. Work is continuing to ensure full roll out and implementation of the system within all nursing departments by This is subject to change depending upon the outcome of the Rosterpro business case. It should be noted that with regard to specialling activity this has not been built into the core staffing establishments recently signed off at Divisional level. As such staffing associated with specialling is often supplementary to the agreed nursing establishment frequently requiring agency utilisation given the unpredictable nature of such requests. Specialling is being monitored closely within each Division and also at the weekly meeting with the Executive Director of Nursing: the UHB Specialling Assessment Tool was recently launched at the Carefully Does It event held on 4 th April and implementation of the tool is being monitored. The Nurse Bank Department is supporting the monitoring arrangement by seeking confirmation that the assessment has been completed Update Report on Eradicating Nursing Agency Page 7 of 37 Workforce and OD Committee

8 whenever a request for additional staffing is made for specialling. This approach also ensures that the most appropriate member of nursing staff is requested and deployed to cover this particular staffing requirement. Wherever possible staff are provided via the Nurse Bank although to meet both the level of demand associated with specialling and the identified individual patient need, additional Registered Mental Health Nurses and skilled Health Care Support Workers are required to be enrolled with the Nurse Bank Department. Failure to recruit additional numbers of Registered Mental Health Nurses (RMNs) will result in continued reliance on nursing agencies: it must be recognised that RMNs and dual qualified staff are in limited supply across the UK. Divisional action plans focused on eradicating the use of nursing agencies have been drafted. The plans identify a range of actions which are being put in place throughout the period 2011/2012: wherever possible Divisions have identified actions which will impact upon specific clinical areas utilisation of agency nursing. It is important to note that the Divisional plans are based upon existing and any planned, agreed changes to capacity and activity. The development and implementation of the capacity plan is fundamental to the achievement of the objective of significantly reducing reliance on high cost agency utilisation: eradication of nursing agency will only be achieved if staffing establishments are implemented in line with the agreed capacity plan and activity levels. CONCLUSION The objective of eradicating nursing agency utilisation within the Health Board is challenging and will not be achieved in the short term. Ensuring that nursing and midwifery resources are deployed so that patient care can be delivered safely, effectively and in a dignified way remains a priority and as such it is essential that a phased approach to reducing reliance on nursing agency provision is put in place. It is believed that the steps identified within the Divisional draft action plans represent a realistic and achievable approach but one that will need to be worked at and closely scrutinised throughout 2011/2012. Scrutiny will be provided at the NSFG and through the Divisional Performance Review process. Update Report on Eradicating Nursing Agency Page 8 of 37 Workforce and OD Committee

9 It is recognised that the opportunity of reducing and avoiding expenditure on high cost agency is influenced by service activity, notably the demand for additional capacity associated with patient flow and clinical need (specialling). The development of the UHB Capacity Plan is an important step forward and work now needs to be undertaken to ensure that staffing requirements are mapped and signed off against the plan. Corporately work will need to be continued in developing a sustainable Nurse Bank which can be responsive to service needs and pressures. Likewise the roll out and full implementation of Rosterpro is a key enabler to ensuring that the nursing workforce are effectively and efficiently deployed. RECOMMENDATION The Workforce and OD Committee is asked to: NOTE this report and support the approach being progressed. IMPACT ASSESSMENT Health Improvement Workforce Education and Training Financial Reducing and eradicating the use of high cost agency will enable the UHB to utilise resources more effectively to meet the health needs of the population. Reducing reliance on high cost agency requires continued recruitment of both internal and external UHB staff to the Nurse Bank. Staff recruited to the UHB Nurse Bank will receive statutory and competency training in line with UHB requirements. This training will be provided within existing resources through inhouse UHB programmes. Reducing reliance on high cost temporary staffing solutions such as nursing agencies will have a positive impact leading to improved efficiency in the use of resources. Update Report on Eradicating Nursing Agency Page 9 of 37 Workforce and OD Committee

