Nursing and Midwifery Establishment Review October December 2015

Nursing and Midwifery Establishment Review October December 2015 Director of Nursing, Establishment Review, October 2015 Page 2 of 14

Nursing and Midwifery Establishment Review Trust-wide 1. Executive Summary The nursing and midwifery establishment review was undertaken in October 2015. Staffing data was reviewed over a 20 day period along with patient acuity data and benchmarking data from five other Trusts. Recommendations from national guidance on staffing ratios and skill mix have been taken into consideration. The methodology and full literature review is detailed in section four. The review recommends some changes to establishments. The overall cost implication is 201,09. Summary of recommendations: Increase staffing at night on 4 wards in the Lister tower block to 4 Registered Nurses (RN) and 2 Care Support Workers (CSW) (currently 4 RN and 1 CSW) as supported by a review of the NHPPD, SNCT and additional duty requests, cost implication 265,18 but with a potential identified annual cost saving of 54, 462 through reducing agency costs, Increase the staffing on Bluebell ward Monday Friday by one CSW for 7.5 hours per day to assist with theatre transfers of elective well children and to support day cases at a cost implication of 27,000. Reduce the establishment on Wards 10 and 11 at Mount Vernon Cancer Centre to appropriate staffing levels in line with patient activity and acuity at a cost saving of 91,045. Head of Midwifery to develop a business case following a review of Midwifery staffing in line with the recommendations of Safe Midwifery Staffing and the birth-rate plus workforce analysis tools. To review the activity and acuity of wards 5A and 7B at night at the next establishment review in April 2016 to inform whether an additional CSW is required at night. To receive a business case for the change of the use of beds on ward 8B from escalation to Acute Surgical Stepdown Beds 2. Introduction Trusts have a duty to ensure safe staffing levels are in place and patients have a right to be cared for by appropriately qualified and experienced staff in a safe environment. These rights are enshrined within the National Health Service (NHS) Constitution, and the Health and Social Care Act (2012) which make explicit the Board s corporate accountability for quality. The Nursing and Midwifery Council (NMC) sets out nurses responsibilities in relation to safe staffing levels. Demonstrating safe staffing is one of the six essential standards that all health care providers must meet to comply with Care Quality Commission (CQC) regulation. This is also incorporated within the NICE guidelines Safe Staffing for nursing in adult inpatient wards in acute hospitals (2014). The NHS England guidance A Guide to Care Contact Hours (2014) recommends inclusion of contact time by nursing staff in the establishment reviews. This is referred to from here on in as nurse hours per patient day (NHPPD). Director of Nursing, Establishment Review, October 2015 Page of 14

The evidence suggests that appropriate staffing levels and skill mix influences patient outcomes, all of which align to the Trusts priorities for 2015/16: Improved mortality. Reducing 0 day readmissions. Reducing failure to rescue. Reducing pressure ulcer incidence. Reducing adverse incidents, particularly related to medication errors and patient falls. Reducing the length of stay for specific identified conditions, such as myocardial infarction and stroke. Improving patient experience. Although not directly referenced within this report other quality indicators have been taken into consideration, i.e. red flags, red ward triggers and the Nursing and Midwifery Quality Indicators. These indicators are considered and reported within the monthly safe staffing report.. Purpose This establishment review was under taken for the following reasons:- The need to provide assurance both internally and externally that ward establishments are safe, that staff are able to provide appropriate levels of care to patients and levels of care that reflect the Trust values and the 6 C s contained within the national nursing strategy (2012). This is particularly important in light of key recommendations made in the Francis Report (201), the Berwick Report (201) and the National Quality Board publication (201) How to ensure 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 in terms of safe ward staffing levels. To provide establishment data that will inform the Trust Workforce Strategy and People Strategy 2014-19. To comply with Care Quality Commission requirements under the Essential Standards of Quality and Safety, including outcomes 1 (staffing) and 14 (supporting staff). To support the implementation of the Trust s annual and strategic objectives, the Nursing and Midwifery Ambitions and Patient and Carer Experience Strategy. 4. Establishment Review Methodology A review of all relevant literature and guidelines was undertaken prior to commencement of this review, these included: NICE Guidance on Safer Staffing for nursing in adult inpatient wards in acute hospitals (2012) Compassion in practice, NHS England (2012) Safer Nursing Care Tool Nurse sensitive indicators Safer Staffing Guidance, Trust Development Authority (2015) As part of this review the following information was collected and reviewed: Comparison of current establishment review data with previous reviews to identify changes or trends Service or speciality provided, this includes any geographical or layout changes undertaken during the last six months. Patient number and acuity for each ward for a continuous 20 day period. Director of Nursing, Establishment Review, October 2015 Page 4 of 14

