UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST BOARD OF DIRECTORS Date of meeting: 29 th January 2014 Title of Report: Status Public Purpose of Report: Report of: Prepared by: Action required / recommendation: This reports aims to provide the Board of Directors with information on its first nursing and midwifery staffing establishment review Sue Smith Executive Chief Nurse Sue Smith Executive Chief Nurse The Board of Directors are asked to: 1. note the contents of this paper Monitoring and Assurance Framework Summary Link to Trust Corporate and Divisional Objectives(s) Link to Corporate Risk Register Have all implications been considered? Quality and Safety Legal Financial Human Resources IM&T Estates Patients and Carers Engagement and Communication Equality and Diversity Reference/Link to Corporate Objective(s) & Risks Yes Description Any Action Required? Yes Detail in report N/A Comment
Introduction UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST 1. To align the national guidance on nursing, midwifery and care staffing capacity an capability with: Background a. Progress made in improving staffing capacity and capability over the last twelve months b. The current staffing capacity and capability (at December 2013) c. Ensuring sustainable nursing midwifery and care staffing capacity and capability in to the future. 2. In February 2013, the report of the Mid Staffordshire NHS Foundation Trust public Inquiry was published. The document, known as the Francis Report describes a system wide failure to protect patients from harm. The documents can be found on http://www.midstaffpublicinquiry.com/report 3. In total, these documents provide almost 2000 pages of report and 290 recommendations. 4. Following publication of the Francis Inquiry, a Trust communication was sent to all staff setting out the key elements of the Francis Report, the Trust s response, and expectations of individual staff. A review was undertaken to identify all those recommendations which were applicable to the Trust, and a gap analysis undertaken in relation to each one. In the majority of cases, work was already underway to respond to the recommendations. For the remainder, named individuals were allocated to lead with the implementation. In order to prevent duplication of work, the recommendations have also been linked into relevant improvement programmes of work. A review of the work undertaken is available to members of the Board of Directors on the Governance website. 5. In July 2013, the Keogh reviews into the quality of care and treatment provided by 14 hospital Trusts in England described frequent examples of inadequate numbers of nursing staff in some ward areas. Whilst there was evidence of insufficient establishment in some wards, in others, there were differences between funded and actual numbers of registered nurses and support staff to provide care on a shift by shift basis (page 22). This document can be found on http://www.nhs.uk/nhsengland/bruce-keoghreview/documents/outcomes/keogh-review-final-report.pdf
6. In August 2013, the Berwick review into patient safety was published. Recommendation 4 directed Government, Health Education England and NHS England to assure that sufficient staff were available to meet the NHS s need now and in to the future. Health Care organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are well supported. Berwick continues that Boards and leaders of provider organisations should take responsibility for ensuring that staffing is adequate, that it takes account of acuity and dependency and is in accord with scientific evidence. This document can be found on https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/22 6703/Berwick_Report.pdf 7. In November 2013, the National Quality Board published a guide to nursing, midwifery and care staffing capacity and capability which was endorsed by the Chief Nursing Officer for England. This document describes expectations of Boards; clinical and managerial leaders; Health Care staff providers and commissioners. This document can be accessed on http://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf 8. Among these recommendations is an expectation that boards receive monthly updates on workforce. There is an expectation that staffing, capacity and capability is discussed at a public board meeting at least every six months on the basis of a full nursing and midwifery establishment review (expectation 7, page 7). 9. This reports aims to provide the Board of Directors with its first nursing and midwifery staffing establishment review in line with the recommendations of all of these afore mentioned publications. 10. The Board of Directors is asked to recognise that a full reconciliation of workforce data is currently being undertaken across the financial ledger, ESR and e-rostering to ensure that all sources of data provide congruent information. This report uses staffing data derived from the financial ledger and clinical outcome data from the clinical governance reporting system. Data was provided in December 2013. Progress made in improving staffing capacity and capacity in the last twelve months. 11. Appendix 1 provides the Board of Directors with an overview of standards outlined in the National Quality Board document published in November 2013. It also provides an outline of actions taken over the last 12-months to demonstrate the current status of nurse staffing. A gap analysis has been undertaken in order to describe actions that the Trust needs to take to achieve full compliance against the national guidance.
