SOMERSET PARTNERSHIP NHS FOUNDATION TRUST AGENCY SELF CERTIFICATION CHECKLIST Report to the Trust Board 22 November 2016 Sponsoring Director: Authors: Purpose of the report: Key Issues and Recommendations: Actions required by the Board: Chief Executive Director of Finance and Business Development NHS Improvement require all Trusts and Foundation Trusts to submit an agency self-certification checklist by 30 November 2016 as part of the oversight on agency usage across the NHS. The Trust has robust processes in place for the authorising and recording of agency expenditure. However, there are some areas where improvements could be made as detailed in the certification checklist. The Board is requested to discuss and approve the certification checklist. November 2016 Public Board - 1 -
November 2016 Public Board - 2 -
SOMERSET PARTNERSHIP NHS FOUNDATION TRUST AGENCY SELF CERTIFICATION CHECKLIST 1. BACKGROUND 1.1 Following the introduction of the agency rules by NHS Improvement (NHSI) there has been a reduction of 600 million nationally on the level of expenditure and spending is 20% lower than the same period last year. 1.2 This is a significant achievement but spend on agency is approximately 250 million a month across the NHS and over reliance on agency staff can put the quality and sustainability of services at risk. 1.3 NHSI have therefore requested that all NHS Trust and Foundation Trusts complete an agency self-certification checklist and that this is discussed and approved at Board meetings. 2. RECOMMENDATION 2.1 The Board are requested to discuss and approve the certification checklist. DIRECTOR OF FINANCE AND BUSINESS DEVELOPMENT November 2016 Public Board - 3 -
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Links to Strategic Themes: Identify to which of the Somerset Partnership NHS Foundation Trust strategic themes this report relates by including a cross behind the relevant theme(s) Quality and Safety Innovation Viability and Growth Integration Service Delivery Culture and People Links to the Assurance Framework: Links to the NHS Constitution and Trust Values: Links to CQC Domains: Identify to which risks of the Assurance Framework this report relates: strong financial management and controls supports all risks on the assurance framework. Identify the Values to which the issues raised in this report relate by including a cross behind the relevant value(s) Working together for patients Compassion Respect and dignity Improving lives Commitment to quality of care Everyone counts Identify which of the CQC domains are covered by this report by including a cross behind the relevant domain(s) Is it safe? Is it caring? Is it well-led? Is it effective? Is it responsive to people s needs? Equality: Identify whether the report has an impact on the protected characteristics set out below, including risks, and if so, say how these risks are to be managed. Only tick the relevant box for which there is an impact. Z Age Disability Gender re-assignment Pregnancy and maternity Religion or Belief Sexual Orientation November 2016 Public Board - 5 - Marriage and Civil Partnership Race Sex Learning Disabilities
Legal or statutory implications/ requirements: Public/Staff Involvement History: Previous Consideration: NHS Improvement Single Operating Framework CQC Essential Standards NHS Protect Standards for Security Management NMC Code of Conduct involvement of staff and/or patients and the public is set out in the individual reports where appropriate. none. November 2016 Public Board - 6 -
Self-certification checklist Please discuss this in your board meeting Governance and accountability Yes - please specify steps taken No. We will put this in place - please list actions 1 Our trust chief executive has a strong grip on agency spending and the support of the agency executive lead, the nursing director, medical director, finance director and HR director in reducing agency spending. The Chief Operating Officer is the Executive lead for agency although it is recognised that the Executive team as a whole takes responsibility for monitoring and reducing agency spend. 2 Reducing nursing agency spending is formally included as an objective for the nursing director and reducing medical agency spending is formally included as an objective for the medical director. Whilst these are not formal objectives the medical director has budget accountability for the expenditure on all medical areas therefore reducing the expenditure will ensure that this objective is met.?? - Nursing director 3 The agency executive lead, the medical director and nursing director meet at least monthly to discuss harmonising workforce management and agency procurement processes to reduce agency spending. There are two monthly meetings where nursing agency usage and strategy is discussed, managing the nursing resource and e-rostering. Medial agency is discussed on a monthly basis within the medical directorate and with the DoF. 4 We are not engaging in any workarounds to the agency rules. All agency expenditure is recorded and there are no workarounds in place. 