10 Legal Equality Environmental To support achievement of the financial obligations of the UHB. Provides an equitable, consistent approach to addressing workforce issues across the UHB. Identification of improvement and action required at Divisional, Directorate and individual clinical areas levels. RISK ASSESSMENT Clinical/Service Financial Reputational Acronyms and abbreviations Sustainability of the nursing workforce is key to providing robust governance by addressing quality and safety, efficiency and effectiveness at ward/team level through to Divisional level. Medium risk associated with the achievement of the financial targets identified for the nursing workforce. An agreed and implemented capacity plan is an integral element of achieving reduction in spend on temporary staffing. Potential for adverse impact upon organisation reputation if sustainable, affordable staffing solutions are not implemented. NSFG - Nursing Financial Sustainability Group UHB - University Health Board Feb- February RMN- Registered Mental Health Nurse WOD- Workforce and Organisational Development Update Report on Eradicating Nursing Agency Page 10 of 37 Workforce and OD Committee

11 CONSULTATION AND ENGAGEMENT Staff representatives are in attendance at NFSG meetings and engagements takes place with key stakeholders in the appropriate forum as necessary e.g. Local Partnership Forum. Update Report on Eradicating Nursing Agency Page 11 of 37 Workforce and OD Committee

12 NURSING FINANCIAL SUSTAINABILITY PLAN Medicine Division - Implementation Plan April 2011 March 2012 A OBJECTIVE LEAD TIME SCALE TO AGREE APPROPRIATE AND SAFE NURSING ESTABLISHEMEMENTS FOR EACH WARD AREA 1. Review of the newly DN green By end implemented nursing LN Sept 11 establishments in the Medical SN Directorate clinical areas FA 2. To undertake review of the new roles and models within the new nursing establishment in the medical Directorate 3. To undertake a detailed review of the nursing establishment and rosters in the USC Directorate 4. Ensure back fill for maternity leave and some episodes of long term sickness SR/CN HW yellow By end Sept 11 DN LN SN FA SR/CN DN LN SN green green By end May 2011 From April 11 ACTION/PROGRESS To review the new establishments and rosters with each sister/charge nurse by September 2011 Helen Watkins Workforce Efficiency and OD to review: Ward coordinator role Night time pool Sister/Charge Nurse time to lead To review the rosters required for the nursing establishments: EU, Minors, MAU, SAU, MEAU, Barry MIU Senior nurses to populate the Divisional Maternity/LTS matrix. To be reviewed at Divisional Nursing PERFORMANCE MEASURE Elimination of agency and reduction of nurse bank/overtime Evaluation to determine actions for continuous improvement Elimination of agency and reduction of nurse bank/overtime Elimination of agency and reduction of nurse bank/overtime Update Report on Eradicating Nursing Agency Page 12 of 37 Workforce and OD Committee

13 5. Review of Nursing A4C bands: Develop and deliver the corporate implementation plan for all Divisions in the distribution of Band 6 and Band 5 nurses. 6. Agree establishments to implement UHB capacity plan. Recruitment to new capacity. FA SR/CN DN LN SN FA HR DN LN SN FA/HR SR/CN AMBER ON GOING FROM APRIL 2011 Establishment meeting authorise backfill arrangements To review and develop the Band 6 and Band 5 Job descriptions to determine role and responsibilities. Maintain Divisional data base to track changes of all band 6 posts conversion to band 5 posts to enable financial tracking Await final UHB capacity plan plan establishments for approval, recruitment and roster implementation 1 Band 6 deputy 2 Band 6 team leaders Additional Band 6 s for admission ward areas Elimination of agency and reduction of nurse bank/overtime Elimination of corridor waits in EU B ELIMINATE AGENCY & REDUCE TEMPORARY NURSING EXPENDITURE 7. Review of temporary staffing performance reports on weekly basis. Maintain Divisional controls for authorisation and review at nursing business meetings 8. Compliance with staff Redeployment and B&A algorithms DN LN/SN LN SN green Weekly Weekly business review meetings with Lead Nurses within Division Forecast risks and review nursing expenditure and agree actions to reduce spend green Daily Compliance monitored daily via Divisional matrix to track Bank/Agency/OT requests Reduction in nursing expenditure Elimination of agency Reduction of temporary nursing expenditure Reduction in nursing expenditure Elimination of agency Reduction of temporary nursing expenditure Update Report on Eradicating Nursing Agency Page 13 of 37 Workforce and OD Committee

