THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST Board Paper - Cover Sheet Date 19 th December 2017 Lead Director Report Title Nursing & Midwifery Staffing Three- Monthly Summary Nursing & Patient Services Director Agenda Item A5(iii) Report Author Classification Helen Lamont, Nursing and Patient Services Director Elizabeth Harris, Deputy Director of Nursing & Patient Services RVI Ian Joy, Senior Nurse for Nursing and Midwifery Staffing NHS Unclassified Purpose (Tick one only) Approval Discussion For Information Links to Strategic Objectives Links to CQC Domains/ Fundamental Standard(s) Identified Risk? (If yes, risk reference) Resource Implications Legal implications and equality and diversity assessment Benefit to patients and the public To put patients and carers at the centre of all we do and to provide care of the highest standard in terms of both safety and quality. To continue to be recognised as a first-class teaching hospital, counted amongst the top 10 in the country, which promotes a culture of excellence, in all that we do. To ensure compliance with National requirements. Regulation 12, 13, 14, 15, 17, 18, 19 Also NICE & NQB Guidance Yes, on the Risk Register 2666 and 2863 On-going staffing reviews continue to highlight the need for additional resources as previously reported to the Board. Future papers will make formal requests. Failure to assure safe staffing levels may lead to patient harm, litigation against the Trust and loss of reputation. There are no specific equality and diversity implications from this paper. Assuring safe staffing levels are in place Supports national mandate to publish staffing levels Report History Next Steps Three monthly update on monthly published data To continue to record and monitor monthly the Nursing Fill Rates and review Care Hours per Patient Day reports.
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST EXECUTIVE SUMMARY NURSING AND MIDWIFERY STAFFING THREE-MONTHLY SUMMARY DECEMBER 2017 Agenda item A5(iii) This paper provides the regular quarterly update to the Trust Board regarding the monthly planned and actual staffing fill rates and Care Hours Per Patient Day (CHPPD) figures between August 2017 and October 2017. This complements the monthly Quality Account. In November, NHS Improvement (NHSI) and the National Quality Board (NQB) released draft improvement resource for safe staffing in Urgent and Emergency Care, Neonatal Services and In-Patient Children and Young People s Services. The Trust is engaging with the relevant Directorates to provide feedback to NHSI on these resources as part of the consultation. The total Nursing vacancy factor and Band 5 vacancy factor have decreased which was expected with the influx of new registrants in September. At present the total vacancy factor of 6.94% and a Band 5 vacancy factor of 8.31%. The Nursing and Midwifery Recruitment and Retention Group (NMRRG) continue to closely monitor the safe staffing metrics on a monthly basis to ensure proactive and responsive action to variances in safe staffing metrics. There has been a steady increase in the Registered Nurse (RN) fill rates for days and nights which correlates with the reduction in vacancy factor. CHPPD metrics demonstrate patients have more time with RN than the same period last year. A new Nursing Foundations Programme has been launched to support newly qualified RN in the first year of their career, with particular focus on those RN who are unsure of which clinical area to start in the career. The aim is to support these staff and provide focused career advice in the first year of work. This work is overseen by the NMRRG. RECOMMENDATION To (i) note the content of this report (ii) comment accordingly. Helen Lamont Nursing and Patient Services Director Elizabeth Harris Deputy Director of Nursing & Patient Services (RVI) Ian Joy Senior Nurse for Nursing and Midwifery Staffing 19 th December 2017
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NURSING AND MIDWIFERY STAFFING THREE-MONTHLY SUMMARY DECEMBER 2017 Agenda item A5(iii) 1. INTRODUCTION/ BACKGROUND This paper provides the regular quarterly update to the Trust Board regarding the monthly planned and actual staffing fill rates and CHPPD figures. This paper covers the period between August 2017 and October 2017, a summary of which is provided at Appendix 1a, 1b, and 1c. This paper complements the monthly Quality Account providing an overview and analysis of data. The Board has regularly been appraised of the continued national and regional shortage of RN and the impact this has on care delivery. There has been an improvement in the vacancy factor in the last few months and a decreasing turnover rate; this is as a result of the work led and co-ordinated by the NMRRG. Focused work is still required as many of the new staff are new registrants who will require ongoing support in the early part of their career. In November, NHSI and NQB published draft safe staffing improvement resources for consultation for Urgent and Emergency Care, Neonatal Services, and Children and Young People s services. The Trust is engaging with the appropriate Clinical Directorates to review the resources and provide feedback to NHSI and the NQB prior to final publication. 2. NURSE STAFFING i) Recruitment & Retention The RN vacancy rate notably improved in October. This was predicted due to a large number of new registrants commencing employment in September. The current total Nursing vacancy factor is 6.94% and the Band 5 RN vacancy factor is 8.31%. The total Nursing vacancy and the Band 5 vacancy percentages are the lowest values since recording and over 2% lower than the same time last year. Recruitment in the last few months has continued to be successful. At present, there are 85 Band 5 RN in the recruitment process and 109 applicants have been shortlisted to interview in the coming weeks. It is therefore expected that if turnover remains static, the vacancy factor should reduce further when the next cohort of RN qualify in March. Although a positive trend, as previously mentioned, further work is required to ensure the Nursing teams remain resilient whilst the new registrants are supported in developing confidence in their new role. Bespoke and generic recruitment days continue to maximise external recruitment potential. A Trust Band 5 recruitment day was held on the 11 th November with 82 candidates attending, many of whom are due to be interviewed for posts in the coming weeks. At this event our new Nursing Foundations Programme was launched. This programme is aimed at supporting newly qualified RN who are unsure of which clinical area to start their career in. A post is offered in one of the 1
