NURSE STAFFING REPORT

NURSE STAFFING REPORT INTRODUCTION This paper fulfills the nationally mandated, post Francis II requirement for monthly Board Reports detailing achievement against required nurse staffing levels. This paper provides compliance report against revised staffing requirements that were discussed and approved at October 2015 Trust Board. ACTUAL Vs. PLANNED NURSE STAFFING LEVELS COMPLIANCE The table below gives aggregate figures for compliance of actual vs planned staffing levels. Urgent Care Planned Care Women & Children s Community Trust Overall 94.26% 97.55% 94.65% 86.51% 95.23% Appendix 1 demonstrates ward-level compliance data for actual vs planned staffing, alongside quality indicators. The report covers the period March 1st 31st 2016. ANALYSIS OF NURSE STAFFING RELATED KPIs (Appendix 1) including highlighted areas of concern Three acute and eight community areas fell below the threshold set for red RAG rating (<90% compliance) during this review period. When an area falls below the threshold of 90%, this prompts a more in-depth analysis of the quality and safety of care provided on those wards and triangulates the data against a set of key performance indicators which aim to demonstrate whether the reduced availability of nursing staff has impacted on patient care. This can be seen on the table below: * Safe staffing levels RAG rated: Green - safely staffed with no immediate patient safety concerns Amber safely staffed but close watch due to concerns Red not safely staffed

Acute Services Ward Area % Compliance Commentary Safely Staffed* Stroke Unit 84.16% Bed occupancy within the stroke unit Yes has been an average of 85% and this reflects stroke bed protection for patients admitted through A&E. This has impacted on staffing numbers as when the ward has a lower occupancy staff will be moved to cover shortfalls elsewhere. There remains a difficulty in filling bank shifts for this area hence temporary staffing for registered nurses remains high at 29.63%. The protected use of the stroke beds is also reflected in friends and family testing for the area with 100% of patients and visitors recommending the ward. This is an excellent achievement. There were no complaints in month and only 1 patient suffered a fall. There are eight vacancies within this area. Neonatal 89.74% Critical Care 84.46% Neonatal ward has unexpected levels of activity. There is always an immediate response to increase staffing numbers but this did take a period of time. This is usual for all neonatal units and was not a cause for concern. Critical care - Staffed to the number of patients in unit rather than to the beds. Yes Yes

Community District Nursing Teams Southport & Formby & West Lancashire DN Team % Compliance Burscough Hillside Sandy lane Tarleton Churchtown Curzon Road Formby 83.6% 78.18% 82.22% 88.29% 78.98% 88.97% 83.46% Commentary Problems with staffing levels due to: Long term sickness Short term sickness Maternity leave Vacancies Work has been reallocated to neighboring teams with some part time staff working additional hours. Patients on the priority patient list have been visited during reduced staffing levels. CERT teams provide added support. Recruitment is a priority as there are 19 vacancies across the Division. These are predominantly out of hours services. A number of staff have been interviewed recently though all were not appointable. Staffing is discussed at the risk summit to ensure all avenues have been explored. Safely Staffed* Yes RISKS ASSOCIATED WITH NURSE STAFFING ISSUES Bed Occupancy Bed occupancy was less than February at 85.29% though this figure is predominantly due to low bed occupancy is women s and children s. Urgent and planned care faced significant pressures due to high bed occupancy and this is reflected in the high use of bank and agency. 7B utilisation of bank and agency was 161.87% for untrained staff. This is due to the discharge lounge being utilised as an escalation area. The protected status of stroke unit beds is reflected in occupancy of 85.81%. Agency usage Thornbury usage has increased due to the increasing demand and escalation of other areas across the Trust. There is a plan in place to stop Thornbury usage from May 7 th 2016. This is being managed with a planned approach to ensure patient safety is not compromised.