14 C 9. Monitor Directorate sickness rates and impact on use of temporary staffing Review compliance of sickness management in all areas Review sickness audits Monitor staff on stages of sickness policy Implementation of Maximising Attendance Action Plan 10 Clinical areas to submit nurse bank requests 4 weeks in advance with planned off duty DN LN/SN SR/CN SN yellow From June 2010 Ensure sickness absence training for all Band 7 and deputies is achieved by September 11 Review Sickness Absence at Nursing business meetings, review cases and maximise opportunities supporting attendance /redeployment Completion of Divisional sickness data base for Long Term Sickness yellow Jan 11 To ensure that all planned off duty requests are submitted to nurse bank 4 weeks in advance via Roster Pro system 11 Band 7 JD for Nurse Bank SC Yellow May 11 Nurse Bank to finalise Band 7 JD to support USC with eliminating agency enable Band 7 nurse bank payments when a Band 7 shift is required RECRUITMENT AND WORKFORCE DEVELOPMENT 12 To work with Nurse Bank to increase the number of staff on Nurse Bank. To maximise the fill rate for Med/ USC to eliminate use of DN LN SN SH yellow From April 11 To maximise all opportunities for recruitment to the nurse bank to expand number of RN and HCSW available (including RMNs for patient supervision). Reduction in nursing expenditure Elimination of agency Reduction of temporary nursing expenditure Compliance with Divisional Sickness Absence target 4.60% All clinical areas are compliant with submitting planned off duty - nurse bank requests 4 weeks in advance Elimination of agency Adequate numbers of staff to fill bank requests Elimination of agency Update Report on Eradicating Nursing Agency Page 14 of 37 Workforce and OD Committee

15 agency. To proactively book nurse bank shifts to cover Bank Holiday periods Nurse bank to undertake questionnaire with staff to explore reasons for failing to proactively plan when available for bank shifts Nurse Bank to explore new methods of seeking staff availability and proactive planning for roster cover (texting, e mail, roster pro, advertise in ward areas) 13Ensure timely nurse recruitment process to eliminate unnecessary use of temporary staff 14 To advertise nursing posts to recruit to the Directorate rather than to specific ward areas to encourage staff rotation and development of skills across all wards. Encourage part time staff 15 To develop training programme for Medical Division for staff working as part of the night time pool. HRM DN LN/SN LN SN LN SN GREEN green yellow ON GOING Nurse Bank to work with Divisions to plan nurse bank bookings for BH periods Timely submission of VAC 1s for consideration & scrutiny to avoid use of temporary staff Ongoing Lead Nurse and Senior Nurses to plan workforce and recruitment to meet the Directorate needs. Encourage recruitment of part time staff to develop flexible workforce re short term back fill From May 11 To work with training and mental health to develop skills re dementia care & liaison. Cohort patients re supervision needs as appropriate Apply supervision risk assessment No delays in nurse recruitment timescales avoidance of agency staff or overtime Contracts issues for Directorate posts Eliminate agency and reduce temporary staffing Update Report on Eradicating Nursing Agency Page 15 of 37 Workforce and OD Committee

16 16 Undertake a review of HCSW roles in the Division to determine equity and role, training needs and maximise potential for A4C KSF D EFFICIENCY & EFFECTIVENSS 17 Ward sisters/charge Nurses to attend Divisional Finance/Operational planning training role requirement and responsibilities LN SN Trainin g nurse LN SN yellow yellow From Sept 2011 From April 11 tool UHB wide JDs agreed To review HCSW role across the Medical and Unscheduled Care Directorates. Maximise training and competency development re direct patient care and care of the environment /equipment Divisional Nurse, Accountants, Lead Nurse and Senior Nurses to promote the learning and messages from the training programme with Band 7s to promote accountability of budget management and implementation of the operational plan (Service, workforce and financial) KSF and PDAR to determine achievement of competencies All Band 7s in Medicine and USC (line managers) to attend Financial training sessions 18 Review of shift patterns and shift principles across Division and UHB to ensure consistency, staff welfare and value 19 To run reports directly from Roster Pro to monitor nursing establishment, forecasting and review of rosters to inform DN LN SN SH DN LN SN amber yellow From Sept 2011 To review shift patterns To review current and develop proposal for standardised shift principles across the UHB (shift length, break allocation etc). Development of UHB rostering policy. Monitor trends of sickness absence re shift patterns in clinical areas October 2011 To work with the Roster Pro team to develop Divisional reports Standardisation of shift patterns and principles Access to Divisional Roster Pro reports Update Report on Eradicating Nursing Agency Page 16 of 37 Workforce and OD Committee

