BOARD OF DIRECTORS MEETING 7th March 2018 Agenda Item TB058/18 Report Title Executive Lead Lead Officer Monthly Safer Staffing Report (January 2018) Sheila Lloyd Director of Nursing Midwifery Therapies and Governance Carol Fowler, Assistant Director of Nursing Workforce Action Required (Definitions below) X To Receive To Approve To Assure For Note For Information Key Messages and Recommendations In line with National Quality Board (NQB) guidance in November 2013, 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. This monthly Safe staffing report details the progress and emerging risks in meeting these requirements. The Trust s mandated monthly submission of staffing (headcount) levels to NHS Choices presented the following overall % fill rates of planned inpatient staffing levels against actual staffing levels for the month of January 2018 against the accepted level of 90%: Trust overall 89.52% 84.26% Registered Nurses (RN) on days 96.98% Registered Nurses on nights 94.77% Care staff on days 100.85% Care staff on nights Trust vacancy: 11.81% (103.16 wte) Registered Nurse vacancies at band 5 and above 10.46% (39.77 wte) Healthcare assistant vacancies band 2 and above. Trust whole time equivalent (wte) funded establishment versus contracted: 874.3 wte funded establishment Registered Nurse 770.3 wte contracted Registered Nurse 380.08 wte funded non registered nurse 340.31 wte contracted non registered nurse There are no new emerging risks to note, the board are advised of the current risks the via the risk register (ID1368) and monthly Safe Staffing reports. Page 1 of 5 Nurse Staffing Paper 27/02/18
Strategic Objective(s) (The content provides evidence for the following Trust strategic objectives for 2017/18) SO1 Agree with partners a long term acute services strategy X SO2 Improve clinical outcomes and patient safety SO3 Provide care within agreed financial limit SO4 Deliver high quality, well-performing services X SO5 Ensure staff feel valued in a culture of open and honest communication SO6 Establish a stable, compassionate leadership team X Governance (the report supports a..) Statutory requirement Annual Business Plan Priority Linked to a Key Risk on BAF / HLRR Ref: Service Change Best Practice Other List (Rationale) Impact (is there an impact arising from the report on the following?) X Quality Finance X Workforce Equality Equality Impact Assessment (If there is an impact on E&D, an Equality Impact Assessment must accompany the report) X Risk Compliance Legal Strategy Policy Service Change Next Steps (List the required actions following agreement by Board/Committee/Group) To note this report Previously Presented at: Audit Committee Finance Performance & Investment Committee Quality & Safety Committee Workforce & OD Committee Mortality Assurance & Clinical Improvement Committee 1. Aim of the Report 1.1 To inform the Board of the Trust s inpatient areas nursing and midwifery workforce staffing levels during January 2018. 1.2 The paper reviews information and whether there is a correlation between the monthly staffing levels and areas of harm that patients are at risk of experiencing. Page 2 of 5 Nurse Staffing Paper 27/02/18
1.3 To update the Board on recruitment activity in order to minimise the number of vacancies in the Nursing and Midwifery workforce in order to optimise staffing levels. 2. Background It is a national requirement of all Trusts to publish their monthly nursing and midwifery staffing levels to NHS Choices website (Unify). Safer staffing levels are the total planned number of hours worked by registered and care staff measured against the total number of actual hours worked to produce a monthly fill rate as a % for nights and days on each ward. A monthly ward fill rate of 90% and over is considered acceptable nationally. Staffing levels are the head count on each shift and is only one indication of the Trust's ability to provide safe, high quality care across all wards. Safer staffing does not analyze skill mix, the impact of temporary staff on a shift by shift basis or being short of a member of staff on a particular shift if it has been unsuccessfully backfilled, e.g. only two trained staff on a night shift instead of 3 which for that shift is a fill rate of 66%. This may not be reflected in the ward s overall monthly average which may still be over 100%. 2.1 Overall Fill Rates The January 2018 submission indicates a trust fill rate for registered nurses on days 84.26 %, non registered nurses days 94.77%. Fill rate of registered nurses nights 96.98% and 100.85% for Non-registered nurses nights. Where the overall fill rates for care staff is higher than 100% the figures are raised by both the employment of additional specials (i.e. 1 patient to 1 care staff member) to protect vulnerable patients and the wards compensating for a shortfall in the registered nurse headcount on a shift by employing a non registered nurse when efforts to backfill with a bank and/or agency registered nurse or the permanent registered nurses being offered extra time or overtime have proved unsuccessful. 3. Recruitment and Retention The recruitment and retention of nursing and midwifery staff remains a priority for the Trust and is an on-going challenge. Trust workforce data shows there were 11.81% Registered nurse Vacancies (103.16WTE) and 10.46% non-registered nurse vacancies (39.77WTE) at the end of January 2018 across the Clinical Business Units. A Reduction to Nurse Vacancies reported in December 2017 for Registered Nurses: 12.98 WTE, Non-Registered Nurses: 4.53 wte. Nurse staffing reports as a high risk on the Trust Risk Register and is reviewed monthly. Recruiting and retaining the nursing and midwifery workforce continues to be an area of increased focus. Apprenticeship Levy: A particular emphasis on the Trust development of an Enhanced Care model will be a focus of the NHSI work going forward. A visit in April 2018 from NHSI will support the diagnostic work around enhanced care for the Trust and links going forward to role requirements through the levy. The trusts impending Bi-annual staffing review in April 2018 will further review and identify current establishments and new role opportunities going forward that can be supported through the apprenticeship levy. Open events have been facilitated at the trusts education centres on 30 th January 2018 and further on 1 st March 2018 where staff can meet colleges, universities and independent providers to find out how apprenticeships can develop individuals and teams. 3.1 The Recruitment of Bank staff via NHSP Page 3 of 5 Nurse Staffing Paper 27/02/18