Urgent Care - At 18.15% bank and agency cover for RNs has increased since last month. This reflects the continuing demands and patient throughput in March. This is reflective of the vacancies, sickness and the number of escalation areas opened. FESS unit utilised 58% agency RN staff to cover shifts. This is a cause for concern. The ward has one of the highest levels of sickness for urgent care at 10.29%. The trust plan is that sickness management will be returning to the business units from HR. This will require monitoring to ensure sickness management is robustly managed. Planned Care As with last month, 15b were relying on over 50% of RN shifts being covered with agency and bed occupancy of over 100%. This is a cause for concern but is being proactively managed by the Matrons and Head of Nursing. Agency usage is proactively managed with all shifts that are above the TDA rate cap requiring Director or Deputy Director Approval. Despite this, agency costs are increasing month on month. The Directors of both Finance and Nursing are also working closely with Pulse agency to reduce costs for specialist areas such as A&E, theatres, spinal and ICU. Falls There were 62 in month for the Trust overall. Urgent care had the highest number 31 which is a reduction in month. Each fall is subject to full RCA. Last month there were 10 falls on FESS and it is pleasing to see this reducing to 2 this month. There weren t any themes identified in last month s review of the ten falls. The rate of falls remains below threshold. C diff and MRSA There was one case of C. diff in month on EAU. C.diff continues to be managed effectively and the trust remains under the yearly trajectory. It has been over 1 month since the last occurrence of MRSA. Sickness Monitoring Sickness continues to be an issue for a number of areas. 7a and B, Stroke, FESS, SSU, Neonates, PIU, the Treatment Centre and theatres are all above 10% sickness despite robust management. This is a mix of short and long term sickness. For community areas Hillside, Sandy Lane, Curzon Road and Formby District Nursing Teams are all above 10%. The impact of this is demonstrated in the failure to achieve acceptable staffing levels in these areas. Conclusion and Recommendations The trust overall achievement against required staffing = 95.66% with 21.75% nonregistered temporary staff usage (similar to previous months) and 11% registered nurse usage (2% increase in month). Performance fell below 90% compliance on three wards which is an improvement in month. It was also below the 90% on critical care however staffing is against patient need. This reduction is due to reduced occupancy and not a cause for concern.

Similarly, neonates were low due to time taken to cover last minute unexpected demand. Demand on Community teams continues to increase with eight out of ten areas falling short of the 90% required staffing levels. This remains a cause for concern. Sickness is slightly above average at 5.73% but there are 19 vacancies across the area. There were ten complaints in month for community. This is monitored closely by the Head of Nursing. All wards have been reviewed not only on compliance against staffing levels, but also against a number of key performance indicators for safe care. Key issues around ongoing high sickness levels remain across many areas within the organisation. All sickness is managed according to Trust policy. The Board can be assured that in order to mitigate the key risks to safe staff that staffing levels are discussed at the escalation meetings three times per day and actions taken to ensure staffing levels remain at safe levels across the organisation, with identified gaps addressed as they occur. Simon Featherstone Director of Nursing, Quality & Risk

ANALYSIS OF NURSE STAFFING RELATED INDICATORS Appendix 1. March 2016 *Acute Trust based on following wards: 11B, 14A, 14B, 15A, 15B,7A, 7B, 9A, E Ward, EAU, FESS, G Ward, H Ward, Obs, PIU, SSU, Spinal.

