Nursing and Midwifery Monthly Staffing Report, May 2017

Nursing and Midwifery Monthly Staffing Report, May 2017 Eileen Aylott, Assistant Director of Nursing Anita Robinson, E-Rostering Lead May 2017 (data from April 2017) 1 P a g e

Safe Staffing Levels April 2017 Executive Summary The purpose of this report is: 1. To provide assurance to the Board with regards to the management of safe nursing and midwifery staffing for the month of April 2017. 2. To provide context for the Trust Board on the UNIFY safer staffing submission for the month of April 2017. South Tees Hospitals NHS Foundation Trust is committed to ensuring that levels of nursing staff, which includes /registered Nurses (RN), Midwives (RM) and health Care Support Workers (HCSW), match the acuity and dependency needs of patients within the clinical ward areas in the Trust. This includes ensuring that there is an appropriate level and skill mix of staff to provide safe and effective care. The SafeCare module is now operational with daily review of safe staffing by Centre Associate Directors of Nursing (ADoN) and Clinical Matron s (CM) in hours and Patient Flow out of hours. Red flags and Clinical Judgement status are discussed and mitigated at this time. No Topic Measure Summary RAG 1. Patient safety is delivered through consistent, appropriate staffing levels for the service UNIFY fill rate Care Hours per Patient (CHPPD) Fill rate of 94% for registered nurses Overall CHPPD for base wards during April was 7.9 and Critical Care was 22.7 2. Staffing risks are effectively escalated to the appropriate person % Red flag reporting events and DATIX Red flags are used to escalate staffing issues in the Trust via SafeCare 3. Temporary staffing provided by NHSP and Agency (Appendix 2) 4. The Board are assured of safe staffing for nursing and midwifery Fill rate by RN/RM, HCA and Agency Board reports and discussion covering overview of safe staffing levels RN fill rate was 65% HCSW 92% and Agency 100% (NHDU only) The overall fill rate for RN/RM s rose slightly for the month 2 P a g e

1. UNIFY Safe Staffing Return The Trust s safer staffing submission to UNIFY for April 2017 was submitted on 16 th overall summary of overall fill % in the table below with the full report in Appendix 1 May with the Table 1 Overall UNIFY Return fill Rate April 2017 rate - RN/RMs rate - HCA rate - RN/RMs rate - HCA 92.7% 99.0% 95.3% 111.9% The April fill % for Registered Nurses/Midwives days increased slightly from the March position from 91.5%. This increase is due to a combination of improved sickness and newly qualified staff completing supernumerary periods within critical care. 2. Factors affecting Planned vs. Actual staffing In April the bed reconfiguration across Planned Care was completed with the following ward moves taking place and consequently movement of staff across the centre. DATE RECONFIGURATION Wed 19 April Ward 6 (Vascular) moved to Ward 5 Thurs 20 April Planned Care Admissions Unit (PCAU) opened Ward 7 & Ward 8 became specialty based wards Wed 26 April Ward 10 (Gastro) moved to Ward 6 All planned care and surgical wards in the old block are now located together on the first floor, along with the new Planned Care Admissions Unit (PCAU). The PCAU will provide effective care for emergency patients who will have their care planned in a dedicated admissions unit before going home or being transferred to a specialist ward. There are a number of other contributory factors which affect the fill rate for April which along with the summary of key findings by ward can be seen below. Wards 11, 12 and 34 have not consistently met the planned hours required to fill night shifts and have required help from other wards. SafeCare live has been used to identify suitable wards to send RN assistance during the daily meeting led by one of the Centre ADoN but has not been consistently recorded on the off duty. Additional Health Care Assistants(HCA) or Therapeutic Care Support Workers (TCSW) have been rostered to maintain safe staffing for patients requiring 1:1 enhanced observation (Specialing). CCU and NNU RN day fill rate was reduced although safe staffing was maintained due to a bed occupancy of 71% and 66% respectively HCA days which fell below 80% were in areas with small numbers and therefore sickness and annual leave significantly affect fill rate. 3 P a g e

