Meeting: Finance and Performance Committee Date: 27 th June 2016 Agenda Item: 7 Monthly Report on Nurse Levels for May 2016 Key Risks - Clinical: The delivery of safe, high quality care is a fundamental to objective of the Trust. This paper reports on the shift by shift information required as part of the Hard Truths. Environmental: Reputation: Failure to deliver high quality care may impact on reputation. Business: Failure to deliver on safe, high quality care may impact on the hospital of choice. Finance and Performance: Failure to deliver on safe, high quality care may impact on the hospital of choice. Legal:None Resource Required: Cross Reference to Trust Strategic Priorities and Objectives:Clinical and Service Excellence Legal and Regulatory Implications/Equality and Diversity issues:none Trust Values and Behaviours consideration and impact:kind Respectful and compassionate: Professional Follows and shares best Practice. Recommendation The Finance and Performance Committee is asked to note the shift by shift information. Requested Action None. Summary This paper is the monthly report of the nurse staffing levels on a shift by shift basis for the planned and actual staffing levels. This paper outlines the Trust s position on the mandatory 1
submission for nursing fill rates to the Department of Health via UNIFY, highlighting key areas of risk and the mitigation taken at directorate level. 1. Introduction The purpose of the paper is to outline the nursing staffing fill rates for the period of 1 st to 31st May and highlight the key areas of risk and mitigation taken throughout this period. This report meets the requirements of National Quality Board and expectations delivered to Trusts in December 2013. The data captures actual versus planned staffing on an hourly basis for day and night shifts. 2. Trust Position The Trust successfully uploaded the Mayunify data within the requested time frame from the TDA.This included a new bed state component which has been required nationally and supports the Lord Carter approach of Care Hours Per patient day (CHPPD). In order to enable an overview of the actual against planned, a summary table is detailed in table 1. The table includesthe reasons, the impact and the actions which have been taken to address the staffing deficit and support quality, safety and patient experience. 2
Table 1 May unify upload summary Ward Unit Average Fill Rate RN % Day Average Fill Rate HCA % Average Fill Rate RN % Night Average Fill Rate Care Staff % Phoenix Ward E122 100.90% 84.40% 96.00% 226.50% Heybridge Ward A303 88.00% 102.10% 99.10% 103.20% Rayne Ward A304 94.10% 106.40% 98.40% 131.80% Reasons Lower activity through the month. Therefore vacant shifts did not require filling Safe care Impact sickness Safe care Senior sr from Actions taken to address the gap Additional staff available on the ward to support safe care Goldhanger Ward E222 93.30% 125.60% 102.30% 161.20% Notley Ward E223 95.10% 96.20% 97.70% 108.10% Lister Ward C451 95.50% 134.90% 91.50% 245.20% John Ray Ward E323 93.90% 91.60% 97.20% 99.20% ESS Ward A205 97.30% 112.30% 98.90% 114.80% EAU Ward A204 92.20% 102.60% 99.50% 111.30% General Intensive Care Unit E226 90.02% 45.60% 99.00% 51.30% 3
Danbury Ward A302 93.20% 99.60% 96.90% 117.30% Terling Ward A305 96.20% 100.10% 100.00% 124.60% Baddow Ward C250 88.00% 96.40% 92.60% 111.10% Braxted Ward C251 89.10% 105.70% 98.10% 130.60% Felsted (A207) 86.40% 102.20% 99.20% 111.40% Stroke Unit E125 110.70% 174.60% 126.80% 162.60% Burns ITU E220 93.50% 96.90% 100.50% 95.70% Sickness Sickness Sickness Safe care as staff moved around the unit Safe care as staff moved 4 staff awaiting pins which will coming through shortly around the unit Recruitment continues Safe because they can work with 3 RNs not filling the 4 th which is used when there are Non Invasive ventilation (NIV) patients Recruitment continues Burns Adult Ward E221 Burns Children Ward E225 80.80% 93.30% 100.00% 82.00% 74.20% 101.70% 100.00% #DIV/0! Staffing levels appropriate for the number of the patients Safe care 2 RNs always on duty, unless the unit is closed. 3 rd RN shift for MDT meeting is not always covered Safe care Stock Ward E320 88.70% 96.00% 119.20% 100.00% Due to vacancies and matched against patient acuity requirements Safe care Billericay Ward E321 85.50% 94.70% 99.50% 119.00% Due to vacancies and matched against patient acuity requirements Safe care Staffing numbers flexed to support the acuity of patients Further review of data will be undertaken for June data Recruitment in progress, additional shifts for airway patients not booked unless required Recruitment in progress, additional shifts for airway patients not booked unless required 4
Birthing Unit A402 91.80% #DIV/0! 102.30% #DIV/0! A4.4 Neonatal Unit (WF 405) A4.3 Postnatal Ward (WF404) Delivery Suite/Labour Ward A402 91.50% 100.00% 88.40% 64.50% Staffing levels reflect patient care requirements 82.70% 75.30% 101.10% 33.70% Maternity staff are moved around the unit to ensure safe care is provided to all areas Safe care 92.10% 189.00% 103.10% 207.00% Staff flexed to meet patient acuity and capacity safe care Staffing levels reviewed shift by shift for safe care, recruitment ongoing Recruitment progressing well, staff are well used to moving around units to support safe care St Peters Maternity 92.40% 68.60% 100.00% 110.60% WJC Maternity 88.90% 61.90% 109.10% 108.90% Maternity staff are moved around the unit to ensure safe care is provided to all areas Safe care Mayflower (BADB) 96.30% 100.50% 91.40% 99.50% MCAs are managed through the Delivery suite and moved according to patient need Safe care No further action required Recruitment progressing well, staff are well used to moving around units to support safe care Gosfield (EACD) 94.50% 131.00% 87.90% 99.80% SEW (GBBK) 81.70% 80.70% 93.90% 101.60% The ward have been trying a revised roster for night duty. This is 3RNs on Monday to Thursday and 2 RNs Friday Saturday and Sunday. FSR being updated to reflect this Staff moved across from Rayne and Heybridge to support care. High number of vacancies which are recruited, awaiting PINS Safe care Safe care, bank providing staff to work lines of off duty to provide continuity Ward responding to patient requirements, FSR being updated accordingly Recruitment team prioritisingsew staff 5