An in-depth review of actual staffing levels (both temporary and substantively employed) over the same 20 days period. An exercise benchmarking key metrics with five other Trusts namely: - The Whittington Hospital Trust - West Hertfordshire NHS Trust - North Devon Healthcare NHS Trust - Bedford Hospital NHS Trust - St Bartholomew s and Royal Marsden (for cancer) Number of inpatient beds and bed occupancy. The registered to unregistered nursing skill mix was assessed against national guidelines. The registered nurse to bed ratio for each shift was assessed against national guidelines. Target nursing hours per patient day (NHPPD) was used to calculate appropriate staffing required. The Safer Nursing Care tool (SNCT) was used to calculate the appropriate staffing required. Incidents of red triggering shifts, indicating when wards fall below acceptable staffing levels for the patients on the ward Current staffing shortfalls for each ward Current levels of specialling required for each ward Analysis of the current applied headroom compared to actual staff unavailability A review of nursing quality indicators, this includes reviewing falls, hospital acquired pressure ulcers and harm events as per national guidelines. Other clinical factors including a review of serious incidents, Datix incidents and complaints for which staffing could have an impact. The Safer Nursing Care Tool methodology recommends that key patient, staffing and flow information is collected over a 20 day period, this data was used to inform the recommendations below. 5. Summary of key actions implemented following previous establishment review Since the establishment reviews commenced in 2012 over 5million has been invested in the Trusts nursing and midwifery establishments, some have been as a direct recommendation from previous establishment reviews and others the result of approved business cases. This is summarised below: Year WTE Speciality Costs Establishment Review - 1.52 2012 Medicine 47,200.00 Establishment Review - 18.61 201 Medicine and surgery 485,24.00 Establishment Review - 19.78 Feb 2014 Medicine and surgery 991,984.00 Establishment Review - Oct 2014 Emergency Department Business Case Establishment Review - April 2015 24/7 Matron Business Case Increase in Band 7 supervisory to days a week Full external review of both Children's and Adult Accident & Emergency departments resulted in an additional 1.5million increase the nursing establishment and skill mix, this was requirement was phased in with full implementation in October 2015. All in patient ward managers Emergency Department Review recommended idnetifying senior nurse Senior nurse and cover out of hours and additional administrative support functions support for this role 550,000.00 1,500,000.00 0.00 Matron 155,962.00 Total 54.91 4,156,470.00 Director of Nursing, Establishment Review, October 2015 Page 5 of 14

