THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST Board Paper - Cover Sheet Date September 2017 Lead Director Report Title Nursing & Midwifery Staffing Three- Monthly Summary Nursing & Patient Services Director Agenda Item A5(iv) 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 NURSING AND MIDWIFERY STAFFING THREE-MONTHLY SUMMARY SEPTEMBER 2017 Agenda item A5(iv) EXECUTIVE SUMMARY 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 May 2017 and July 2017. This complements the monthly Integrated Quality Report. In June, NHS Improvement (NHSI) and the National Quality Board (NQB) released a draft improvement resource for safe staffing in Maternity Services. A full gap analysis will be produced once guidance is released in final version but in the Trust, investment is likely to be required to procure a maternity-specific acuity tool such as Birth Rate Plus. National guidance continues to indicate investment will be required to increase the establishment uplift and support Sister/Charge Nurse supervisory time to ensure compliance. The final version of this guidance is yet to be released. The total Nursing vacancy factor and Band 5 vacancy factor have increased in recent weeks which is expected due to posts being offered to September new registrants. At present the total vacancy factor is 8.3% and Band 5 vacancy factor is 10.3%. Responsive Nurse Staffing reviews have been undertaken as required through review of safe staffing metrics and reporting mechanisms in close collaboration with the Senior Nursing Team. The Nursing and Midwifery Recruitment and Retention Group (NMRRG) continue to manage and prioritise this work. There was an increase in Registered Nurse (RN) percentage fill rates in May, June and July. The July fill rates for RN on night shift is the highest since reporting commenced There are 160 RN currently in the recruitment process with 100 staff members confirmed for deployment in September. This should substantially improve the vacancy factor
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 25 th August 2017
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NURSING AND MIDWIFERY STAFFING THREE-MONTHLY SUMMARY SEPTEMBER 2017 Agenda item A5(iv) 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 May 2017 and July 2017, a summary of which is provided at Appendix 1a, 1b, and 1c. This paper complements the monthly Integrated Quality Report providing an overview and analysis of data. The Board have previously been informed of the continued national and regional shortage of RN and the impact this has on care delivery. There are significant controls and mitigation in place across the Trust. NHS Improvement (NHSI) has recently set up a national retention taskforce whose key aim is to work with Trusts with a high vacancy factor or high turnover rate to optimise retention workstreams. The Trust currently has one of the lowest turnover rates nationally and has recently been asked by NHSI to share best practice. In June, NHSI and the National Quality Board (NQB) published a draft document for consultation Safe, Sustainable, and productive staffing in Maternity Services. Although only in draft for consultation at this present time, it is likely that a robust real-time acuity monitoring tool such as Birth Rate Plus will be required to comply with this guidance which will require investment. A full gap analysis to understand the Trust s position will be completed once the guidance is confirmed and published. 2. NURSE STAFFING i) Recruitment & Retention The RN vacancy rate has deteriorated in the last three months with a steady decline since May. This is a predictable trend due to a large number of new registrants due to commence employment in September. The current overall Nursing vacancy factor is 8.3% and the Band 5 RN vacancy factor is 10.3%. Despite the small percentage decline in the last few months, the total RN vacancy factor and Band 5 RN vacancy factor are still substantially lower than the same period last year due to successful recruitment initiatives. Recruitment in the last few months has been successful. At present there are 160 Band 5 RN in the recruitment process. Of those, 100 have agreed start dates with the majority due to commence employment in late September. The remaining 60 are still in the process of undergoing pre-employment checks. It is therefore expected that the vacancy picture will not improve substantially until October when a further percentage reduction is anticipated. Bespoke and generic recruitment days continue to maximise external recruitment potential. There is a Medicine and Care of the Elderly recruitment day planned for 1
9 th September to encourage staff to apply for posts in these areas as a high vacancy factor remains. The next Trust Band 5 recruitment day is planned for November to capture March 2018 new registrants. Effective and far-reaching social media advertising continues to be used to maximise interest and increase the footfall at these events. International Recruitment continues and a cohort of 14 recruits arrived in May and 7 recruits in July. The new recruits are being supported in practice in preparation for their Objective Structured Clinical Examination (OSCE) and have been placed in clinical environments which are appropriate to their skill set. It is expected that the next cohort will arrive in the autumn. ii) Reporting & Monitoring The Nursing and Midwifery Recruitment and Retention Group (NMRRG) continue to meet monthly to provide strategic and operational oversight in relation to recruitment and retention. One of the key tasks at this multidisciplinary group meeting is to pro-actively review safe staffing metrics, observing trends and