12. Table 1 demonstrates the net increase of nursing and midwifery staff recruited to the Trust between January 2013 and December 2013. Staff Group Leavers Commenced Recruited (not Net gain/loss yet commenced in post) Registered 107 79 85 57 nurses Registered 16 24 5 13 midwives Healthcare 39 62 42 65 assistants Total 162 165 132 135 The Current staffing capacity and capability (at December 2013) 13. A review of nursing and midwifery establishments has been undertaken by the recently appointed Executive Chief Nurse 14. A nursing dashboard is being developed and will provide patients, staff and members of the public with staffing and clinical outcome data for every inpatient ward and department. 15. Although the nurse to bed ratio and the skill mix ratio in many of the areas appears to be adequate, there are a number of departments that require an element of investment. It is clear from staffing data that steps have already been taken in a number of areas to address potential shortfalls in staffing or skill mix. Discussions are currently taking place with the Directors of Workforce & OD and Finance to ensure that in the longer term, these changes are captured through workforce planning and reflected in the funded establishment. 16. Additional work is being undertaken to understand the costs of temporary staffing solutions (bank, agency and overtime) against which to align any changes in funded establishments. 17. As and when wards move onto e-rostering, parameters will be set and issues immediately flagged, providing a robust governance and audit process for managing staffing or skill mix pressures. 18. A daily teleconference led by the deputy directors of nursing and assistant chief nurses takes place at 9.30am every morning. This provides an opportunity to ensure that staffing capacity and capability are optimised across the Trust.
Ensuring Sustainable Nursing, Midwifery and Care Staffing, Capacity and Capability into the future. 19. The Trust is looking to develop a modern apprentice programme which will support delivery of a longer term workforce strategy. This programme will result in unregistered health care staff with a level of qualification that will provide values, knowledge and skills to ensure that patient care remains the focus of all that we do. At the end of the apprentice programme, apprentices will receive a recognised academic qualification. Those who pass the programme will be provided with a choice of whether to take on a health care assistant role or alternatively to go into registered nurse training on a two year programme, returning to the Trust as a band 5 registered nurse. 20. The Trust have doubled the number of Nurse Cadets from Furness College this year and plans for the same at the Lancaster end of the Trust. Also of note: the very high conversion rate of the last cohort of cadets into nurse and AHP training locally including one of the FGH cadets winning cadet of the year 21. The Trust aims to introduce an extended values based induction programme for all clinical staff. 22. A development programme for registered nurses/midwives and health care assistants will be developed during 2014/15 and will complement the development programme already in place for band 7 staff, for matrons, and for senior nurse leaders. A programme of supervision will be available to all registered nurses and will be aligned to the appraisal process. Clarity of Role, responsibilities and accountabilities will be developed and aligned to a nursing and midwifery strategy from 2014 to 2020. 23. The programmes of development for nurses and midwives will make clear, each person s duty of care in relation to escalating concerns about patient safety. The development of a nursing dashboard will support a culture of honest and open display of clinical outcomes in relations to nursing and midwifery care. Information relating to staffing numbers, skill mix and to clinical outcomes alongside Friends and Family data and I want Great Care data will be displayed on public boards for staff, patients and visitors to view in each nursing and midwifery area. 24. Key performance indicators are being developed and these will provide the Board of Directors with assurance that investing in the workforce in a sustainable way will result in improved clinical outcomes for patients, improved experience for patients and staff. The release of overall efficiencies will also be demonstrated though measurable outcomes.
Summary 25. During 2013/14 there have been a number of national reports and recommendations relating to nursing and midwifery staffing and skill mix. The University Hospitals of Morecambe Bay NHS Foundation Trust has made significant improvements in relation to nursing and midwifery workforce. An ongoing, proactive recruitment campaign has enabled the Trust to close the gap between funded establishment and those nurses and midwives in post over the last 12-months. 26. It is important that the Board of Directors recognise the significant improvements made to staffing and skill mix during the past year, however it is also important to recognise that there is still more work to do. Recommendation 27. The Board of Directors is requested to note the content of this report to recognise the progress made to date and to agree to receive a six monthly report aligning nursing and midwifery workforce data to impact on patient outcomes and efficiencies released through ensuring the right people, with the right skills are in the right place at the right time.