In addition to the targeted establishment reviews a number of factors have influenced changes to anticipated establishments. These are summarised as follows: In October 2014 additional inpatient capacity was created by opening ward 6A as a medical ward and Ashwell, a ward caring for delayed transfer of care patients and gastroenterology patients. This was a late revision to the Our Changing Hospitals programme. The Emergency Department received an additional 09,46 to fund 1 Registered Nurse and 1 Care Support Worker to support triage activity in the department, this was implemented in October 2015. Swift Ward received 21,49 to extend the ward opening times over the weekend; this opened an additional 12 beds at the weekend to support capacity demands. Bluebell Ward received 101,625, to allow for the flexible use of an additional registered nurse at night, this is only utilised if the number of inpatients exceeds 16. Safer team set up to support the increasing need for patients requiring specialling, this consists of specially trained Clinical Support Workers with skills in 1 to 1 patient care. This is facilitated by an increase in the substantive staffing by 5,700 (full year effect 2016/17) which is for 1.0 wte Band 6 and 17.28 wte Band, this is coupled with a reduction in the temporary staffing budget which will create a saving of 224,000 full year effect 2016/17. Additional uplift to children s services covering the Emergency Department, CAU and day surgery 291,67 6. Current assumptions 6.1 Skill Mix and Nurse to Bed Ratio There is an agreement of a minimum 60:40 ratio of registered to unregistered nursing staff in Medicine and 65:5 in Surgery. The average registered to unregistered staff ratio for Medicine is 62:8 and in Surgery is 6:7. In Cancer the registered to unregistered ratio is 70:0. In Midwifery there is currently a midwife to birth ratio of 1:0 with a contractual target of 1:29. Children s ratios are age and acuity dependent i.e. for under 2 s the ratio is 1: and over 2 years 1:4. Details of the skill mix for each inpatient ward are shown in Appendix 1. All adult wards have a registered nurse to patient ratio of no less than one registered nurse to 8 patients during the day and night, in line with national recommendations. The table below shows the average cover per shift along with the registered nurse to bed ratio for each Division. The available cover and registered nurse to bed ratio for each inpatient ward can be seen in Appendix 2. Available Shifts (RN + Unreg) RN to Bed Ratio Division Early Reg Early Unreg Late Reg Late Unreg Night Reg Night Unreg Early Late Night Medicine 6 5 4 2 1/5 1/6 Surgery (Excluding Critical Care) 5 4 4 1 1/6 1/8 Women's and Children's 4 2 4 2 1 2/9 2/9 1/6 Cancer 5 2 4 2 0 1/4 1/5 The staff to patient ratio indicates the total number of registered nurses required to care for a specific number of patients, this will vary according to the type of ward, acuity and patient, location/ward layout, activity and patient flow. Director of Nursing, Establishment Review, October 2015 Page 6 of 14

6.2 Review of Nursing Hours per Patient Day (NHPPD) Benchmark Clear national guidance on NHPPD is awaited, however the methodology for this review is based on evidence that is widely used in Australia. It uses a calculation of the number of registered nurses and care support workers required to provide direct patient care in a 24 hour period. Direct patient care time includes: all hands-on care (for example assistance with eating and drinking, patient hygiene, administering medication, taking clinical observations) providing one-to-one observation or support to patients (for example, taking them too or from theatres) all direct communication with patients. Indirect patient care time includes: patient documentation professional discussions to plan patient care discharge planning communication with patients relatives and friends ordering investigations shift handovers Healthcare services in Western Australia use a recommended NHPPD based on ward type and activity. The recommendations have been used to assign a target NHPPD to the wards in the new configuration. Table 1 below indicates the average target benchmark for the Division, along with the average occupancy. This is then used to calculate the recommended WTE for the Division which is then compared to the actual funded WTE. Table 1 Division Average Benchmark NHPPD Oct 2015 Average Bed Occupancy % Oct 2015 Total Recommended NHPPD recruitable WTE based on occupancy Total Recruitable Establishment Oct 2015 Total Variance from actual funded WTE Medicine 5.79 95% 8 425 42 Surgery (Excluding Critical Care) 5.76 92% 207 209 2 Women's and Children's 6.80 84% 4 48 5 Cancer 7.00 65% 42 72 1 As a benchmark, the average NHPPD on a Medical ward is 5.79 and on a Surgical ward is 5.98 (excluding Critical Care). It should be noted when aggregated at divisional level service specific variables are not taken into account, eg increased NHPPD for Ward 11A for the high dependency beds. This accounts for the variance between the NHPPD recommended recruitable WTE and the actual WTE. The NHPPD benchmarking data for each ward is compared to the SNCT data in Appendix. The review of the NHPPD has identified four wards that require an uplift in WTE see section 8. 7 Safer Nursing Care Tool (SNCT) Safecare has been used for the first time to provide the safer nursing care data for the establishment review. Table 2 shows the total funded operational WTE compared to the total actual worked WTE for each Division, this is then compared to the SNCT recommended WTE. The NHPPD benchmarking data for each ward is compared to the SNCT data in Appendix. Director of Nursing, Establishment Review, October 2015 Page 7 of 14