variations and agreeing action plans when required. Alongside this, responsive Nurse staffing reviews are undertaken where concern has been highlighted either from professional judgement or changes in data trends. These reviews can then allow effective and efficient deployment of the available Nursing and Midwifery workforce. In the last three months, responsive reviews have been undertaken in Peri-operative & Critical Care and in the Directorate of Internal Medicine. Datix and Red Flag events for these areas are also reviewed to triangulate data. When required, areas of concern have been escalated to the Executive Management team. The NMRRG continue to focus on maximising retention strategies to support an improvement in turnover rates. Work is ongoing to understand what factors influence the Trust s low turnover rate to ensure retention work-streams are effective and have a positive impact. Scoping work is planned in the coming months. 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 (%) May 95.7 June 95.7 July 96.1 2
Average fill rate Registered Nurse/ Midwives (%) Average fill rate Care Staff (%) Average fill rate Registered Nurses / Midwives (%) Average fill rate Care Staff (%) Freeman May 91.9 100.8 95.7 115.0 June 90.1 102.3 95.9 120.7 July 90.5 107.5 99.5 127.2 RVI May 93.2 94.7 93.0 110.6 June 92.7 92.9 94.2 113.1 July 91.4 94.0 92.7 115.0 CAV Acute May 81.8 133.5 98.9 133.8 June 85.6 116.3 100.0 133.3 July 94.5 113.1 98.9 143.6 NCCC May 93.9 89.3 101.4 105.9 June 91.9 95.4 102.4 110.1 July 91.0 92.9 101.0 108.1 Trust May 92.6 97.6 94.2 112.6 June 91.7 97.1 95.1 116.4 July 91.0 99.3 95.3 119.7 It is noted that the Trust overall fill rate in the last three months has improved from the previous three months. This was expected as 90 new RN commenced employment in the Trust in April and there is often a delay before the impact on fill rates is noted. It is particularly encouraging to note the improvement in RN fill rates on nights as this represents an increased Nursing presence out of hours. Although the site breakdown demonstrates a relatively static picture with minimal statistical variations, this is not the case for CAV Acute. Recent successful recruitment in this area has ensured a significant improvement in RN fill rates. Work is ongoing to understand the impact of overtime and temporary staffing usage on the overall Trust fill rates as it important to triangulate this with the fluctuations in vacancy factor. Once the SafeCare module from the Allocate rostering system goes live next year, this data will be available in real time and will help ensure the most effective and efficient deployment of the available staffing resource. Freeman CHPPD Registered Nurse/Midwife CHPPD Care Staff Overall May 5.5 2.4 7.9 June 5.8 2.6 8.4 July 5.8 2.6 8.4 RVI May 6.5 2.4 8.9 June 7.0 2.5 9.4 July 6.9 2.5 9.4 CAV Acute May 2.4 2.8 5.2 June 2.6 2.7 5.3 July 2.9 2.9 5.8 NCCC May 4.4 1.6 6.0 June 4.8 1.8 6.6 July 4.8 1.8 6.6 3
It is important to note the CHPPD data for the same period in the table above (please note the CHPPD value is a rounded figure). The CHPPD metric is becoming increasingly useful as a tool to provide assurance of care provision where there has been fluctuation in fill rates and helps data triangulation. It is noted that the CHPPD metrics for this period have improved or remained static despite the small increase in the vacancy factor. The reporting of the CHPPD metric has now been undertaken for over a year allowing for a year on year comparison. It is noted that CHPPD values have increased since the same time last year demonstrating that patients are receiving more direct care hours from front line staff. 4. RISKS AND RISK MITIGATION Despite a national shortage of RN, the Trust has benefited from successful local and national recruitment. This has led to an improvement in safe staffing metrics such as planned and actual fill rates and CHPPD values. It is important to note, however, that a Band 5 RN vacancy factor of 10.3% remains a significant challenge as this has an impact on patient care and safety. This is particularly the case for those areas whose vacancy factor is higher than the Trust average and where responsive Nurse staffing reviews have been undertaken to assess risk and maintain safety To mitigate these risks, the Trust process for monitoring Nursing and Midwifery staffing is robust. Data is closely monitored to ensure early variances in trend data invoke a responsive Nurse staffing review to ensure Nursing resource is effectively and efficiently deployed. It is also noted that there are 160 RN in the recruitment process and these staff will be deployed in September and October. This will have a substantial impact on the vacancy factor at a Trust and Directorate level. 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 recruitment and retention strategies have helped increase the RN fill rates and improve the CHPPD values. This is despite a small increase in the total and Band 5 vacancy factor. The Senior Nursing Team remains confident that staffing continues to be robustly monitored and responsively managed across the Trust. The guidance published by NHSI/NQB in relation to Maternity Services once finalised is likely to necessitate further investment with particular reference to procuring a maternity acuity tool. If future guidance documents remain consistent, investment will also be required to increase the establishment uplift and support consistent Sister/Charge Nurse supervisory time. 4
6. RECOMMENDATION To i) receive the briefing, note the contents are retrospective and contain May 2017, June 2017 and July 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 25 th August 2017 5