17 E actions for further reduction in expenditure Support pilot of e sickness reporting Module within the Division 20 Optimise nursing efficiency and effectiveness and direct care time by: The roll out of Transforming Care Compliance with PDDs and morning discharges Reduction in DTOC DETERMINE ROLE PURPOSE FROM CNS /NP REVIEW 21 Division to review Clinical Nurse Specialist (CNS) and Nurse Practitioner (NP). Support Setting the Direction. Ensure CNS/NP Outcome measures and activity is reported (annual report). HRM MR DN LN SN CD DD DN LN yellow amber By Dec 2011 From FEB 11 To await pilot evaluation and promote value of e sickness reporting to improve accuracy and timeliness of data reporting All Medical Wards to implement Transforming Care by end Dec 2011 All Medical Wards to demonstrate compliance with PDDs and 50% am discharges, and a reduction in DTOC To review CNS/NP roles job plans, role questionnaires. Identify posts to support working one day each month in a ward area. To consider Setting the Direction, Community Nursing Strategy, Post Registration Career Framework E sickness to inform live sickness absence reporting and management All wards compliant with implementation of TC, PDDs, am discharges and reduction in DTOC CNS review complete UHB consistency of roles Annual service reports Outcome measures reported key: DN Divisional Nurse; LN Lead Nurse; SN Senior Nurse; FA Finance Accountant; SR/CN Sister/Charge Nurse; HRM Hr Manager; MR Mandy Rayani; SC Sandra Coles; CD Clinical Director; DD Divisional Director Update Report on Eradicating Nursing Agency Page 17 of 37 Workforce and OD Committee

18 NURSING FINANCIAL SUSTAINABILITY GROUP Children & Women Services Division Nursing review & Use of bank/agency staffing action plan. April 2011 March 2012 ACTION LEAD TIMESCALE PROGRESS Child Health 1 Paediatric integrated medicine (Land and Ocean wards) 2 Paediatric Surgery/Haematology/oncology WH & KR WH& AG May 2011 Implementation plan in place Work in progress May 2011 to complete by June 2011 Implement seasonal establishments to reflect slightly reduced activity for 5 months between May and September Implementation plan has been agreed with the directorate and monitoring of seasonal establishment will be undertaken on a monthly basis as part of Divisional NMB Complete review of staffing in inpatient surgical and oncology services. 3 Paediatric and Neonatal Critical care services WH&MG Draft implementation plan for phased introduction in pace. May 2011 Increased flexibility across all 3 critical care areas already showing a major reduction in use of agency (1 shift in winter 2010/2011 as compared with 20 shifts in winter 2009/2010). Greater flexibility in progress to retain safe and minimum staffed beds for summer 5 month period. 4 Review of Paediatric Nurse pool WH & WR August 2011 Work underway but progress slow due to high levels of maternity leave over past 6 months. Update Report on Eradicating Nursing Agency Page 18 of 37 Workforce and OD Committee

19 5 Review of substantive staff joining nurse bank 6 Roll out of all areas on Rosterrpro from live rostering to link with R link Obstetrics & Gynaecology 1 Review midwifery workforce in line with latest birth rate plus 2 Discuss and actively encourage midwifery staff to join bank 3 Review of staffing in Gynaecology as part of a on site inpatient service 4 Review and agree a workforce model for women s health, including SARC, ISH 5 Roll out of all areas on Rosterrpro from live rostering to link with R link WH& SC DIV. GROUP JH/ MC& EF JH/ MC& EF ongoing August 2011 June 2011 June 2011 Historical use of bank/agency staff minimal. Work is underway with Sandra Coles with regards to encouraging substantive staff to join the bank over summer months. Divisional project group for 12months for full roll out in all areas in Division. Initial stages of review underway. Further details required on direct hands on care versus indirect care. Initial discussion with Sandra Coles re: marketing campaign. Numbers increasing and requires plan to be put in place. JH&DH August 2011 Initial stages of workforce plan being discussed. Current temporary spend on staffing is at band 2 and reflects vacancies held until new model agreed. JH&DH June 2011 Workforce modernisation underway in lie with changes to structures. DIV. GROUP October 2011 Divisional project group for 12months for full roll out in all areas in Division. N.B. Potential risks in Division: Increased usage of temporary staffing if seasonal establishments do not meet activity levels. Failure to recruit band 6 substantive staff onto bank, thereby necessitating the need of agency staff Update Report on Eradicating Nursing Agency Page 19 of 37 Workforce and OD Committee