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The majority of fill rates for nursing and care staff were above 80%. In May 201614wards reported staffing fill rates below 90%. This excludes GICU/GHDUwhichhas reported low fill rates of unregistered support staff, as this resource is not essential to provide safe staffing levels within these acute units, and generally reflects the patient activity requirements. Each ward has been reviewed with the Associate Chief Nurse (or representative) within each directorate to provide mitigation to areas where a shortfall was identified. In areas where there are high levels of HCSW numbers this is due to specials. 3. Wards Reporting Above 100% 3.12 out of 28 wards reported over 100% fill rate of Registered Nurses within the day ( 7 % ) compared with 7wards at night (25%). The incident of HCSWs fill above 100% was significantly more within the night duty period. On day duty there were 14 out of 28 wards with excess of 100% (50%) compared to 19 out of 28 (67%) in the night. The following reasons are attributable to this: Submission of data includes additional duties that have been added over and above the ward establishment. This includes specials, increased capacity and increased acuity. It has been identified during this period that some wards planned hours (reflected in the FSR) does not match with the amount of staff the ward is actually using (irrespective of 1:1 special requests). As part of the V10 update all MAPS templates are being reviewed against budgeted establishment and FSRs to ensure an accurate picture of fill rates. It is easier to fill night duty shifts with temporary staff than day duty shifts and explains the higher numbers of wards with more than 100% fill on night duty. 4. Incident reports and red flags In May 2016, 33 incidents were reported with the specific category Staffing Issues, 18 of these fell within red flag criteria. A total of 32 incidents reported in May fell within red flag criteria, all of which resulted in no or low harm. (The graph below details the categories of the 32 incidents recorded on Datix where red flag criteria was met). May 2016 Incidents reported where the category 33 was Staffing Issues Incidents reported where the category 18 was Staffing Issues and Red Flag criteria was met Red Flag (where staffing issues or skill 32 mix was a contributing factor all recorded categories) Of those the degree of harm: 8 7
Near miss No injury 23 Minor/Minimal 1 8
Birthing Unit Closures: 1 incident was reported in May relating to the closure of the WJC Birthing Unit and no injury is recorded. WJC birthing unit being closed overnight on 26 May 2016 and the correct procedure was followed. Incident details for reference: Birthing Unit Closures: WEB38098 WJC No Injury closure of birthing unit due to low staffing levels at Broomfield hospital brining it below safe levels. the closure of the unit will still ensure Broomfield can operate at safe staffing levels and the provision of on call community midwives will ensure that home births are not affected. managed as per guidelines no women were compromised as a result of the closure. 5. Recruitment update The recruitment of qualified nurses remains a challenge for the Trust. Scoping work is being undertaken to review the gaps within the workforce and develop an international recruitment plan for next year. 9
10.32 HCA s commenced employment with the Trust in May 2016 4 HCA s commenced employment at the start of June 2016 and a further 4.33 HCA s have confirmed start dates for the end of June 2016. 32.55 HCA s have received conditional offer letters and are anticipated to start in July 2016. 7.80 Band 5 RGNs commenced employment via Local recruitment in May 2016. 5.29 Band 5 RGN s commenced employment in June 2016 from Local Recruitment 44.96 Band 5 RGN s are anticipated to start in July 2016. 5.1 European Recruitment Following recent Skype interviews: 8 x Band 5 RGN commenced employment in May 2016 via EU recruitment. 1 x Band 5 RGN has a confirmed start date for September 2016. 5.2 International Recruitment The Trust is currently recruiting 25 Indian Nurses through Kate Cowhig. Skype interviews have taken place and 4 nurses have been conditionally offered positions and further Skype interviews are taking place on 23 June 2016. Kate Cowhig will be providing 10 nurses for ED, 10 nurses for Wards and 5 nurses for Theatres. The plan is to have 1 cohort of 5 nurses per month from November 2016 to March 2017. Month No. of Indian Nurses No of Philippine Nurses Nov 5 Dec 5 Jan 5 8 Feb 5 8 Mar 5 9 A meeting is taking place on Friday 17 June 2016 with MSI Group and the plan is for them to provide us with 25 nurses from the Philippines. 10 nurses for ED, 10 nurses for Wards and 5 nurses for Theatres. 5.3 Monitor/TDA Nurse agency rules The final agency rate reduction came into place on April 1 st 2016. We are showing as red rag rated at the TDA as we continue to use agencies with above the cap rates in the following areas: Chemo day unit ED Burns ITU Theatres Paediatrics 10
Table 2 shows the trend Table 2: Above the cap usage trend Table 3 shows that since the final agency reduction came in in April it has been more challenging to work within this. Progress with nurse recruitment is the mitigation for this. A detailed plan has been developed for ITU and Burns ITU to reduce their use of noncompliant agencies. The next area to address this will be ED. The Trust target for agency spend is not to exceed 10% of the total nursing and midwifery qualified spend. In May the agency spend as percentage of the total qualified nursing and midwifery budget was 7.9%. Next Steps The Finance & Performance Committee is asked to: Note the monthly submission of nurse staffing data for May 2016 Note the areas below 90% and the mitigations and steps taken to address staffing shortfalls Author Lyn Hinton, Deputy Chief Nurse June 2016 11
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