1 P age NLG(18)246 DATE OF MEETING 26 th June 218 REPORT FOR Trust Board of Directors Public REPORT FROM Tara Filby, Chief Nurse CONTACT OFFICER Diane Hughes, Nurse Staffing Improvement Manager SUBJECT Update to the Board relating to nursing, midwifery and care staffing capacity and capability BACKGROUND DOCUMENT (IF ANY) National Quality Board (NQB) report How to ensure the right people, with the right skills, are in the right place at right time 213 (NHS England). PURPOSE OF THE PAPER: For Assurance EXECUTIVE SUMMARY (PLEASE INCLUDE A BRIEF SUMMARY OF THE PAPER, KEY POINTS & ANY RISK ISSUES AND MITIGATING ACTIONS WHERE APPROPRIATE) This is the monthly report outlining those wards where staffing capacity fell short of what was planned and any risks were mitigated. This shows an overall achievement of fill rate for inpatient wards with a continued high reliance on the use of temporary staff including agency staff (both on and off framework). p.5the overall fill rates have seen an increase to 99.6% p.5 Midwife to birth ratios in month 1:29 DPOW, 1:24 SGH p.6/7 1 wards are showing fill rate of less than 8% HAVE STAFF SIDE BEEN CONSULTED ON THE PROPOSALS? HAVE THE RELEVANT SERVICE USERS/CARERS BEEN CONSULTED ON THE PROPOSALS? ARE THERE ANY FINANCIAL CONSEQUENCES ARISING FROM THE RECOMMENDATIONS? NO IF YES, HAVE THESE BEEN AGREED WITH THE RELEVANT BUDGET HOLDER AND DIRECTOR OF FINANCE, AND HAVE ANY FUNDING ISSUES BEEN RESOLVED? ARE THERE ANY LEGAL IMPLICATIONS ARISING FROM THIS PAPER THAT THE BOARD NEED TO BE MADE AWARE OF? NO WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO THE NHS CONSTITUTION IN ANY DECISIONS OR ACTIONS PROPOSED? YES WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO SUSTAINABILITY IMPLICATIONS (QUALITY & FINANCIAL) & CLIMATE CHANGE? YES THE PROPOSALS OR ARRANGEMNTS OUTLINED IN THIS PAPER SUPPORT THE ACHIEVEMENT OF THE TRUST OBJECTIVE(S) To ensure safe and effective Nurses staffing levels
2 P age THE PROPOSAL OR ARRANGEMENTS OUTLINED IN THIS PAPER ENSURE COMPLIANCE WITH THE REGULATORY OR GOVEANCE REQUIREMENTS LISTED THE PROPOSALS OR ARRAGEMENTS OUTLINED IN THIS PAPER TAKE ACCOUNT OF REQUIREMENTS IN RESPECT OF EQUALITY & DIVERSITY ACTION REQUIRED BY THE BOARD The Board is asked to note the report and support any further action required.
3 P age Report From: Tara Filby, Chief Nurse Date: 26 th June 218 Subject: Purpose: Safer Staffing Monthly Exception Report This report provides an overview of nursing and midwifery staffing and advises the Board of those wards where staffing capacity and capability fell short of what was planned and any mitigation. 1. Background This report will advise the Trust Board of those wards where staffing capacity and capability fell short of what was planned, the reason why and any impact on quality and the action taken to mitigate any risk in staffing from 1 st May- 31 st May 218. This report provides details of where compliance was less than 85%, our Trust internal target (Amber rated) along with those areas where compliance was less than 8%, national target (Red rated) 1 of the 38 wards fall into this red rated category for May 218. 2. May Position The overall fill rate for nurse staffing has been identified as higher than March 218. The Trust has continued to support the ward areas with moves across wards when appropriate. The percentage of actual to planned trained staff is less than 8% on one ward on days and zero wards on nights this month. This ward is part of Surgery and critical care where there are concerns due to the high vacancy rate on ward 25 and ward 1/11. A number of options are currently being worked though in the operations directorate to risks associated with this. There were 4 NICE red flag events for staffing identified for May, an increase from 31 in April, however 12 out of the 4 had been identified as being on one ward. These incidents were reviewed and showed a registered nurse short to the agreed establishment, although the staffing still met the 1:8 ratio (nurse/patient). FFT feedback scores remain high with most areas achieving 1%. Low ward return rates however do not show a complete picture at present, so this will be explored further in future reports. This reports show the number of all pressure ulcers and falls, previously reported were those falls/pressure ulcers deemed avoidable following RCA. Pressure ulcers for April grade 2= 44, grade 3 =1, Suspected deep tissue injury =21, unstageable= 6. This shows a decrease from April in grade 2 but an increase in grade 3. A focused piece of work is underway across the trust to reduce the incidence of pressure ulcers.