20 Due to the nature of the work in C&W failure to recruit bank staff and difficulty in obtaining agency may result in reduced or closed services. Consideration Vacancies application, should eb accepted for recruitment after the Divisional scrutiny process has been met. The current process feels repetitive and unnecessary. JH - Jane Herve WH Wendy Herbert MC Mary Coakley MG Mary Glover EF Eiryls Ferris DH Denise Hancock SC Sandra Coles Update Report on Eradicating Nursing Agency Page 20 of 37 Workforce and OD Committee

21 NURSING FINANCIAL SUSTAINABILITY GROUP Specialist Services Division Plan to move to a Zero usage of Agency. April 2011 March 2012 ACTION LEAD TIMESCALE PROGRESS Review Nursing Establishment and Skill Mix and Recruitment on the Nurse Bank 1 Increase HCSW and RMN s to the Nurse Bank T4/B4/C4 SC MONTHLY TARGET 2 Increase internal application of staff to register on the Nurse Bank. Ward SC/CF IMMEDIATE Sisters to encourage application All areas 3 Block Booking look at organising block booking bank staff for Renal Transplant. Extra capacity. Contact NL to look at requirement- T5/B5 4 Consider optimum staffing of C4 Med beds view to substantive staffing C4 SC/NL IMMEDIATE Currently set at 40 per month training issues (and additional cost of recruitment could impact on this) List of staff currently registered on the bank has been sent to LNs and SNs, they will advertise the bank to other staff and encourage them to join if they wish to work extra hours CF/PL/BI MAY 11 Block booking of bank in place. Finance undertaking comparison of temp staff costs vs substantive staff costs. Finance has confirmed that substantive staffing is the most financially viable option. In order to ensure appropriate recruitment; staff Update Report on Eradicating Nursing Agency Page 21 of 37 Workforce and OD Committee

22 5 Consider block booking RMN s for neuro areas with the intention of reducing the need/reliance on agency staff for specialing. SC to determine numbers of RMN s on bank. Looking at potential plans to recruit RMN s to area for rotation - T4/B4/C4 6 Look at number of HCSW s on bank with MH/REACT training SC to determine this and look at training more staff - T4/B4/C4 7 Look at number of dual trained staff on bank RGN/RMN. Consider advertising for dual trained staff to join bank - T4/B4/C4 8 Scrutinise 4 weekly requests to improve planning and ensure appropriate timescales given to fill shifts with bank staff prior to utilising agency nurses. Feedback to be given to Divisional Nurse to identify clinical areas not working to this deadline All areas 9 Look at agency nurse usage reasons etc, to determine hotpsots and help with planning and recruiting of bank will be appointed to Specialist Services Division in permanent posts. When/if C4 med beds close staff will be moved to vacant Band 2 & 5 posts within the Division. SC/SM/CF END MAY Discussion with CB/LW in relation to having an RMN on site every shift has occurred. Finance is undertaking a costing exercise. SC END OF MAY Discussion re adding a MH HCSW to the pool has been had with CB/LW. Finance has been asked to cost. SC/CV HR have been requested to determine the number of dual trained staff LN/SC IMMEDIATE Discussed with LNs and SNs when SC attended SP S Nursing Board on SC IMMEDIATE Reports sent weekly Update Report on Eradicating Nursing Agency Page 22 of 37 Workforce and OD Committee

