TAMESIDE & GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST Report to Public Trust Board meeting of 25 th November 2016 Agenda Item 7b Title Sponsoring Executive Director Author (s) Purpose Previously considered by Safe Staffing Report Pauline Jones Chief Nurse Dawn Downing, e-rostering Lead Sean Jackson, Assistant Chief Nurse Pauline Jones, Chief Nurse To note/receive n/a Executive Summary In-line with the Hard Truths Commitments regarding the publishing of Staffing Data, the Trust Board are required to review staffing data on a monthly basis. The aim of this report is to provide the monthly update on the continuing actions and developments to support safe staffing. Related Trust Objectives Risk Assurance risk impacted upon Legal implications/regulatory requirements Financial Implications 1. All patients receive harm free care through the Trust s Patient Safety Programme. 2. To improve the quality of patient care through the implementation of the Trust s agreed Quality Strategy. 3. To improve the patient experience through a personalised, responsive, compassionate and caring approach to the delivery of patient care. CR734: Nurse vacancies, leadership and nurse staffing/ recruitment across medicine and the ability to provide safe care. AF3480: Failure to meet CQC registration requirements relating to staffing. AF3482: Failure to ensure adequate staffing levels to ensure patient safety and quality of services NHS England monthly requirement to publish and report Staffing Data None Has a quality impact assessment been undertaken? How does this report affect Sustainability? Yes where applicable in plans The Trust is required to ensure staffing levels are adequate to meet patient safety and quality. Action required by the Board The Trust Board is requested to receive this update and note the assertive monitoring of staffing levels that are in place to ensure quality & safety.
Background Following the Francis Report in to the findings of Mid Staffs and the subsequent publication of Hard Truths (a commitment to publishing staffing data), Trust Boards have been required to be sighted on various aspects of nurse staffing in adult wards to ensure patient safety is paramount. This information is required monthly and any exceptions where shifts have not been fully compliant are highlighted outlining any action taken to mitigate any risk to patient safety. This report provides a monthly summary of Safe Staffing on all in-patient wards across the Trust. It includes exception reports related to staffing levels, related incidents and will incorporate red flags from the month of January 2017, which are then triangulated with a range of quality indicators such a Safety Thermometer and surveys. Safe Staffing Update October 2016 Data Each month the data collection compares the number of nurse staff hours Planned against the number of nurse staff hours used Actual. This is collected by ward, by shift, and is reported by calendar month as a % fill rate by day and by night: The overall Trust position for October 2016 is: RN/RM Average Fill rate % Day Night 90.9 96.3 Variance on Sept 16 +2.4-1.2 Care Staff Average Fill rate % 97.7 111.0 Variance on Sept 16-1.9-1.4 This is the UNIFY upload of October s Staffing Data: the information is published via NHS Choices. This data is currently available via our public website in a specific designated section Safe Staffing : (www.tamesidehospital.nhs.uk/nurse-staffing.htm) Overall, Registered Nurse (RN) fill-rates remain constant month on month, but Healthcare Assistant (HCA) fill rates fluctuate due to levels of enhanced care required (1:1 s) and additional support for RN shortfalls. Exception Report The submission only represents monthly aggregated data and percentages, which have limited benefit. The data gives a summary and aggregated overview of how frequently the Trust met its planned requirements. NHS England have suggested that greater scrutiny should be given to any area reporting <80% fill rates. The Chief Nurse scrutinises these areas as recommended.