4 P age 3. Improvement Actions Each ward is reviewed daily by the operational matrons and Associate Chief Nurses and any redeployment of staff is undertaken on a shift by shift basis. The operational matrons plan the next day staffing requirements by reviewing the acuity and dependency of the wards they are responsible for and in conjunction with the ward sister/charge nurse. The skill mix of the nursing workforce is taken into account daily. We make conscious decisions to move nurses by ward or within their own ward according to competency and skills. Where we have vacancies in ward areas we are actively recruiting to these posts using social media, filming of ward staff talking about benefits of working in the ward and through Trust and NHS Jobs website. A focused piece of work is looking at non-eu nursing recruitment. A risk assessment is in place to empower midwives to escalate concerns re: staffing levels and the acuity and complexity of women in their care. Mitigating actions are then put in place as per the Trust escalation policy, including calling in supportive resource from the community midwifery team and informing the Matrons: sickness levels in the community need to be monitored to ensure cover can be provided. 4. Forward Planning and Opportunities A table-top review of Birthrate Plus was undertaken in May to ensure that the staffing levels are adequate to meet the current and proposed changes in the model of care and development in service provision. A report is expected to be received in July. A new deal for nursing is currently being developed to look at career progression across nursing and looking how we can sustain a safe, effective workforce. 5. Recommendation The Board is asked to note the report and support any further action required.
5 P age Appendix A Overall fill rates. The table below demonstrates the site level fill rates. December Day Night Day Night Overall Site Fill registered nurses/midwives Fill rate - care staff Fill registered nurses/midwives Fill rate - care staff Average Nurse fill rate Total average fill rate Care Hours Per Patient Per Day (CHPPD) Nurses Care Overall Staff Ratio s to HCA s Grimsby 95.2% 99.4% 98.8% 13.9% 96.8% 1.6% 98.3% Scunthorpe 97.2% 98.3% 1.7% 116.4% 97.6% 15.8% 1.8% Goole 97.5% 12.1% 99.6% 174.2% 99.3% 114.5% 14.8% Trust Overall 96.2% 99.