23 staff into specific areas All areas 10 Re-visit idea of Regional Critical Care Bank Dependant upon neighbouring Health Boards paying comparative rate on Nurse bank SC to determine plans for this - CC 11 Fully implement the agreed nursing establishments All areas 12 Process in place whereby LNs/SNs do not contact Div N for authorisation unless they have contacted their colleagues in other Directorates to look at flexible use of staff All areas 13 High levels of maternity leave particularly in CC, Haem and N&T 14 Modelling being undertaken with Cardiff University to determine optimum level of activity and therefore staffing for CC - CC SC/CF SEPT 11 Meeting arranged between CF C&V and NR AB to discuss taking this issue forward CF/LN This is continuing throughout the Division. LNS/SNS IMMEDIATE In place, process being formalised LN/CF IMMEDIATE Ongoing work with Finance to agree levels of recruitment that can be undertaken within resource DIVISION/DIR ECTORATE JUNE 11 Initial report received, further work required, next meeting 6th May Supporting Information. Authorisation process for agency is tight within the service further work is planned to highlight hotspot areas, reasons for usage and ways of increasing bank only nurses to work in these hotspot areas. Plans to highlight areas not planning rotas in advance, and these are to be addressed. Update Report on Eradicating Nursing Agency Page 23 of 37 Workforce and OD Committee

24 Neighbouring organisation now making plans to incorporate Agenda for Change pay rates within their Nurse Bank. Once the key issues have been addressed within the service, a reduction of contracted agencies is forecast. ACROYNMS NL Noreen Lewis SM Sean Murphy SC- Sandra Coles CF Carys Fox LN Lead Nurses SN Senior Nurses Update Report on Eradicating Nursing Agency Page 24 of 37 Workforce and OD Committee

25 NURSING FINANCIAL SUSTAINABILITY GROUP Mental Health Division Plan to move to a Zero usage of Agency. April 2011 March 2012 ACTION LEAD TIMESCALE PROGRESS Review Nursing Establishment and Skill Mix and Recruitment on the Nurse Bank 1 Increase HCSW and RMN s to the Nurse Bank SC MONTHLY To be monitored against agreed target. 2 Increase internal application of staff to register on the Nurse Bank. Ward Sisters to encourage application SC/HB IMMEDIATE 3 Any newly Qualified RMN s to be registered on the Bank and will be supported with mentorship via Mental Health Division 4 Review Block Booking & Pool within Mental Health Division SC/HB IMMEDIATE SC/HB APRIL/MAY 5 Review Nursing Establishments, Not all areas signed off at present. Key wards which are high agency users are HB COMPLETE BY MID APRIL Update Report on Eradicating Nursing Agency Page 25 of 37 Workforce and OD Committee

26 identified for an establishment uplift. These include West 1, West 4, West 3 Forensic and Glan Ely and Hamadryad wards at St David s HB 6 Unprecedented increase of specialling required at present within the Mental Health Division and hence this is reflected in the increase use of bank and agency to cover wards when staff are redeployed across hospitals to cover specialling. Specialling high within East 2A, East 3, West1, West 2 & Morgannwg wards. (Some patients are requiring a high volume of specialling sometimes needing 3:1 staff per shift.) HB DAILY REVIEW Staff re deployed across Mental Health to accommodate specialling. Nurse Bank to increase Mental Health bank 7 Reduce High Sickness Levels: High sickness is being addressed within the Division with regular panel reviews. Ward Sisters and Charge Nurses are held accountable to reinforce sickness policy.staff are being terminated within service via the sickness policy. This is a key target within the Division. With the increase in high risk clients the HB REVIEW EACH MONTH. EXPECTED PROGRESS BY AUGUST 2011 Update Report on Eradicating Nursing Agency Page 26 of 37 Workforce and OD Committee

27 number of industrial injuries is increasing, REACT trainer involved in ensuring good practices are maintained. 8 Qualified vacancies are being filled for Older People service, but a skill mix review is underway to look at the HCSW mix, hence some HCSW vacancies. All newly qualified students have been appointed within mental health. Some qualified vacancies remain across the Division. HB END OF MAY Rehabilitation Pool (internal pool within Mental Health, not Nurse Bank service). This service appears to be successful but the service has some vacancies at present HB END OF MAY Vacancies to be filled Supporting Information. Update Report on Eradicating Nursing Agency Page 27 of 37 Workforce and OD Committee