Table 2 Division Total Operational WTE Total Worked WTE Total SNCT recommended WTE Total Variance of operation establishment to SNCT recommended Medicine 68 91 477-109 Surgery (Excluding Critical Care) 180 180 224-44 Women's and Children's 44 41 9 5 Cancer 62 56 5 9 A comparison of the funded establishment and SNCT recommended establishment indicates a significant increase is required in the funded staffing for ward areas. This is not consistent with the other data collected as part of this establishment review, a summary of the overall findings of the establishment review can be seen in the recommendation section at the end of the report. The higher than anticipated SNCT requirements are at odds with the national guidance. There are several factors that have influenced the SNCT recommended WTE, regarding the nurse to patient ratios and registered to unregistered ratios. This is the first establishment review where Acuity/Dependency scores have been taken from SafeCare. There has been a change to the data collection times and grade of nurse collecting the data following the implementation of SafeCare. Some of the variance is attributable to specials for patients assessed as high risk of harm. Increased daily focus on acuity scores on most wards rather than just at establishment review data collection time period. Comparison of April and October acuity scores will vary due to seasonal variation. The bed configuration and speciality mix has changed since October 2014 on some inpatient wards. The SNCT is for general adult wards and does not take into account specialist areas including care of the elderly and assessment areas; further work is needed with acuity/dependency models and multipliers for these areas. Despite the issues with the SNCT acuity tool within SafeCare outlined above this method for assessing acuity and dependency is the nationally recommended tool. However, other variables should be taken into consideration: Clinical model Staff capacity, capability, seniority and confidence Organisational support and support roles Ward manager supervisory time National guidance on nurse to patient ratios, NHPPD and registered to unregistered ratios In order to further test some outcomes from the SNCT results the following actions will be implemented: Undertake inter-rater reliability training Safety specialling team, which will be included in the staffing numbers Implementation of revised acuity tool for elderly care and specialist areas Continue to benchmark with other organisations Director of Nursing, Establishment Review, October 2015 Page 8 of 14

8 Outcome of Adult Inpatient Ward Establishment Review There is one recommendation following the adult inpatient ward establishment review. It is recommended that for four of the 0 bedded wards in the tower block at the Lister that currently have an RN to CSW night duty roster of 4 and 1 that this is uplifted to 4 and 2. This recommendation is predominately based on the layout of the wards with 15 beds at either end, including a back bay which cannot be easily observed from the nurses station or other ward areas, there is also a significant distance between the two fifteen bedded ends of the ward. In addition the NHPPD tool and SNCT both recommend an uplift in the WTE for these areas, although there is a discrepancy between the two tools with regards to the WTE. On review of the number of additional duties requested, over and above the current establishments this further evidences the need for an additional CSW on the night shift, Table 4 summarises the NHPPD and SNCT recommended WTE, Table 5 provides evidence of the additional duty hours and costs in the quarter September to November and Table 6 incorporates the cost of the recommended uplift of WTE per ward. There is a potential cost saving through use of substantive staff versus agency staff, which equates to 54,462 p.a. Table 4 Ward NHPPD Bench Marking Data Variance form actual funded WTE SNCT Data Variance form actual funded WTE 6A -0.25-9.05 10B -2.18-1.16 8A -2.4-6.55 5B 0.42-14.29 Table 5 Ward Additional Night Temp Staffing cost of additional duties Cost if substantively employed Savings 10B 91.25 15,899.68 9,799.17 6,100.51 5B 214.75,78.80 2,04.27 1,44.5 6A 202.50,525.5 2,172.8 1,52.70 8A 707.75 12,21.9 7,594.16 4,727.77 Grand Total 208.25 5,485.9 21,870.42 Additional night duty requests and associated costs and potential savings Sept - Nov 1,615.51 Director of Nursing, Establishment Review, October 2015 Page 9 of 14

