Integrated KPI Board Report Page 1 Integrated KPI Board Report for (unless otherwise stated) Executive Sponsors Jane Hayward Director of Transformation Jane.Hayward@uhs.nhs.uk Date of Board Meeting 01 February 2018
Page 26 The following highlight report (in fulfilment of the National Quality Board (NQB) expectations on trust board awareness of safe staffing) focuses on any hotspot areas in which the board needs to be aware of in each Division after review of the overall staffing figures, daily staffing reports and staffing incident reports. The table below represents the high level summary of the planned and actual ward staffing levels reported for. This is the information which has been uploaded and will be for public display via NHS choices from early February 2017. Detailed ward by ward information is also included as part of this KPI report. From May 2016 Care Hours Per Patient Day (CHPPD) showing average care hours per patient for SGH, PAH and CMH has been included as part of the Model Hospital dashboard and is included in this report. Costs per ward have also been included in the model hospital dashboard since December 2016. Staffing position for Site Name SOUTHAMPTON GENERAL HOSPITAL COUNTESS MOUNTBATTEN HOUSE PRINCESS ANNE HOSPITAL Day Night Care Hours Per Patient Day (CHPPD) 1 Average fill rate - Total Average fill rate Average registered Average care - registered fill rate - nurses/ fill rate - Reg. hours nurses/ care staff Midwives care midwives/ Care per Midwives (%) (%) (%) staff (%) nurses Staff patient 79.8% 115.4% 89.3% 128.6% 5.1 3.3 8.3 91.8% 118.4% 95.5% 114.1% 3.6 3.9 7.5 81.5% 64.5% 97.9% 73.9% 6.3 2.0 8.3 NB: Arrows indicate changes against the previous month and do not represent either a positive or negative performance position. Whilst it can be seen that we were not able to staff many clinical areas with our planned level of registered nurses due to current vacancy levels, we maintained our staffing levels at or above minimum safety levels. This was achieved by using our nursing bank and agency, through reviewing nurse staffing on a daily basis across the Trust and deploying non-ward based staff to support. Hotspot areas for nursing/midwifery staffing in Key metrics show that staffing and capacity challenges were extreme during periods in December despite the reduced levels of annual leave for staff across the holiday period. Acuity and dependency remained high across the trust and staff sickness impacted a number of areas. 1 CHPPD, split into registered nurses/midwives and health care support workers is calculated using this formula:- Actual hours worked_ Patient count at midnight
Page 27 Exceptions by Division are detailed below: Division A Surgery The surgical ward vacancies are improving slowly but the wards continue to be challenged with staffing. Band 2-4 staff have been over-recruited to support the ward areas and the band 6 supervisory roles have been boosted to improve supervision for junior staff. Cancer Care Registered nursing vacancies at CMH continue to be a challenge and this is being supported by movements within the care group, recruitment of additional support staff and the support of bank/agency. D2, D3 and AOS experienced high levels of activity with additional capacity required during the month. Critical Care All critical care areas are working together to safely staff shifts despite fluctuating levels of acuity and occupancy. RN vacancy rate is stable at 11% across the 4 units. With lower patient occupancy during the initial part of December staff were moved across the division to support other care groups. The latter part of the month saw a pressure on capacity and led to necessary use of high cost agency for breakglass safety reasons after a period of 7 weeks without usage. Division B The Divisional registered nurse vacancy position remains significant at 21.2% (104 FTE) up on the previous month and inclusive of the recruitment of the newly qualified staff. The division s daily staffing challenges have remained consistent in December with some shifts remaining at critical levels. Key mitigating actions and daily senior nurse focus have supported the ward teams to keep patients safe; golden key release is monitored carefully in order to ensure that high cost agency is only used for true break glass eventualities however the latter part of December saw a rise in the number of requests to maintain safety. Following consultation, all the divisions matrons are now providing a core hours, evening and weekend on site service and one element of their role is to lead safe staffing planning and decision making. ED and AMU - The vacancy position within the Emergency Care group rose slightly to 12.6% (24 FTE) for RN s. The activity challenges experienced at the end of December were particularly focussed on ED and AMU and this was reflected in the requests for high cost agency for break glass safety reasons. Emergency medicine wards & Medicine for Older People Registered nurse vacancies rose to 29.9% (78 FTE) and this was reflected in the need to use high cost agency for break-glass safety reasons and an increase in staff moving from across the hospital to support. Medicine continues to over-recruit unregistered staff which really supports the risk associated with the RN vacancy rate. Division C Child Health - RN vacancies across child health rose slightly to 14.5% (47 FTE) despite the appointment of the new qualified children s nurses. This has impacted on the ability to open the beds closed over the summer however there is an improved pipeline of starters expected from January Maternity & Neonates Vacancies for midwives have further reduced this month. A further intake of external NQM s appointed in October are now fully orientated and working within the clinical areas. They have been brought constructive practice suggestions from their home NHS Trusts that the service is learning from. Whilst vacancies remain low, December saw high levels of short term sickness within the midwifery workforce due to seasonal illness. Both the Obstetric led and Midwifery led pathways have worked together to cross cover in order to continue to provide safe care and minimise use of agency staff.