28 Authorisation process for agency is tight within the service and this is reflected with no Thornbury being used for over 6 months. Staff are redeployed within the service to cover day to day needs especially to cover specialling requirements. Once the key issues have been addressed within the service, a reduction of contracted agencies is forecast. Concerns raised regarding central recruitment process are taking too long before a person can be appointed and start a new post. i.e. getting references, occupational health, HR letters. etc ACROYNMS HB-Helen Bennett SC- Sandra Coles Update Report on Eradicating Nursing Agency Page 28 of 37 Workforce and OD Committee

29 NURSING FINANCIAL SUSTAINABILITY GROUP Surgery Services Division Plan to move to a Zero usage of Agency. April 2011 March 2012 ACTION LEAD TIMESCALE PROGRESS Surgery 1 C2 UHW (131 agency shifts, 6 Thornbury shifts in last 6 months.) High usage of contracted agency and non contacted agency in the last 4 months due to patient acuity and specialing required (RMN s) for one particular patient. No plans for discharge of patient at present 2 B2 Vascular Surgery 10 staff on LTS, 5 staff on mat leave, 2 staff on extended leave. Plan to relocate staff from other surgical wards to accommodate B2 shortfall. Skill mix reasons. Recruit staff onto other surgical AH/LW LW/SC/AH Review monthly Review monthly 1. Assess the patient every shift and step up and down the type of nurse required for specialling duties for this patient. Patient due for further surgery shortly. 1. Met with ward manager of B2 and ward managers in the directorate to discuss recruiting as a directorate and not as a ward and then sharing the resources across the directorate with the possibility of moving some experienced nurses to B2 backfilling with junior staff to help with the skill mix issue on B2. Update Report on Eradicating Nursing Agency Page 29 of 37 Workforce and OD Committee

30 wards to backfill Any newly Qualified RGN s to be registered on the Bank and will be supported with mentorship via Division 3 A5 Urology Patient acuity high due to transfer of C2 patient to ward. Patient requires specialing and RMN s. Plan to discharge patient in 4 weeks LW/AH Review weekly 1. Assess the patient every shift and step up and down the type of nurse required for specialling duties for this patient. 4 A2 Surgery Acuity issues. Establishment agreed to change HCSW and co-ordinator monies into RGN post LW/AH Immediate 1. As an interim arrangement establishment agreed to change By using some HCSW and co-ordinator monies into RGN post. Agreed with accountants. 5 A5 Head and Neck No consideration given to HDU nurses re establishment. Business case has been agreed for further HDU /ITU nurses. LW/AH June Business case being drafted to fall in line with the changes to Critical Care capacity changes. 7 A6 and A4 Trauma. LW /SC/GE Review Impact to be reviewed Update Report on Eradicating Nursing Agency Page 30 of 37 Workforce and OD Committee

31 Vacancies have been filled, reduction of agency to be monitored weekly 8 West 2 Surgery-now T2 LW/AH Review weekly Impact to be reviewed Vacancies exist, establishment now agreed and waiting to be signed off 9 Theatres./Recovery. Minimal spend on contracted agency (2 shifts) SC/LW/JS/JT Review monthly No authorisation given to contracted and non contracted agency for theatre. Escalation plan in place for the use of overtime 23K per month spend on overtime. To reduce overtime, need to increase bank theatre recruitment and monitor and scrutinise overtime process, booking procedures and utilisation of Bank only theatre staff. Vacancies went through scrutiny panel beginning of April 2011 Need to agree date to stop overtime 10 Engage Ward Sisters in planning roster in advance (4-6weeks) and engage with Nurse Bank to fill shortfall due to LTS and Mat Leave and block booking LW/SC/AH/G E Review monthly 11 Increase internal application of staff to register on the Nurse Bank. Ward SC/CF Immediate Meeting with Sisters in General Surgery to discuss this on 18/4/11 and the expectations that they will map this work out. LNs and SNs will advertise the bank to other staff and encourage them to join if they wish to work Update Report on Eradicating Nursing Agency Page 31 of 37 Workforce and OD Committee