5 6 7 High quality timely data We know what our biggest challenges are and receive regular (eg monthly) data on: - which divisions/service lines spend most on agency staff or engage with the most agency staff - who our highest cost and longest serving agency individuals are - what the biggest causes of agency spend are (eg vacancy, sickness) and how this differs across service lines. Clear process for approving agency use The trust has a centralised agency staff booking team for booking all agency staff. Individual service lines and administrators are not booking agency staff. There is a standard agency staff request process that is well understood by all staff. This process requires requestors and approvers to certify that they have considered all alternatives to using agency staff. Weekly data on agency usage is discussed at the Executive Team meeting at service level across the inpatient areas. The reasons for agency usage are recorded and discussed within operational divisions. The booking office in Wells undertakes the majority of agency bookings except for out of hours where there is an agreed process in place and the booking office are updated in hours. One specialist service area (MIU) are still booking directly but only use agencies that are approved by the Trust and maintain robust records of all shifts booked. There is a process for requesting agency staff for both in hours and out of hours. Having undertaken the recent exercise identifying the longest serving and highest cost agency members of staff this will continue to be collected and reviewed.
8 There is a clearly defined approvals process with only senior staff approving agency staff requests. The nursing and medical directors personally approve the most expensive clinical shifts. Actions to reducing demand for agency staffing Heads of Division approve agency requests with Tier 3 only being approved by CCO / HOP's. All Medical locums are approved by the Medical Director. 9 10 There are tough plans in place for tackling unacceptable spending; eg exceptional over-reliance on agency staffing services radiology, very high spending on on-call staff. There is a functional staff bank for all clinical staff and endeavour to promote bank working and bank fill through weekly payment, auto-enrolment, simplifying bank shift alerts and request process. Agency usage is currently being used mainly for vacancies and these are assesed on a case by case basis but with the shortage of RMN's and Medical staff the usage is higher that the Trust would like but unavaiodable. The Trust has a bank in place for most staff groups and also a relief team for HCA's. Weekly pay was introduced during 2016 to encourage staff to undertake bank shifts. 11 All service lines do rostering at least 6 weeks in advance on a rolling basis for all staff. The majority of service lines and staff groups are supported by erostering. E-rostering is in place in all inpatient areas across the Trust and is done 6 weeks in advance. The e-roster steering group meets monthly to review the KPI's from the rostering system but we do akcnolwedge there is room for improvement in the rostering practices. 12 13 There is a clear process for filling vacancies with a time to recruit (from when post is needed to when it is filled) of less than 21 days. The board and executives adequately support staff members in designing innovative solutions to workforce challenges, including redesigning roles to better sustain services and recruiting differently. The recruitment process is robust and timely providing the staff are available to be recruited which is the biggest challenge for the organisation. The Trust is actively looking at alternatives to traditional roles due to the inability to recruit. There are cohorts of assistant practioners being trained to support registered staff to ensure that they are working to the 'top of their licence'. 14 15 The board takes an active involvement in workforce planning and is confident that planning is clinically led, conducted in teams and based on solid data on demand and commissioning intentions. Working with your local health economy The board and executives have a good understanding of which service lines are fragile and currently being sustained by agency staffing. The Board is aware of the recruitemnt issues, in particular RMN's, medical staff and AHP's. Workforce planning has been identified as an area that requires strengthening across the organisation and specific HR resources are currently being recruited to assist with this.
16 The trust has regular (eg monthly) executive-level conversations with neighbouring trusts to tackle agency spend together. Signed by Trust Chair: Trust Chief Executive: The Trust is aware of the recruitment issues across the Health and Social Care ecomony and does have regular discussions regarding strategies for recruitment. [Date] [Signature] [Signature] Discussions are required to ensure that neighbouring organisations understand the implications of introducing incentives within their Trusts and these are ongoing. Please submit signed and completed checklist to the agency inbox (NHSI.agencyrules@nhs.net) by 30 November 2016