Table 6 Ward Operational CSW Uplift Funded CSW Uplift Cost of Increased Coverage 10B 2.10 2.54 66,284.5 6A 2.10 2.54 66,284.5 5B 2.10 2.54 66,284.5 8A 2.10 2.54 66,284.5 Total 265,18.10 Costings are based on band 2 CSW midpoint with on costs, including night enhancement The SNCT also indicates that wards 5A and 7B may require an additional CSW at night, however, this is not supported by the NHPPD tool. As such it is recommended that these wards have further scrutiny of their activity and acuity and the WTE is reviewed in April 2016. Ward 8B has been identified through the NHPPD and SNCT as potentially requiring an uplift in a CSW at night. However, the ward currently has 4 additional capacity beds open and a separate proposal to change the use of these beds to Acute Surgical Stepdown Beds will be reviewed at the Divisional Operational Committee (DOC) and the Divisional Executive Committee (DEC) in December. 9 Additional Establishment Review Considerations: Midwifery Establishment Review An independent review of midwifery services was undertaken in 2015 following the procurement of a Birth-Rate Plus review. The recently appointed Head of Midwifery has undertaken an establishment review, including the Birth-Rate Plus recommendations, which identified a phased approach to increasing establishments over a three year period based on clinical need and recommendations contained within the NICE Safe Staffing for a Maternity Setting guidance. Consideration has been given to Phase 1 of the recommendations, see Table below: Phase 1 - Table Band TRIAGE Phase 1 Day Assessment Unit Phase 1 WTE WTE 6 2.51 10505 1.17 48800 2.51 57444 1.17 26760 BANK B6 0.09 2414 0.04 107 BANK B 0.09 119 0.04 586 TOTAL 5.20 166482 2.42 77219 The total costs to increase midwifery and care support worker numbers at Phase 1 equate to 24,701. Although it is reported that there has been an increase in the number of triage attendances it is recommended that a review is undertaken of the appropriateness of attendances. Dependent on the outcome of this review, a separate business case will then be prepared and considered through DOC and DEC. It should be noted that the Trust currently has 1:0 midwives against a target of 1:29 within the current contract. A benchmarking Director of Nursing, Establishment Review, October 2015 Page 10 of 14

exercise against other Trusts in the East of England shows that the Trust establishment is within the range of 1:28 to 1:. The request for 7.62 WTE additional midwifery posts has not been supported in the recommendations at this point. Paediatric Establishment Review A paediatric establishment review, including the neonatal unit, was undertaken in April and May of this year by the newly appointed Nursing Service Manager for Children s Services. Throughout the year there have been two uplifts in establishment funded and agreed through the business case process. An uplift to children s services of 8.2 WTE providing additional staff to support the Children s Emergency Department, Children s Assessment Unit and day surgery, at a cost of 291,67 In October Bluebell Ward received 101,625, to allow for the flexible use of an additional registered band 5 nurse at night, this is utilised if the number of inpatients exceeds 16, or if there are more than two higher dependency patients on the ward. In addition to this funding a further request has been made for an additional Clinical Support Worker for the early shift to support children attending theatres for day surgery and additional day attenders. If this was funded on a Monday to Friday basis to cover peak activity the cost would be 27,000. Mount Vernon Cancer Centre Review An establishment review has been undertaken by the recently appointed Nursing Services Manager at Mount Vernon Cancer Centre. Each ward area contains a step up bed for the management of level 1 patients, the proposed shift plan allows for a patient to trained nurse ratio of 1:6 patients for ward 10 and 1:5 ratio for ward 11 (as there are a larger number of side rooms on this ward). The shift plans allow for 4 trained and 2 untrained nurses on each long day shift with the exception of Mondays and Tuesdays when the brachytherapy procedures are carried out. On these days there are 4 trained and untrained nurses rostered. All night shifts have trained nurses allocated to work on them. There is a supernumerary trained nurse each day shift to manage the Acute Oncology Service referrals and enquiries. The review has identified that due to a number of recent changes e.g. the reduction in RN:CSW ratio to 70:0 in line with benchmark organisations a cost saving can be made at MVCC of 91,045. Supervisory Ward Managers Review The Francis Report (201) recommended that Acute NHS Trusts should make all ward managers supervisory;, this means supplementary to the rostered workforce. As part of the 201 review a comprehensive diary exercise of the ward manager role was undertaken to assess the supervisory allocation. The diary exercise demonstrated that there was variation by ward in the supervisory allowance and following the 201 establishment review it was recommended that each ward manager had a minimum of 15 hours supervisory allowance per week. Director of Nursing, Establishment Review, October 2015 Page 11 of 14