The three month TCSW Specialing pilot across the Specialist Care Centre has proved extremely successful in providing 1:1 support for patients on level 3 enhanced observations. Plans will be to expand this service trust wide. 3. UNIFY Care Hours Per Patient (CHPPD) From 1 st May 2016 each Trust is required to report the number of CHPPD calculated by: (Sum of the actual number of patient on the ward at 23.59 each day) This is a standard calculation indicating the number of care hours provided to each patient over a 24 hour period. The table below shows the CHPPD for April. (Full report in Appendix 3) TRUST-WIDE (Excluding MLU FHN) Registered Nurses/Midwives Care Hours Per Patient (CHPPD) Care Staff (HCA/TCSW) Overall 7.5 3.4 10.9 The Trust overall CHPPD is 10.9 which include a number of critical care areas which run at a higher requirement due to either 1:1 or 1:2 staff ratios for RN s. The Midwifery Led Unit at FHN has been removed from the calculation due to calculation skewing the data. Future reports will use these year start figures as a baseline to ensure consistency and will also enable monitoring through the Model Hospital Dashboard with our peer group. The revised National Quality Board (2016) guidance suggests that a triangulated approach to safe staffing should be taken using the actual vs planned and CHPPD recorded via UNIFY monthly safe staffing returns and clinical judgement all of which are used in the SafeCare module recently implemented across the Trust. 4 P a g e

4. Red Flag Reporting Red flags have been reported during April and are addressed during the morning SafeCare meetings with ADoN. The six NICE red flags plus red and amber beds open have been regularly reported with two further flags for unavailability of critical care beds and ambulances queuing in AAU to be added from mid-may. Red Flags raised on SafeCare during April 2017 Closing of red flags has just commenced and the functionality to create a report from the system will enable more detail to be shared in future reports. 5. Redeployed staff SafeCare gives the Trust the ability to redeploy staff from an area with excess hours to one which is short safely using the acuity and dependency calculation. During the month of April hours of nursing time was redeployed across the centres saving a significant amount of money which would have previously come from an NHSP spend. 6. Band 5 Vacancy Rate and Recruitment Activity Band 5 WTE vacancies remain around 100 with the following vacancies appointed to since 1 st April 2017 Centre Clinical Support WTE Appointed to Community Care 15.44 Planned Care 1.00 Specialist Care 13.78 Urgent & Emergency Care 2.00 Grand 32.33 ODP WTE Appointed Clinical Support 1 Adult Student Nurse Interviews are planned for 16 th June with the advert attracting 69 applicants from across the region. 1 was a paediatric nurse and has been redirected to the correct team, 3 have secured posts at NTEES and have withdrawn, 4 have already secured posts at STEES (including 1 RTP RN) and 1 will not qualify until January so will move to the October interview date. 7 further students were interviewed and appointed to posts before the cohort interviews were planned leaving 60 for interview. 5 P a g e

An advert is currently open for RTP posts for the September Cohort. The Trust has 5 places to allow suitable candidates to work in a B3 post whilst undertaking the programme. The University module for RTP will also provide students who will complete the programme via the traditional route potentially increasing this pool of nurses returning to the workforce. Overseas recruitment is planned for July with the potential to provide successful applicants into the Trust by November. Ward 10 (Exemplar Ward) is due to open on the 22 nd May providing additional medical beds and will be staffed by a combination of new and redeployed staff. Conclusion The Board is asked to receive and note the content of this report Eileen Aylott, Assistant Director of Nursing, Workforce April 2017 References Department of Health (2016) Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. An independent report for the Department of Health by Lord Carter of Coles https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/operational_prod uctivity_a.pdf National Quality Board (2016) How to ensure the right people, with the right skills are in the right place at the right time. A guide to nursing, midwifery and care staffing capacity and capability. London 6 P a g e