Recruitment of bank Health Care Assistants (HCA) is on-going, advertising every two months to recruit to the nurse bank and is delivering continued improvements. Monthly operational meetings with NHSP continue with key leads from clinical business units attending to assure business unit staffing requirements are actioned. The Trust has used Thornbury during the month of January outside of the NHSP platform in the Critical Care area due to vacancy and Sickness in this area on top of Winter Pressures. The trust has engaged with NHSP and agency assistance through NHSP to support safe staffing requirements advised on, for opening Ormskirk beds required during January and proposed for the month of February 2018. On the 16 th January the trust engaged nursing staff support from Walton Centre and Liverpool Women s NHS Foundation Trust to facilitate opening of additional escalation beds. 4. Student Nurse Recruitment Update The Trust attended the following careers fairs during January 2018: RCN recruitment event Manchester Feb 2018 inviting 7 conditional offers of employment LJMU careers fair 20 th Feb 2018 On-going Recruitment of Registered Nursing Staff The Trust has representation on the Cheshire and Merseyside Director of Nursing workforce recruitment and retention collaborative program. The program awaits appointment of a Director of Nursing to deliver this program going forward advert remains out to recruitment currently. The Trusts Assistant Director of Nursing (Workforce) represented the Trust on 13 th December 2017 at the North Region Workforce Think Tank/Summit - Care in the North: Our Future Our Workforce Chaired by Margaret Kitching, Chief Nurse North, NHS England/NHS Improvement. This meeting has formulated local, regional and national actions to support the next steps. Following this event Trust representation continues to deliver on the work regionally via the North of England Nursing and Midwifery workforce group. 5. Staffing Related Reported Incidents A total of 22 staffing related incidents were reported in January 2018, of which 11 related insufficient nurses/midwives. Of the 11 incidents reported, 3 where attributable to movements of staff to accommodate shortfalls to other ward areas to maintain safe staffing. 1 incident reported in relation to opening additional bedded area with insufficient staffing to handover to initially (ACU). 2 related to support required to back-fill the Bed management role. Remaining incidents were attributable to short term nurse sickness leaving areas challenged against being able to accommodate the acuity and volume of patients. Senior Nurses continue to contribute to additional temporary cover across the Trust to assure safe staffing is reviewed and supported against patient flow challenges. Ward matrons and Ward leaders clinical input remains considerable and necessary in supporting the safe staffing of each ward across the Trust sites. These clinical hours are not Page 4 of 5 Nurse Staffing Paper 27/02/18
routinely captured on either HealthRoster or the Unify data. 6. Inpatients experiencing moderate harm or above in January 2018 There was 1 fall resulting in moderate harm following an unwitnessed fall on SSU This has been STEIS reported and is subject to the Trusts internal robust review processes. There was 1 grade 3 Pressure Ulcer in January 2018. Patient transferred from A+E to EAU where grade 3 pressure ulcers were discovered to heels. STEIS meeting 1st February 2018 to review issues. 7. NHS Improvement (NHSI) Safer Staffing Guidance NHSI visited Southport site as agreed on 30 th January 2018. A timeline supports the collaborative engagement going forward and will be shared amongst executive and clinical teams with NHSI planned to visit 12 th /13 th March 2018. The visit on the 30 th January resulted in an invitation from Mark Radford to join the StaffEngage Pilot. This has been accepted and agreed. In summary, this is a free of charge pilot for a period of 6 months to engage with our staff to gain greater insight into what makes the workforce consider leaving the organisation. A WebEx in March with all trusts in the pilot will explore options around the questions we will be using. Summary The report has presented information on staffing headcount fill rates on inpatient wards for the month of January 2018 and provided an update regarding on-going nursing and midwifery workforce recruitment activities to address vacancies. The Draft health and care workforce strategy for England to 2027 is out for consultation. The consultation will lead to a workforce strategy for the health service to be published in July 2018 the trust is participating in this consultation. Actions since December 2017: NHSI visited Southport and Ormskirk Hospital Trust 30 TH January 2018 Trust selected to participate and signed up to the NHSI Staff Engagement Pilot Trust Nursing teams Attended RCN careers Fair Trust Nursing teams Attended Liverpool John Moores University (LJMU)Careers Fair Roster Management Policy Drafted-in circulation for ratification at Workforce Committee April 2018 Reduction to Nurse Vacancies RN: 12.98 WTE HCA: 4.53 wte Page 5 of 5 Nurse Staffing Paper 27/02/18