The 7 escalation beds on Ward 31 are not included on the reported Unify Safe Staffing Report. Escalation beds pose a significant challenge in terms of the patient experience and safe nurse staffing. The safe staffing exception report (Appendix 1), provides actual fill rates on a ward by ward basis. Fill rates are RAG rated by exception and a number of related factors are displayed alongside the fill rates to provide an overall picture of safe staffing: Sickness rate, vacancy rate and the staffing of escalation beds are the three main factors that affect fill rates. The Indicators in Appendix 1 demonstrate the outcome for patients by measuring harm: Falls resulting in harm, Pressure Ulcers resulting in harm. There are a number of wards that have not been able to maintain fill rates during the month of October. Safe Staffing for each ward is assessed on a daily basis by the relevant Divisional Matrons and during the evenings and at weekends the Senior Nurse has responsibility for ensuring safe staffing of all ward areas across the Trust. This information is shared with Trust Board and uploaded onto NHS Choices. Incident Reporting Incident form submissions related to staffing are monitored to act as an early warning system and inform future planning. Staff are encouraged to report incidents related to any staff shortage so that trends can be picked up but more importantly so that immediate action can be taken. There have been 5 occasions during the month of October when moderate harm for patients has been reported on our Inpatient ward areas via the incident reporting system. It is following the analysis of the data that it has been determined that nurse staffing deficits are not a factor in any of the 5 incidents. Actions to Address Shortfalls & New Developments A successful recruitment evening took place on Friday 21 st October 2016 aimed at general nursing staff. A total of 30 RN posts were offered and the majority of candidates qualify in 2017. It was noted that we offered posts to students from a wide range of Universities including Edge Hill, Sheffield, Huddersfield and Uclan. A Keeping in Touch event is planned for the 6 th December 2016 where all successful applicants who have not yet started in post will be invited along to meet the Divisional teams. These events are always really well received and help us to maintain engagement with the applicants during their last months at University. Members of the team attended two events in November; one event was at Manchester Metropolitan University where the team identified names and contact details to target for our next recruitment event in February 2017. The other event was an RCN event in Liverpool where the team interviewed and subsequently offered posts to 3 students from Chester University who qualify next year.
There is a Paediatric Nurse recruitment day scheduled for Saturday 26 th 2016. November As part of the Greater Manchester Pilot an advertisement was placed for the new Nurse Associate role. There were 201 applications received within a 5 day period, 46 people were shortlisted and following interviews held on the 11 th November, 20 people were successfully recruited on to the programme as Trainee Nurse Associates with 5 on the reserve list. The start date for the programme is the 30 th January 2017. The Trust have an ongoing proactive recruitment campaign on various mediums of social media. Ongoing recruitment meetings chaired by the Chief Nurse are held on a weekly basis with recruitment events twice a month. Staff across the hospital are re-deployed to support areas that experience staffing deficits, this process is controlled at Divisional level following a risk assessment of all the clinical areas. Ward Managers, non-ward based Nurses and Matrons are providing direct support to escalation beds. HR support is in place to ensure improved efficiency in the management of sickness. Short-term sickness/vacancies and the staffing of escalated beds continue to be the main reasons for shortfalls in substantive staffing. Staffing The details of NHSP are outlined in the Monitor Cap paper. Shire Hill is currently using the uncapped agency Thornbury to achieve safe staffing levels. However a full staffing review is underway. An action plan has been developed to support safe staffing levels at Shire Hill with NHSP Care Support Workers. A Staffing meeting is chaired by the Chief Nurse and the Terms of Reference are being reviewed to ensure rigorous scrutiny is applied to the use of NHSP/Agency staff. The Trust are part of a successful Northwest Collaborative group consisting of 6 local Trusts who meet each month to discuss, enable and agree strategies with regards to the use of temporary staffing. This meeting is usually attended by our Head of Procurement and one of our Assistant Chief Nurses. Care Hours per Patient per Day (CHPPD) As recommended following the Lord Carter review, the Trust has been collating and reporting CHPPD since May 2016. This provides a single consistent way of recording and reporting deployment of staff working on inpatient wards/units and is calculated by adding the hours of registered nurses to the hours of healthcare support workers and dividing the
total by every 24 hours of in-patient admissions (or approximating 24 patient hours by counts of patients at midnight). CHPPD reports the split of registered nurses and healthcare support workers to ensure skill mix and care needs are met. This work is ongoing across Organisations and we await further guidance, however we are currently developing a Model Hospital Dashboard as part of the recommendations. Summary Ensuring the correct numbers of Nurses, Midwives and Healthcare Assistants are in post is essential for the delivery of safe and effective patient centred care. This paper shows that the Chief Nurse is providing scrutiny, leadership and oversight of this essential area of quality and safety. Recommendations The Trust Board is requested to receive this update and note the assertive monitoring of Nurse/Midwifery staffing that is in place.