Study Study Appendix 1 James Cook < 80 80-95 > 95 ou P rate - RN/RMs rate - HCA rate - RN/RMs rate - HCA UEC Critical Care 90.3% 80.9% 89.2% 101.6% 14.10% 0.60% 3.00% 7.70% 0.30% 4.40% 30.0% 9.10% 8.10% 3.40% 20.6% UEC AMU JCUH 95.6% 96.2% 99.3% 133.3% 12.30% 2.00% 4.90% 0.20% 2.50% 21.9% 6.80% 4.00% 2.80% 13.5% UEC RAFAU 91.5% 102.8% 95.7% 81.6% 13.50% 0.60% 1.10% 0.40% 3.90% 19.4% 14.10% 2.90% 0.70% 17.8% PL JC06 Gastro 86.4% 81.7% 98.3% 108.5% 11.60% 4.60% 2.70% 2.10% 4.80% 25.9% 15.40% 0.40% 0.10% 6.10% 22.1% COM JC09 (Ward 9) 89.6% 108.3% 92.8% 94.5% 8.40% 4.60% 5.30% 0.90% 0.70% 19.9% 9.60% 0.70% 4.20% 10.90% 0.70% 26.1% COM Ward 12 General Medicine 83.0% 125.8% 78.6% 177.9% 9.20% 8.10% 0.70% 14.10% 32.1% 6.70% 0.40% 8.10% 5.20% 20.4% COM JC28 (Ward 28) 83.8% 108.5% 86.7% 105.0% 13.20% 0.30% 6.20% 2.90% 2.20% 26.6% 16.80% 2.60% 0.00% 0.90% 20.3% UEC AAU JCUH 94.6% 88.8% 94.7% 110.1% 14.30% 2.30% 1.70% 2.40% 0.60% 2.50% 23.7% 15.00% 2.30% 0.40% 2.40% 20.0% COM Ward 3 103.6% 113.6% 87.7% 148.5% 15.40% 6.70% 2.30% 0.50% 24.9% 13.90% 8.10% 0.80% 22.8% COM Ward 11 Elderly Care 81.7% 134.2% 78.9% 151.7% 13.80% 11.50% 0.50% 4.10% 30.0% 7.60% 16.00% 6.00% 29.7% PL PCAU 94.8% 100.0% 100.0% 100.0% 1.9% 9.3% 3.1% 1.5% 1.5% 17.6% 34.9% 11.6% 5.8% 1.5% 0.7% 2.2% 21.8% PL JC35 (Ward 35) 103.8% 85.4% 108.4% 101.7% 15.30% 11.80% 0.30% 5.10% 32.4% 14.50% 2.60% 17.2% SP JC05 Vas 122.9% 103.0% 84.5% 117.1% 11.30% 7.10% 11.30% 1.20% 30.9% 8.90% 0.20% 1.60% 10.7% PL Ward 7 Colo 93.9% 100.2% 99.0% 96.8% 9.30% 0.30% 6.60% 1.70% 4.10% 22.0% 10.20% 1.80% 4.00% 1.90% 1.40% 20.6% PL Ward 8 88.8% 98.0% 104.8% 89.2% 12.60% 1.30% 10.90% 2.50% 1.00% 7.20% 35.6% 12.30% 6.00% 3.70% 1.10% 6.00% 31.3% SP JC04 (Ward 4) 92.7% 103.2% 85.5% 98.3% 15.00% 0.40% 10.20% 2.10% 5.70% 33.5% 8.90% 7.10% 0.10% 3.30% 19.5% SP JC14 Oncology (Ward 14) 92.1% 112.5% 97.0% 115.2% 15.20% 0.60% 1.10% 5.40% 0.50% 4.50% 27.3% 10.90% 0.60% 5.80% 3.10% 6.10% 30.0% SP JC33 Specialty (merger of ward 18 and ward 27) 81.9% 97.2% 91.6% 100.0% 11.10% 0.40% 9.40% 6.70% 4.40% 36.6% 14.60% 6.70% 0.50% 21.9% PL JC34 (Ward 34) 94.2% 83.6% 67.8% 142.9% 9.70% 0.60% 1.10% 2.60% 14.0% 16.30% 9.40% 1.40% 27.1% PL Ward 25 Ortho Plan 94.1% 93.2% 100.1% 70.7% 12.50% 6.70% 3.60% 0.40% 4.20% 27.4% 12.30% 