An outcome of the establishment review of October 2014 was an increase by one day per week of supervisory time for ward managers. An outcome of the last establishment review was that further increases in supervisory days should be considered on an annual basis. No change is advised at this time although it is recommended that this be reconsidered during the next establishment review which will be undertaken in April 2016. 10 Summary and Cost of Recommendations for Executive approval Although the SNCT recommended WTE were higher than anticipated, this review has demonstrated the overall Trust registered nurse staffing levels are appropriate and in line with national guidance. This is demonstrated by an average registered nurse to patient ratio of 1:8 for adult in patient wards and in addition to this the NHPPD benchmark recommendation is within threshold on all wards apart from 5B, 6A, 8A and 10B. Based on the data collected during the establishment review there are recommendations that have a financial implication, these are summarised below: Recommendation Costs/Savings Increase in Bluebell establishment Additional: 27,000 Additional CSW during day Additional CSW on nights for 4 wards Additional: 265,18 Reduction in Mount Vernon Establishment Reduction: 91,045 Total Cost Implication Additional: 201,09 There is a total cost implication of 201,09 taking into account the cost reduction at Mount Vernon Cancer Centre. It is possible that there will be a reduction in CSW agency spend due to substantive recruitment equating to 54,462, Recommendations without associated costs: 1. To receive a business case detailing activity vs maternity establishment and income to DEC in Spring 2016 2. To review the supervisory status of ward sisters/charge nurses at the next establishment review to be undertaken in April 2016 and reported in July 2016. To receive a business case for the change the use of beds on ward 8B from escalation to Acute Surgical Stepdown Beds 4. To review the acuity and activity on nights at wards 7B and 5A in April 2016 11 Next Steps Continue to undertake acuity and dependency reviews to measure against seasonal changes. Weekly auditing of acuity/dependency on all wards using safecare Implement the Shelford SNCT for Acute Elderly Care Wards into Safecare by February 2016 Continue to review specialist areas and adapt the multipliers and acuity/dependency tools to make them more appropriate for each service, ensuring they are in line with national guidance To develop a business case for extending the hours of the eroster team to support the duty matron out of hours, with SafeCare and temporary staffing Director of Nursing, Establishment Review, October 2015 Page 12 of 14

Cancer W& C Surgery Medicine Cancer W&C Surgery Medicine Appendices Appendix 1 The table below shows the registered and unregistered nurse % for each ward: Div Speciality Ward RCN RCN Actual Actual Recomended Recomended Registered Unregistered Registered Unregistered Nurse % Nurse % Nurse % Nurse % 9B 60.00 40.00 66.87.1 Care of the Elderly Ashwell 60.00 40.00 61.4 8.57 9A 60.00 40.00 55.0 44.70 Stroke (HASU) Pirton 65.00 5.00 61.11 8.89 Stroke Barley 60.00 40.00 60.00 40.00 General 6A 60.00 40.00 61.72 8.28 General 10B 60.00 40.00 54.14 45.86 Respiratory (and HDU) 11A 75.00 25.00 69.9 0.07 Cardiology ACU 60.00 40.00 68.28 1.72 Acute AMU Ward 60.00 40.00 60.82 9.18 SSU 60.00 40.00 59.67 40. Renal 6B 60.00 40.00 65.18 4.82 General Surgical Spec 8A 11B* 65.00 65.00 5.00 5.00 62.48 62.62 7.52 7.8 8B 7B 65.00 65.00 5.00 5.00 67.24 6.56 2.76 6.44 5A 65.00 5.00 57.82 42.18 T&O Swift 65.00 5.00 65.01 4.99 5B 65.00 5.00 68.00 2.00 ATCC Critical Care 90.00 10.00 92.6 7.7 Gynae 7A* 60.00 40.00 62.72 7.28 Paeds Bluebell 70.00 0.00 75.04 24.96 Ward 10 70.00 0.00 74.4 25.57 Inpatient Ward 11 70.00 0.00 84.85 15.15 Michael Sobell House 70.00 0.00 71.00 29.00 Appendix 2 The table below shows the available staff on shift as per the agreed shift plan and the Registered Nurse to bed ratio Available Shifts (RN + Unreg) RN to Bed Ratio Div Speciality Ward Early Reg Early Unreg Late Reg Late Unreg Night Reg Night Unreg Early Late Night 9B 5 (4) 4 4 4 2 Care of the Elderly Ashwell 5 4 4 2 1/5 1/6 1/8 9A 5 (4) 4 4 4 2 1/6 Stroke Pirton 5 2 5 2 2 1/4 1/4 Stroke Barley 5 4 2 2 2/9 1/5 General 6A 5 4 4 4 4 2 1/6 General 10B 5 4 4 1 1/6 Respiratory 11A 6 2 6 2 5 1 1/5 1/5 1/6 Cardiology ACU 8 4 8 4 7 1/4 1/4 1/5 Acute AMU Ward 5 5 4 1/5 1/5 1/6 SSU 5 4 4 2 1/6 Renal 6B 6 4 5 4 2 1/4 1/5 1/8 General Surgical Spec 8A 11B * 5 (4) 2 4 2 4 2 1 1 1/6 1/5 1/5 8B 7B 5 5 4 4 4 4 1 1 1/6 1/6 5A 5 4 5 2 4 1 1/6 1/6 1/8 T&O Swift 5 4 2 1/5 1/6 1/8 5B 5 4 4 1 1/6 ATCC Critical Care** 19 2 19 2 17 1 1 1 6/7 Gynae 7A * 2 2 2 1 1/5 1/5 1/8 Paeds Bluebell 5 1 5 1 4 0 1/4 1/4 1/5 Inpatient Ward 10 6 2 6 1 0 1/4 1/4 1/8 Ward 11 4 2 4 2 0 1/5 1/5 Michael Sobell House 4 2 2 2 2 1 1/4 1/8 1/8 Director of Nursing, Establishment Review, October 2015 Page 1 of 14

