Board Briefing Board Briefing of Nursing and Midwifery Staffing Levels Date of Briefing January 2018 (December 2017 data) This paper is for: Sponsor: Chief Nurse- Dame Eileen Sills (DBE) Decision Author: Workforce Team (Chief Nurse s Office) Discussion Reviewed by: Director of Nursing, Adult Services (Chief Nurse s Office) Noting CEO* Information ED* Board Committee* TME* Other* * Specify
1.0 Summary This briefing provides the Board with an overview of the Nursing and Midwifery workforce during the month of December 2017. It provides the monitoring arrangements that are in place to safely staff our clinical services with the appropriate number of nurses & midwives with the right skills. We monitor the acuity of our patients using the nationally accredited Safer Nursing Care Tool (SNCT) alongside professional judgement. There is an escalation process in place to monitor safe staffing levels in all of our inpatient areas across the 24 hours period 7 days a week so staff can be flexed according to need. In addition harm events, adverse incidents that have been caused by inadequate staffing levels, are monitored and reported on. 2.0 Key highlights for December 2017 Average fill rates of planned hours for Registered Nurses (RNs) for days were 98.8%, with nights at 100.1%. Average fill rates for planned hours for NAs was 98.4% in the daytime and 119.3% for the night. Overall 100.6% of planned hours were used. The rate of spend on agency staff has come down 1.1% from the previous month to 4.7% which brings it close to being within the target of 4.3%. On 5 January 2018 there were 346 external candidates in the Recruitment Pipeline, who are expected to join the Trust over the next few months.
Table 1: Nursing and Midwifery Staffing Levels in December 2017 compared to December 2016 Table 1 Staffing measures Nursing Establishment WTE Nursing Staff in Post WTE December 2016 December 2017 Change 6044.44 6189.44 145.00 5230.35 5508.94 278.59 Vacancies WTE 815.49 680.50-134.99 Vacancy rate 13.5% 11.0% -2.5% Annual turnover 14.1% 14.4% 0.3% Red Flags raised 68 86 18 Agency % of Pay bill 5.3% 4.7% -0.6% Planned v Actual Hrs used 99.0% 100.6% 1.6% Care Hours per Patient Day 10.6 10.5-0.1
3.0 Recruitment & Retention 3.1 The overall Nursing vacancy rate for December 2017 was 11.0%, which is 0.8% higher than the previous month. The rise in vacancy rate is mostly due to a high volume of leavers outstripping joiners which is to be consistent with what normally occurs during this month of the year. Table 2 highlights the success of recruitment activity in 2017 and of note is the additional 278.59 wte nursing and midwifery staff in post compared to the same period in 2016. 3.2 Recruitment activity continues with the Band 5 generic assessment centres every 3 weeks, yielding good numbers of high quality candidates. There are currently 346 candidates in the pipeline that are being prepared for employment commencement across the Directorates. The 3 weekly assessment centres will continue throughout the winter period in order to maintain the pipeline of staff coming into the Trust. There is also focused recruitment in key areas with greater staffing challenges alongside ongoing retention strategies. 3.3 Retention continues to be a focus with promotion of the Internal Transfer Policy, highlighting opportunities for staff across the Trust. Nursing and Midwifery Staff in Post 5600.00 5500.00 5400.00 5300.00 5200.00 5100.00 5000.00 4900.00 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Series1 Series2 Table 2
Safe Staffing 4.1 As outlined in table 3 below, the number of bed days in December 2017 stood at 43,571. This is 3,716 more than the previous shorter month and significantly an additional 10,529 bed days from the same period in 2016. This represents a rise of 31.9% in activity from December 2016. From an acuity perspective, Level 1b (heavily dependent or acutely unwell) patients in non-critical care beds, continue to be the most predominant across the Trust, this has been consistent over the past few years. Count of bed days Proportion of bed days Month Level 0 Level 1a Level 1b Level 2 Level 3 Total level 0 Level 1a Level 1b Level 2 Level 3 December 8,404 9,992 23,088 2,071 16 43,571 19.3% 22.9% 53.0% 4.8% 0.0% November 9,244 8,953 19,651 2,003 4 39,855 23.2% 22.5% 49.3% 5.0% 0.0% Table 3 4.2 SafeCare has now replaced IPAMS