1.70% 0.40% 15.2% PL JC36 Trauma 100.6% 99.5% 99.0% 123.4% 12.80% 0.30% 2.50% 0.80% 2.80% 19.3% 13.80% 7.70% 11.70% 0.20% 0.40% 33.9% SP Spinal Injuries 97.6% 98.8% 100.0% 100.0% 9.60% 0.20% 5.30% 3.10% 0.20% 4.50% 22.9% 17.80% 1.30% 0.30% 4.40% 23.8% SP Cardio MB 100.0% 126.5% 96.7% - 14.20% 15.10% 0.60% 0.10% 30.0% 4.90% 19.60% 7.70% 32.2% SP CCU JCUH 75.8% 135.0% 99.3% - 14.80% 0.60% 9.00% 0.50% 0.40% 4.00% 29.3% 4.40% 4.40% 5.80% 1.10% 15.8% SP CICU JCUH 94.3% 70.8% 97.8% - 13.00% 0.40% 2.90% 8.00% 0.90% 5.70% 31.0% 13.40% 2.80% 3.10% 19.3% SP JC24 (Ward 24) 87.1% 143.2% 86.0% 149.9% 12.60% 0.20% 5.10% 0.70% 2.90% 21.5% 13.70% 1.80% 0.90% 0.80% 3.10% 20.2% SP JC27 Neuro 84.0% 101.4% 102.2% 112.9% 15.90% 6.20% 0.90% 1.50% 24.6% 10.20% 9.90% 0.90% 21.0% SP JC26 (Ward 26) 97.9% 122.5% 99.6% 134.3% 9.10% 0.60% 0.60% 0.50% 3.40% 14.3% 14.30% 8.70% 0.60% 23.5% SP JC29 (Ward 29) 99.2% 113.4% 98.8% 163.8% 14.10% 0.40% 6.30% 0.50% 3.30% 24.6% 12.70% 0.70% 5.40% 0.70% 19.6% SP JC30 (Ward 30) 90.0% 87.3% 87.5% - 18.70% 1.90% 20.6% SP JC31 (Ward 31) 100.0% 100.0% 100.0% 103.3% 14.30% 3.90% 2.20% 5.90% 26.3% 13.30% 5.00% 2.50% 2.50% 23.3% SP JC32 98.7% 101.1% 100.1% 130.2% 6.50% 1.00% 11.30% 1.80% 7.20% 27.8% 7.20% 12.40% 1.50% 0.50% 21.7% SP Cardio HDU 102.5% 100.0% 93.0% 91.3% 13.70% 0.50% 8.10% 6.90% 2.10% 6.80% 38.1% 10.20% 2.60% 1.30% 1.30% 15.3% COM JC21 (Ward 21) 99.8% 66.2% 97.4% 96.7% 11.70% 10.30% 1.80% 2.80% 3.10% 29.6% 13.90% 1.20% 0.50% 15.6% COM JC22 (Ward 22) 105.6% 104.7% 94.9% 95.0% 13.40% 3.60% 2.40% 4.60% 24.0% 9.30% 1.20% 0.40% 10.9% COM JCDS (Central Delivery Suite) 94.9% 50.8% 99.2% 97.8% 10.90% 0.10% 1.50% 1.70% 3.00% 6.30% 23.4% 12.60% 8.00% 1.30% 0.20% 22.1% COM Neonatal Unit 79.4% 76.7% 88.9% - 12.90% 0.40% 8.50% 1.50% 1.20% 1.90% 26.4% 7.90% 25.80% 33.8% COM Maternity Assessment Unit 96.6% 100.0% 100.2% - 9.10% 4.80% 5.30% 5.50% 0.90% 25.6% 9.00% 6.80% 15.8% COM Paediatric Intensive Care Unit (PICU) 84.0% 41.3% 87.9% - 11.70% 3.50% 4.90% 4.00% 6.70% 30.8% 3.80% 51.40% 55.2% COM Ward 17 JCUH 95.3% 94.3% 100.1% - 11.80% 8.00% 2.80% 0.90% 4.00% 27.4% 4.30% 13.10% 1.60% 6.40% 25.4% COM Ward 19 Ante Natal 88.0% - 98.4% - 13.70% 5.50% 3.10% 2.70% 25.0% 7.80% 7.8% 93.4% 98.8% 94.3% 113.8% Registered Unregistered 7