Page 28 Division D The overall Divisional registered nurse vacancy position remained stable at 20% (92 FTE) with a pipeline of 11 registered nurses to start in the next 2 months. Staffing of uncommissioned capacity to support the capacity challenges has resulted in an increased usage of high cost agency. T&O and Neurosciences remain areas of focus with trained nurse vacancies of 33.9% (43 FTE) and 23.6% (33 FTE) respectively. High vacancies are being managed with staff doing bank shifts, over recruitment of band 3 and 4 s and deploying staff across wards. ------------------------ Staff continue to reference the red flags identified in the NICE guidance on safe staffing when completing adverse event reports (AER) linked to staffing. These red flags highlight when patient care has potentially been impacted due to staffing shortfalls. These AERS are reviewed, actioned and mitigated in real-time to reduce the risks. They are also themed monthly and identified actions taken forward linked to the reporting on safe staffing and the trust risk register. Care group and divisional reports are also available to enable focus on trends in incidents being reported from each clinical area. In December there were 110 staffing incident reports in total covering 7 different staff groups. This is a significant increase on the 81 reported in November and brings the level back to the high seen in August and September before vacancy improvements. These incidents have been rated from near miss to moderate (18) impact. This also shows a rise in the number of incidents rated at moderate (11 in November). We will be monitoring the rise both in the number of incidents and severity closely. Of these incidents, 88 were related to nurse staffing, a rise on the 61 reported in November. There was 1 Midwifery incident reported for the month. Hotspot areas identified through the reporting are being closely reviewed by the divisions. In addition to the existing system, in August we introduced the capability to report red flag incidents in real-time on the safecare acuity/dependency system in healthroster. These red flags will then be reviewed at the daily staffing meetings. ------------------------ The overall vacancy level for ward staffing (registered, unregistered and other support roles) worsened slightly in December reflecting a normal pattern for this time of the year. The overall vacancy level now stands at 407 FTE (12.8%). This is made up of 378 FTE (18%) registered vacancies and -1 FTE (- 0.1%) unregistered vacancies as a result of conscious over-recruitment. It should also be noted that, with the arrival of the most recent cohort of nurses from overseas, an increased number of 57 registered overseas nurses are currently working as unregistered nurses as they await the results of their English language testing (IELTS) requirements and competency requirements stipulated for NMC (Nursing and Midwifery Council) registration. Graph 1 below details the breakdown of temporary staffing cover across the last year. Overall use rose slightly in the month despite the reduced levels of annual leave for staff across the holiday period. High cost agency usage rose with 6 FTE (99 shifts) in for break glass safety reasons. This equates to 1.6% of the total temporary nursing staff usage. The extreme capacity pressures at the end of
Page 29 the month led to the higher level of requests. Shifts escalated to high cost agency remained unfilled in a number of cases and all measures were taken to manage staffing across the trust to ensure safety was maintained. Daily escalation processes continue to support the most effective deployment of staff in real-time with the use of safecare acuity/dependency data embedded as part of the daily staffing reviews. Graph 1
Page 30 Graph 2 Ward Staffing - Predicted vacancies