32 Sisters to encourage application All areas 12 Look at number of HCSW s on bank with MH/REACT training SC to determine this and look at training more staff 13 Fully implement the agreed nursing establishments All areas extra hours SC end of May Discussion re adding a MH HCSW to the pool has been had with CF/CB/LW. Finance has been asked to cost. LW/AH/GE/JS This is continuing throughout the Division. N.B. Surgery plans to eradicate Thornbury out of the Surgery Division in the next 3 months (June 2011) apart from SSSU at UHW which is unfunded additional capacity. Consideration Vacancies application needs to be streamlined and simplified, as current scrutiny is taking too long.the downfall of the scrutiny process is that theatres, and wards are utilising bank and agency to compensate for the scrutiny/ vacancy delay. ACROYNMS LW- Linda Walker SC- Sandra Coles AH Anne Hiscocks GE Gillian Edwards JS Judith Smith JT Jayne Thain CF Carys Fox Update Report on Eradicating Nursing Agency Page 32 of 37 Workforce and OD Committee

33 CB Claire Bevan Update Report on Eradicating Nursing Agency Page 33 of 37 Workforce and OD Committee

34 NURSING FINANCIAL SUSTAINABILITY GROUP Primary, Community and Intermediate Care Division Plan to move to a Zero usage of Agency. April 2011 March 2012 ACTION LEAD TIMESCALE PROGRESS Review Nursing Establishment and Skill Mix and Recruitment on the Nurse Bank 1 Increase HCSW and RGN s to the Nurse Bank to accommodate Primary, Community and Intermediate Care Division. LEAD NURSES & SC MONTHLY To monitor against agreed target. 2 Vacancies to be filled asap in Stroke Unit LLandough and RSU West Wing to reduce agency spend SC/VW 3 Any newly Qualified RGN s to be registered on the Bank and will be supported with mentorship via Division SC/VW IN PROGRESS 4 ALR The provision of care for ALR is fully supported by MPS Agency. There is a general understanding that this will be continued by MPS at present. When VW IN PLACE Update Report on Eradicating Nursing Agency Page 34 of 37 Workforce and OD Committee

35 5 gaps occur, where MPS are unable to fill shifts Vicky Warner will authorise Thornbury. 6 Agreed that all contracted and non contracted agencies to cease use as from April 11 th 2011 from the following wards. St David s Hospital: Rhydlafar and Lansdowne Wards VW COMMENCE D APRIL 11 TH Barry Hospital: Neal and Kent, & Sam Davies Ward Consideration needs to be given to OPAIC establishment. A lot of work has been undertaken into the establishment. There is a 400K shortfall at present which is contributing to the use of temporary staffing and agency spends. Operational plan for OPAIC sets out service reduction which can enable rebalancing of establishments VW 7 Ward 6 Rookwood, difficult to get bank cover due to isolation of Hospital. This SC/VW Update Report on Eradicating Nursing Agency Page 35 of 37 Workforce and OD Committee

36 will be rectified once the ward has been moved over to West Wing Consider Block booking bank nurses or Mentorship for newly qualified nurses 8 Analysis /trend required of bank request for OPAIC. Consider the need for Pool to cover across OPAIC. Discuss if the medicine pool could be extended to include OPAIC. Costs discussed and bank shift costs for pool would be met by the receiving ward. OPAIC agreed to pay travelling costs for bank staff. 9 OPAIC wards to liaise with shift booking department regarding availability of bank staff. If availability of bank staff is nights, OPAIC will consider moving night staff to work days to utilise best resources and to reduce agency spend. This needs to be well planned between wards and Nurse Bank. 10 Community DN. - No contracted agency or Thornbury being utilised within this area. SC/VW SC/VW SC/VW APRIL /MAY2011 APRI/MAY 2011 IMMEDIATE IN PROGRESS Community Bank Nurses being Update Report on Eradicating Nursing Agency Page 36 of 37 Workforce and OD Committee

37 recruited to the Nurse Bank 11 Issue of RMN s required within OPAIC due to specialing of patients, this can lead to escalating costs and agency spend. Availability of RMN s has improved from the Nurse Bank. Need to increase RMN s on the Nurse Bank. SC/VW ON GOING Consideration Vacancies application needs to be streamlined and simplified, as current scrutiny is taking too long.the downfall of the scrutiny process is that wards and ward managers are utilising bank and agency to compensate for the scrutiny/ vacancy delay. OPAIC requests that all clinical post need to be signed off and approved by the Clinical Director. ACROYNMS VW-Vicky Warner SC- Sandra Coles Update Report on Eradicating Nursing Agency Page 37 of 37 Workforce and OD Committee