Study Da Study Da Study Da Study Da Other A Parentin Sicknes Study D Unknow Workin g Other A Parentin Sicknes Study D Unknow Workin g Study Study FHN < 80 80-95 > 95 FHN Average fill rate - RN/RMs Average fill rate - HCA Average fill rate - RN/RMs Average fill rate - HCA Registered Unregistered COM Ainderby FHN 97.6% 91.5% 100.0% 98.3% 11.10% 6.70% 1.20% 1.50% 2.30% 22.9% 11.90% 1.40% 2.70% 15.9% UEC Clinical Decisions Unit FHN 80.5% 123.2% 96.6% 100.0% 13.30% 3.80% 6.50% 0.70% 3.10% 27.3% 15.70% 5.40% 0.80% 21.8% UEC FHICU (ICU FHN) 90.6% 123.6% 89.4% - 11.00% 0.50% 3.70% 1.80% 0.10% 5.10% 22.2% 23.30% 2.90% 26.3% COM Romanby FHN 88.7% 86.9% 100.0% 103.3% 11.50% 5.50% 1.40% 0.50% 9.20% 28.2% 13.50% 1.00% 1.40% 0.30% 16.2% COM Rutson FHN 94.9% 89.5% 99.3% 110.0% 11.30% 6.70% 8.20% 0.10% 26.3% 9.30% 11.20% 0.70% 5.60% 26.7% PL Allerton Ward FHN 94.0% 93.2% 100.0% 98.3% 13.70% 3.50% 4.60% 7.20% 29.0% 9.70% 4.90% 9.50% 0.10% 8.30% 32.5% PL Gara Orthopaedic FHN 87.1% 85.2% 97.3% 96.7% 8.00% 2.50% 6.30% 7.60% 1.30% 2.60% 28.2% 10.90% 0.80% 9.30% 0.50% 21.6% COM Maternity FHN 95.7% 96.7% 100.0% - 10.90% 1.30% 4.10% 0.30% 16.6% 5.20% 2.60% 7.50% 0.60% 15.9% 91.1% 98.7% 97.8% 101.1% East Cleveland < 80 80-95 > 95 rate - RN/RMs rate - HCA rate - RN/RMs rate - HCA COM Tocketts Ward East Cleveland Hospital 90.4% 97.4% 97.8% 105.5% 12.40% 6.90% 0.90% 0.20% 20.4% 15.10% 8.80% 0.90% 4.80% 29.6% Redcar 90.4% 97.4% 97.8% 105.5% < 80 80-95 > 95 rate - RN/RMs rate - HCA rate - RN/RMs rate - HCA Registered Unregistered COM Zetland 92.6% 102.6% 97.2% 212.0% 5.20% 0.10% 10.70% 0.50% 0.90% 17.4% 13.90% 0.30% 0.30% 9.90% 1.20% 0.30% 25.9% 92.6% 102.6% 97.2% 212.0% Friary Community Hospital < 80 80-95 > 95 rate - RN/RMs Average fill rate - HCA rate - rate - HCA RN/RMs Registered Unregistered COM Friary Community Hospital 96.3% 100.7% 100.0% 103.3% 13.00% 0.40% 1.60% 5.10% 20.1% 6.20% 0.70% 1.10% 8.1% 96.3% 100.7% 100.0% 103.3% Registered Unregistered 8 P a g e