Cancer W&C Surgery Medicine The table below shows the NHPPS Benchmark Recommended WTE compared to the SNCT Recommended WTE. NHPPD Bench Marking Data Div Speciality Ward Recommended NHPPD recruitable WTE based on occupancy Recruitable Establishment Oct 2015 Variance form actual Worked WTE funded WTE SNCT recommended WTE Appendix SNCT Recommended Data Variance of operation establishment to SNCT recommended 9B.9 5.12 1.19 1.7 49.07-18.91 Care of the Elderly Ashwell 25.70 1.1 5.61 0.1 8.05-9.59 9A 2.69 5.12 2.4 9.62 46.85-16.69 Stroke Pirton 21. 0.2 8.87 25.94 25.2 0.85 Stroke Barley 26.5 0.84 4.49 28.51 4.84-8.4 General 6A 4.6 4.11-0.25 2.55 40.45-9.05 General 10B.8 1.65-2.18 29.56 40.6-1.16 Respiratory 11A 5.9 5.02-0.91 2.29 4.52-1.44 Cardiology ACU 47.56 54.68 7.12 54.52 50.68 -.80 Acute AMU Ward 28.5 6.87 8.4 4.8 7.80-6.22 SSU.52 4.11 0.59 1.04 9.11-9.81 Renal 6B 29.12 5.52 6.40 29.56 1.04-0.5 General Surgical Spec 8A 11B *.99 18.85 1.56 19.68-2.4 0.8 0.65 14.5.67 16.2-6.55.6 8B 7B 5.18 5.1 2.1 1.19-2.87 -.94 26.76 25.99 4.65 5.0-6.89-8.50 5A.65.76 0.11 28.58 41.81-12.81 T&O Swift 17.1 27.44 10.1 24.49 19.7 1.4 5B 2.8.25 0.42 28.96 42.85-14.29 ATCC Critical Care 79.48 110.9 0.91 108.76 82.84 27.55 Gynae 7A * 21.47 21.56 0.09 16.90 16.86 4.70 Paeds Bluebell 22.00 26.47 4.47 24.40 22.15 0.62 Ward 10 15.28 27.14 11.86 18.67 16.69 6.65 Inpatient Ward 11 1.77 22.54 8.77 18.22 17.91 1.50 Michael Sobell House 12.48 22.81 10. 19.51 18.66 0.98 Director of Nursing, Establishment Review, October 2015 Page 14 of 14