% 99.7% 11.4% 97.3% 13.3% 99.6% 4.3 2.7 7.1 63% 4.7 2.8 7.5 6% 5.2 3.1 8.3 6% 4.7 2.8 7.5 6% A number of areas had escalation beds open during May which required additional staffing above the agreed establishments this is evident in the increased fill rate. Maternity Birthrate Plus The chart below demonstrates the midwife/birth ratios calculated using the Birth Rate Tool for May 218: DPOW SGH Trust-wide Staffed to full Establishment Excluding mat leave and vacancies With gaps filled through NLAG Bank/Agency 3.22 24.97 27.93 32.27 26.6 29.79 28.46 23.9 26.49
6 P age Appendix B Fill rates Nursing, Midwifery and Care staff May 218 DPOW Day Night Day Night CHHPD WTE establ ished wte s care staff care staff ve Substanti ve care staff ve rate - v e care staff Ca re Staff Overall % safety thermometer harm free care Bed Occupancy midday Falls Pressure Ulcers grade 2 =Pressure ulcer garde 3 Unstageable/or deep tissue injury CDIFF MRSA RED FLAG S COMPLAINTS FFT Amethyst 24.23 96.% 98.7% 12.2% 1.9% 86.3% 74.2% 82.6% 5.86% 3.2 2.5 5.6 95% 18% 9 3 1 3 2 2 1% Blueberry 23.64 1% 49%/ 97.8% 96.8% 98.4% 11.1% 12.7 5.9 18.5 1 /Holly 93.% 92.1% 95.1% 91.3% 55% 1% C1 17.28 1% 9.2% 95.5% 1.% 99.6% KENDALL 71.1% 91.5% 59.7% 93.15% 2.5 2.1 4.6 11% 1 5 1 1% Coronary 13.73 1% 99.4% 1.8% 1.1% 1.6% 6.3 2.4 8.7 96% 5 care unit 87.5% 1.8% 88.9% 87.68% 1% Honeysuckl 27.36 1% 48%/ 13.5% 96.1% 98.1% 11.1% e /Jasmine 94.4% 81.6% 78.4% 95.51% 14.1 5.5 19.6 56% 1 1% ITU 36.4 113.5% 13.8% 95.% - 17.9% 93.8% 81.3% - 29.9 2.1 32. 83.3% 95% 3 2 1 n/a LAUREL 16.25 87.5% 11.5% 12.% 1.% 112.9% WARD 91.1% 91.8% 85.5% 96.77% 3.7 2.5 6.2 91% 3 1 1 95% NICU 2.91 98.8% 9.% 99.3% 71.9% 9.7% 88.4% 86.9% 65.42% 6.6 2.7 9.3 1% 12% 1 1% Rainforest 21.1 88.4% 121.2% 97.8% 13.2% 82.5% 114.7% 94.6% 96.77% 6.8 2.5 9.3 n/a 65% 1 2 94.1% STROKE 16.42 69.% 86.9% 99.9% 11.7% 14.5% UNIT 78.2% 8.2% 74.2% 64.52% 2.6 3.2 5.7 13% 13 3 3 1 1% WARD B2 2.1 1% 88.6% 1.4% 95.7% 14.8% SAU 85.3% 88.6% 84.9% 79.3% 4.1 3.1 7.3 83% 5 2 1 94.1% WARD B3 24.5 98.9% 95.8% 1.% 11.6% 79.1% 84.% 81.5% 77.42% 3.9 2.1 6. 96.4% 15% 3 2 1 2 1% WARD B4 16.42 84.6% 129.8% 1.% 98.4% 72.4% 89.4% 64.5% 72.58% 2.8 3.1 6. 91.7% 92% 4 1 1 95.5% WARD B6 27.45 96.7% 98.1% 1.% 98.2% 8.9% 89.5% 64.5% 82.26% 2.8 2.8 5.6 95.5% 94% 8 5 1 1 1% WARD B7 96.7% 98.1% 1.% 98.2% 78.3% 118.4% 69.8% 77.24% 2.9 2.8 5.7 95.% 89% 1 2 2 1% WARD C1 16.42 1% 91.8% 96.2% 98.4% 93.8% HOLLES 8.5% 66.3% 83.6% 75.27% 2.6 3.1 5.7 99% 2 1 1 1% WARD C5 16.52 8.5% 86.1% 12.9% 127.9% 63.5% 81.9% 61.4% 97.8% 2.6 2.6 5.2 1% 99% 3 1 1 1% WARD C6 16.42 88.9% 9.8% 1.% 122.6% 86.6% 8.8% 75.1% 8.65% 2.8 2.5 5.3 87.5% 13% 13 2 1 4 12 2 1% AMU 32.22 92.3% 92% 8 1 1 1 95.7% HDU 11.2% 139.8% 99.% - 94.2% 24.7% 88.2% - 14.2 1.3 15.5 1% 99% 1 1 1 n/a ECC DPOW 52.16 n/a n/a 1 1 9 84.9% Fill rate key <85% <8% >115% Safety thermometer. Over 95% Over 85% Under 85%