Appendix 2 NHSP (Nurse Bank) Request vs Fill Rate for both RN and HCA 2016/17 9 P a g e

Appendix 3 Bed Occupancy and Care Hours Per Patient April 2017 Cumulative count over the month of patients at 23:59 each day Registered midwives/ nurses Care Staff Ward Critical Care 865 20.2 3.0 23.1 AMU JCUH 557 7.2 5.0 12.3 RAFAU 617 4.9 4.3 9.1 JC06 Gastro 548 3.4 3.9 7.3 JC09 (Ward 9) 815 3.3 3.6 6.9 JC12 (Ward 12) 696 2.1 4.7 6.8 JC28 (Ward 28) 621 5.1 3.1 8.2 AAU JCUH 507 9.4 5.5 14.9 Ward 3 800 3.3 3.6 6.9 Ward 11 876 2.3 4.0 6.4 PCAU 102 5.1 5.2 10.3 JC35 (Ward 35) 658 3.5 3.0 6.5 JC05 Vas 548 4.0 4.3 8.3 Ward 7 Colo 940 3.2 3.2 6.4 JC04 (Ward 4) 656 3.7 2.8 6.5 JC14 Oncology (Ward 14) 664 4.1 3.1 7.2 JC33 Specialty (merger wards 18 + 27) 526 4.3 3.9 8.1 JC34 (Ward 34) 644 3.8 4.9 8.7 Ward 25 Ortho Plan 435 3.8 3.3 7.1 JC36 Trauma 836 3.4 2.8 6.2 Spinal Injuries 718 5.3 4.0 9.3 Cardio MB 240 5.9 2.3 8.2 CCU JCUH 299 12.4 1.6 14.0 CICU JCUH 289 24.1 4.8 28.9 JC24 (Ward 24) 584 8.1 6.0 14.1 JC27 Neuro 418 4.6 5.1 9.7 JC26 (Ward 26) 494 3.6 2.8 6.4 JC29 (Ward 29) 711 3.5 2.6 6.1 JC30 (Ward 30) 139 5.5 3.0 8.5 JC31 (Ward 31) 559 3.2 2.0 5.2 JC32 429 4.3 3.1 7.4 Cardio HDU 184 16.3 3.2 19.5 Ward 8 872 3.1 3.5 6.6 JC21 (Ward 21) 525 7.4 1.7 9.1 JC22 (Ward 22) 302 6.8 2.3 9.0 JCDS (Central Delivery Suite) 557 12.8 2.6 15.4 Neonatal Unit 582 11.8 0.7 12.5 Maternity Assessment Unit 41 48.1 8.2 56.3 Paediatric Intensive Care Unit (PICU) 99 30.2 0.9 31.1 Ward 17 JCUH 775 4.7 1.1 5.8 Ward 19 233 7.6 0.7 8.3 Ainderby FHN 656 3.1 3.2 6.3 Overall 10 P a g e

Clinical Decisions Unit FHN 453 5.3 4.2 9.5 FHICU (ICU FHN) 78 26.0 2.4 28.3 Romanby FHN 651 2.6 3.0 5.7 Rutson FHN 609 2.8 3.3 6.2 Allerton Ward FHN 584 3.6 2.9 6.5 Gara Orthopaedic FHN 454 3.8 2.8 6.6 Maternity FHN 20 91.8 17.4 109.2 Tocketts Ward East Cleveland Hospital 690 3.8 3.8 7.6 Zetland 796 4.0 6.4 10.3 Friary Community Hospital 438 3.4 2.6 6.0 11 P a g e

Redeployed hours for April 2017 12 P a g e