larger Directorates where staff can develop core skills in a supported environment. Career clinics, one to one sessions and shadowing opportunities will be offered in the first year to support a career pathway in the Trust. The aim is to further reduce turnover and provide a long term structured career pathway in the Trust. ii) Reporting & Monitoring The NMRRG continue to meet monthly to provide strategic and operational oversight in relation to recruitment and retention. As part of the monthly meetings Red Flag and Datix incident data is reviewed to observe for trends and highlight areas of concern due to an increase in reporting. It has been noted in the last 3 months that Datix reporting and Nursing red flag numbers have reduced compared to the same time last year and when compared to the previous 3 months. The red flag reduction is expected due to the increase in RN fill rates. It is the opinion of the NMRRG that there is under reporting of staffing related Datix and staff have been encouraged and supported to report. 3. NURSE STAFFING REPORT Planned and Actual Staffing and Care Hours per Patient Day (CHPPD) The tables below contain the Trust summary of the planned and actual staffing, for a three-month period broken down by site for NHS Choices, and the overall Trust fill rates. Month Overall Trust Fill rate (%) August 94.8 September 96.0 October 96.9 Average fill rate Registered Nurse/ Midwives (%) Average fill rate Care Staff (%) Average fill rate Registered Nurses / Midwives (%) Average fill rate Care Staff (%) Freeman August 89.4 104.6 96.5 126.6 September 92.8 105.0 97.4 130.8 October 93.8 105.4 96.6 129.4 RVI August 90.3 95.5 91.3 111.4 September 92.0 92.3 92.3 113.1 October 92.8 96.0 93.6 112.6 CAV Acute August 94.6 113.3 96.8 140.3 September 89.4 133.6 98.8 136.7 October 102.0 109.1 95.7 106.5 NCCC August 87.7 88.5 99.8 101.0 September 89.6 85.9 99.0 100.9 October 90.1 94.3 98.7 113.7 Trust August 89.9 98.9 93.3 117.6 September 92.1 97.6 94.3 119.9 October 93.1 99.6 94.8 119.1 2
It is noted that the Trust overall fill rate in the last 3 months has improved from the previous 3 months. This was expected with new RN commencing employment in the Trust in September. It is particularly encouraging to note the improvement in RN fill rates on days on all sites with a relatively static position noted for RN on nights. Freeman CHPPD Registered Nurse/Midwife CHPPD Care Staff Overall August 5.8 2.6 8.4 September 5.8 2.6 8.4 October 5.8 2.5 8.3 RVI August 6.9 2.5 9.4 September 6.7 2.4 9.0 October 6.7 2.4 9.0 CAV Acute August 3.1 3.0 6.1 September 2.7 3.0 5.7 October 2.8 2.3 5.1 NCCC August 4.7 1.7 6.5 September 4.6 1.7 6.3 October 4.8 1.9 6.7 The table above details the CHPPD data (rounded figure) for the same period. The overall CHPPD metric appears to have reduced over the last 3 months on the CAV Acute site. This is a single Ward site and the reduction in RN and HCA CHPPD is due to an increase in bed capacity. It is important to note that the 5.1 overall figure for October for CAV is similar to most other Medical/Rehab Wards across the Trust. All other areas demonstrate a relatively static position and all areas have an improved CHPPD figure when compared to the same period last year. 4. RISKS AND RISK MITIGATION Despite the national trend, the Trust has benefited from successful local and national recruitment. This has led to a notable drop in the vacancy factor across Nursing and in particular, the Band 5 RN. This trend is demonstrated in the Trust level fill rates and CHPPD values. It is noted that despite the improvement, risk still remains with a Band 5 vacancy factor of 8.31% and focused long term work is required to support the growing junior Nursing workforce and improve and maintain the resilience of the experienced Nursing workforce. This is alongside continued work to recruit locally and nationally. To mitigate these risks, the Trust process for monitoring Nursing and Midwifery staffing is robust. A very strong professional leadership is in place. Recent responsive staffing reviews have taken place where there has been concern highlighted through the reporting process and this has ensured resources have been deployed to reduce risk and optimise patient safety. 3
5. SUMMARY This paper contains the regular monthly planned and actual staffing levels with a cross reference to the CHPPD values for the Trust sites. The recent improvement in the Nursing vacancy factor has positively impacted on other safe staffing metrics and this is encouraging. The Senior Nursing Team remains confident that staffing continues to be robustly monitored and safely managed across the Trust. Work is ongoing to maintain and improve this picture influenced by robust data sets alongside professional judgement and engaging with the frontline workforce. The guidance documents published by NHSI/NQB for consultation will be analysed to understand the impact of the documents once finalised, on the Trust s current position. Updates of risk and mitigation will be highlighted to the Board and Executive Team. 6. RECOMMENDATION To i) receive the briefing, note the contents are retrospective and contain August 2017, September 2017 and October 2017 data and ii) comment accordingly. Helen Lamont Nursing and Patient Services Director Elizabeth Harris Deputy Director of Nursing & Patient Services (RVI) Ian Joy Senior Nurse for Nursing and Midwifery Staffing 19 th December 2017 4