Appendix 1 Heat map - October 2016 Inpatient Ward Compliments Complaints Moderate Harm + Incidents Falls with Harm MRSA C.Diff PU (+G2 only) FFT Positive (%) Qual Staff Days Qual Staff Nights Care Staff Days Care Staff Nights Planned Orthopaedic Unit 35 1 0 0 0 0 1 92.0% 91.9% 1.65% 97.9% 43.37% 121.4% 18.30% 149.5% 39.79% 3.7 4.1 Surgical Unit 70 2 0 0 0 0 0 100.0% 80.2% 17.22% 80.8% 33.69% 82.1% 12.84% 85.5% 37.07% 3.5 3.5 Emergency Orthopaedic Unit 28 0 0 0 0 0 0 100.0% 96.2% 6.79% 97.0% 35.72% 109.0% 23.57% 114.0% 33.65% 3.4 3.1 Critical Care 18 0 0 0 0 0 0 N/A 87.4% 11.27% 86.1% 18.70% 90.3% N/A N/A 11.23% 33.5 1.9 AMU 16 1 0 0 0 0 4 94.0% 112.4% 7.47% 98.7% 20.80% 92.9% 18.29% 97.0% N/A 4.2 4.2 Acute Cardiology Unit 4 2 0 0 0 0 0 100.0% Heart Care Unit 6 2 0 0 0 0 0 80.0% 85.8% 23.39% 114.2% 53.54% 106.9% 10.76% 73.2% 19.27% Ward 31 5 2 1 0 0 2 0 94.1% 101.5% 24.02% 150.7% 89.42% 119.2% 34.69% 134.9% 54.64% 2.8 3.7 Ward 40 13 2 0 0 0 0 0 94.4% 92.4% 12.07% 99.2% 44.56% 78.2% 27.82% 108.8% 63.06% 2.5 2.6 Ward 41 24 0 2 0 0 3 0 87.5% 87.4% 10.86% 81.4% 57.07% 92.9% 34.04% 114.0% 15.28% 2.3 3.2 Ward 42 15 0 0 0 0 1 1 100.0% 84.4% 3.99% 100.8% 44.53% 103.1% 25.12% 112.7% 49.64% 2.8 3.1 Ward 44 19 0 1 0 0 0 1 89.3% 69.7% 23.88% 100.1% 40.38% 130.6% 23.91% 132.9% 50.27% 2.2 4.3 Ward 45 11 1 1 0 0 1 0 100.0% 74.2% 7.11% 100.1% 4.97% 99.5% 21.71% 101.7% 40.23% 2.3 4.3 Ward 46 11 0 0 0 0 1 1 94.7% 76.0% 7.54% 87.9% 30.81% 109.7% 16.30% 138.6% 49.15% 2.5 3.1 Ward 27 (Maternity) 20 0 0 0 0 0 0 100.0% 76.9% 14.80% 81.5% 19.56% 78.0% 18.30% 106.7% 36.91% 3 2.0 Women's Health Unit 12 1 0 0 0 0 0 92.9% 101.5% 1.28% 77.4% 22.81% 104.2% 40.07% N/A N/A 4.8 3.0 NICU 27 0 0 0 0 0 0 N/A 100.4% 19.92% 99.7% 3.33% 100.0% N/A N/A N/A 11 0.7 Children's Unit 20 1 0 0 0 0 0 100.0% 101.3% 6.75% 92.7% 21.14% 57.3% N/A N/A N/A 6.3 1.4 Stamford Unit 2 21 0 0 0 0 0 0 100.0% 103.7% 10.96% 100.1% 57.56% 95.5% 32.19% 99.8% 44.05% 1.9 4.0 Shire Hill - 0 0 0 0 1 0 95.8% 98.6% 33.65% 102.3% 56.40% 94.9% 23.60% 94.4% 77.01% 2.8 3.6 Inpatient Totals/Averages 375 15 5 0 0 9 8 97.2% 90.9% N/A 96.3% N/A 97.7% N/A 111.0% N/A 3.7 3.3 CHPPD RN CHPPD HCA 4.3 2.5 KEY Complaints Moderate Harm + Falls with Harm MRSA CDIFF PU(+G2) Staffing Fill Rates 0 - Green 0 - Green 0 - Green 0 - Green 0 - Green 0 - Green > 90% - Green >1- Amber >1 - Amber >1 - Amber >1 - Red >1- Amber >1 - Amber 80-90% - Amber >2 - Red >2 - Red > 2 - Red >2 - Red >2 - Red < 80% - Red NB: Please note that Inpt FFT Total shown does not include Community areas.