7 P age May 218 SGH/Goole Day Night Day Night CHHPD Ward name WTE estab lishe d wte s care staff care staff ve Substant ive care staff ve ve care staff CCU 15.15 89.5% 12.2% 99.3% 97.8% 79.1% 65.1% 77.9% 91.34% 5.7 2.2 7.9 9% 77% 1 1 1 1% Disney 21.95 n/a 86.8% 77.9% 97.8% 13.2% 9.2 3.3 12.5 55% 1 86.2% 72.% 93.9% 1.% 1% ITU 41.56 99.9% 73.9% 93.9% - 141.5% 93.8% 9.9% - 29.5.7 3.2 1% 77% 1 n/a NICU 15.75 1% 1.9% 93.8% 15.% 82.9% 96.5% 98.9% 95.% 72.28% 8.9 5.1 14. 13% 1% SGH 15.33 Gynaecology 96.9% 13.7% 1.% - 96.5% 11.6% 95.8% - 7. 2.1 9.2 1% 82% 1% Stroke 29.21 92.1% 13.2% 97.4% 1.% 57.1% 97.2% 62.4% 98.39% 6.9 3.4 1.3 1% 89% 7 2 2 93.7% WARD 1 21.48 94.1% 84% 2 1 2 1 77.8% 11.6% 17.3% 11.7% 279.5% 4. 2.9 6.9 Ward 11 88.9% 84.4% 94.9% 48.8% 243.99% 76% 1 1% Ward 16 16.87 96.5% 99.4% 12.9% 126.4% 74.2% 113.2% -8.% 18.11% 3.1 2.9 5.9 87.% 99% 15 1 1 2 1 94.1% Ward 17 16.87 8.8% 117.9% 98.4% 13.2% 51.4% 12.6% 52.5% 98.39% 2.8 3. 5.9 1% 99% 8 1 1 1% Ward 18 16.4 18.5% 13.1% 1.9% 93.5% 16.9% 91.1% 93.4% 9.32% 3.6 2.8 6.4 1% 125% 2 1 3 1 1% WARD 22 18.89 121.7% 91.2% 99.2% 147.3% 62.2% 68.1% 34.2% 13.74% 4.3 3.5 7.7 96.2% 1% 1 3 3 3 1 97.8% WARD 23 2.46 95.1% 86.% 98.9% 14.7% 66.3% 111.5% 85.4% 78.42% 3. 2.6 5.6 96.% 98% 4 2 1 95% WARD 24 16.42 13.3% 118.5% 149.9% 129.% 55.% 68.3% -4.5% 8.65% 3. 2.5 5.5 1% 1% 4 1 2 1% WARD 25 16.87 73.1% 85.5% 98.6% 93.6% 42.9% 9.1% 26.4% 66.17% 2.8 2.5 5.3 1% 97% 2 1 1 1 1 1% WARD 26 17.5 99.6% 1.6% 97.4% 93.1% 79.4% 85.5% 84.7% 83.87% 7.2 2.1 9.3 1% 69% 2 1% WARD 28 2.46 16.2% 93.4% 99.2% 94.6% 83.6% 13.1% 54.7% 84.95% 3.8 3.2 7. 1% 96% 1 2 1 75% WARD 3 12.6 94.9% 98.5% 12.4% 1.% 94.9% 89.1% 41.9% 1.% 4.2 2.9 7.1 92.3.% 87% 3 1 1 92.9% Ward 6 13.2 1.8% 19.1% 96.8% - 98.4% 96.% 9.3% - 7. 3.4 1.4 1% 56% 3 1 Nil return EC SGH 51.72 n/a 1 4 69.1% CDU-SGH 24.69 95.2% 87% 6 1 1% Fill rates <8% <85% 86-114% >115% Care Staff Over all % safety thermo meter harm free care Bed Occupancy midday Falls Pressure Ulcers Grade 2 Pressure ulcer G3 Unstageable/Deep tissue injury Safety thermometer. Over 95% Over 85% Under 85% CDIFF MRSA RED FLAG S COMPLAINTS FFT