in the adult inpatient ward areas (excluding Howard Ward and Critical Care) for recording and analysing safe staffing data, red flag alerts and recording of CHPPD. As this is a live system it is enabling meaningful conversations regarding safe staffing in areas based upon acuity and dependency data triangulated with staffing requirements and actual staffing levels. SafeCare will be implemented in Howard Ward and the Community inpatient areas during February 2018. Planned and actual staffing numbers, patient acuity and dependency are collated on SafeCare twice daily. In December 2017, actual hours for Registered Nurses were 1,584 below the planned hours, which equates to 9.72 WTE, whilst Nursing Assistants were 3,503 above planned hours which equates to 21.50 WTE. This variation is driven by occasions where Nursing Assistants are employed in addition to the planned numbers to provide 1:1 care for those requiring enhanced care. There is also appropriate deployment of Nursing Assistants to cover a vacant shift for a Registered Nurse where patient acuity is lower. 4.3 A total of 86 Red Flags, highlighting potential concerns regarding safe staffing were raised in December 2017 (Table 4), an increase of 12 on the previous month. The numbers of red flags do fluctuate on a month by month basis and these were resolved within the Directorates without there being an impact upon patient care or patient safety.
There were no reported quality incidents related to staffing reported in December 2017. All adult inpatient areas (with the exception of Howard Ward) are using SafeCare and raise their red flags directly which is a simple process for staff to action. 60 Red Flags in November Red Flags December 2017 Red Flags in December 50 40 30 20 10 0 Table 4 4.4 Care Hours per Patient Day (CHPPD) continues to be collated on a monthly basis and reported as part of the UNIFY data report. The Trust measure for December 2017 was 10.5, up 0.4 hours from the previous month.
4.5 There is a continued focus on reduction of agency staff within the Nursing and Midwifery workforce. Spend on agency in December 2017 was 4.7, 1.1% lower than November 2017. This percentage relates to actual spend or invoices paid in month, however the number of agency hours used in December was the lowest since April 2017 as demonstrated in Table 5. 2,139.8 2,102.4 2,259.2 2,076.9 2,056.5 1,752.5 1,843.9 1,703.7 1,832.0 1,856.5 1,847.4 1,742.8 1,506.8 1069.9 1199.3 1192.1 1407.7 1000.8 1139.9 1155.3 1167.6 1093.5 1137.6 1258.1 1035.7 933.34 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Bank WTEs Agency WTEs Table 5
The Senior Nursing teams are working closely with the HoNs, Staff Bank and HR teams to lower the percentage of spend to below 3% by April 2018. It is envisaged that with the review of bank rates agreed at TME in December, alongside the decision to pay staff at their substantive grade when undertaking a bank shift, there will be a resultant reduction in agency usage. In addition, 48 Continental Travel Agency Nurses (CTN) were interviewed and successfully recruited to substantive posts in December 2017. 5.0 Effective Rostering All areas are now working towards effective rostering either using a rolling pattern or through other rostering practices. From January 2018 all in patient area leads will go through a Roster Challenge Board which will initially be focused on education and promoting understanding of rosters, KPIs and ensuring all information within Health Roster is updated and accurate. Going forward the Challenge Boards will provide a platform for holding roster creators and area leads to account for the effectiveness of their roster. The KPIs have all been reviewed and will now be reported separately to the Workforce Scorecard on a monthly basis as they cover different reporting periods. 6.0 Impact of staffing on quality No relationship has been identified between the levels of staffing within the clinical areas and any critical incidents. All incidents are reviewed in relation to any safe staffing concerns and also whether red flags have been raised. 7.0 Request to the Board of Directors The Board of Directors are asked to note the information contained in this briefing: the use of the red flag system to highlight concerns raised and the continued focus on recruitment and retention, as well as controlling the use of temporary staff.