Realtime Staffing % Temp staffing usage - Registered % Temp staffing usage - Non Registered Staffing related Incidents Bed Occupancy Falls Pressure Sores C-Diff Cases MRSA Total Relating to clinical treatment Relating to attitude FFT - % recommended Sickness - Registered Sickness - Non Registered Vacancies Unplanned Admissions to ITU % of Obs that were late Agency usage Harms Infection Complaints FFT Sickness Mar-16 Trust 95.23% 11.00% 21.75% 41 85.29% 62 1 1 0 63 25 11 90.77% 5.89% 5.98% 114 0 18.1% Urgent Care 94.26% 18.15% 33.21% 14 96.23% 31 1 1 0 17 10 3 85.11% 4.72% 5.23% 74 0 19.5% 7A 90.60% 41.53% 45.00% 0 106.80% 3 1 0 0 1 1 0 86.49% 11.82% 1.81% 6 0 25.1% 7B 100.56% 33.33% 161.87% 0 102.85% 6 0 0 0 1 0 0 92.59% 10.69% 0.00% 9 0 22.1% Stroke Unit 84.16% 29.63% 24.13% 0 85.81% 1 0 0 0 0 0 0 100.00% 11.25% 10.45% 8 0 13.7% FESS 94.64% 58.49% 48.07% 0 106.22% 2 0 0 0 0 0 0 92.31% 10.29% 8.47% 11 0 14.9% EAU 96.50% 25.32% 64.61% 1 110.56% 3 0 1 0 1 1 0 86.67% 0.93% 0.87% 1 0 36.4% SSU 94.87% 22.93% 49.79% 1 100.89% 4 0 0 0 1 0 1 90.00% 15.61% 12.38% 5 0 21.1% 11B 96.61% 37.99% 67.81% 1 100.84% 3 0 0 0 1 0 0 77.78% 0.00% 4.96% 11 0 11.5% 14B 99.62% 35.90% 1.90% 1 99.57% 3 0 0 0 1 1 0 83.87% 5.54% 1.38% 3 0 9.1% A&E 99.76% 21.59% 4.53% 0 N/A 0 0 0 0 5 2 1 47.95% 6.08% 6.54% 9 0 N/A Obs 97.76% 36.50% 12.10% 1 58.06% 3 0 0 0 3 2 0 100.00% 0.36% 0.00% 4 0 36.7% H Ward 103.78% 13.70% 27.92% 1 92.63% 3 0 0 0 0 0 0 95.00% 0.00% 15.57% 1 0 3.8% Critical Care 84.46% 4.50% 2.71% 0 66.31% 0 0 0 0 0 0 0 N/A 2.47% 0.26% 7 0 N/A Women & Childrens 94.65% 3.55% 6.83% 11 55.87% 2 0 0 0 6 3 2 90.71% 6.22% 6.73% 2 0 17.5% E Ward 109.05% 10.54% 3.85% 0 38.23% 0 0 0 0 0 0 0 68.75% 7.72% 3.72% 2 0 17.5% Maternity 92.47% 4.00% 17.31% 5 61.58% 0 0 0 0 1 1 0 91.11% 1.24% 9.85% -6 0 N/A NNU 89.74% 3.87% 0.00% 0 27.22% 0 0 0 0 0 0 0 N/A 14.68% 0.00% 1 0 N/A Childrens Ward 93.02% 3.54% 0.00% 2 46.00% 0 0 0 0 0 0 0 88.68% 6.75% 2.22% 2 0 N/A Childrens A&E 99.75% 2.87% 0.00% 4 N/A 0 0 0 0 2 2 0 94.44% 1.03% 0.49% -2 0 N/A PAB 93.55% 0.00% 0.00% 0 82.95% 1 0 0 0 0 0 0 N/A 100.00% N/A 2 0 N/A Planned Care 97.55% 16.62% 18.11% 9 89.10% 15 0 0 0 29 8 3 97.23% 7.11% 5.89% 35 0 15.6% PIU 94.90% 31.87% 66.67% 0 110.04% 5 0 0 0 3 2 0 95.83% 11.30% 0.00% -3 0 12.4% 14A 98.86% 14.78% 39.52% 1 99.46% 3 0 0 0 2 0 1 90.00% 5.13% 10.89% 3 0 18.5% 15A 101.12% 38.22% 91.50% 0 96.65% 2 0 0 0 1 0 0 95.45% 1.80% 13.89% 3 0 16.8% 15B 101.18% 55.50% 27.56% 0 100.50% 1 0 0 0 3 2 0 82.14% 3.36% 2.44% 3 0 16.8% Spinal Unit 93.60% 21.73% 8.63% 5 90.62% 3 0 0 0 0 0 0 N/A 3.84% 7.44% 8 0 16.3% G Ward 107.90% 7.50% 1.24% 0 34.92% 0 0 0 0 1 1 0 95.45% 2.32% 1.80% 7 0 12.8% Treatment Centre N/A 0.00% 0.00% 0 N/A 0 0 0 0 1 0 0 99.22% 10.10% 4.48% 2 0 N/A Theatre N/A 26.44% 0.00% 2 N/A 0 0 0 0 0 0 0 N/A 11.43% N/A 9 0 N/A Radiology N/A 0.00% 0.00% 0 N/A 0 0 0 0 3 1 2 N/A 0.00% N/A 0 0 N/A Community & Continued Care 86.51% N/A N/A 6 N/A 13 45 N/A N/A 10 4 3 100.00% 5.73% 8.24% 19 N/A N/A Burscough D/Ns 83.60% N/A N/A 0 N/A 0 4 N/A N/A 0 0 0 N/A 2.63% 0.00% 0 N/A N/A Hillside D/Ns 78.18% N/A N/A 0 N/A 0 5 N/A N/A 0 0 0 N/A 12.20% 0.00% 1 N/A N/A Hants Lane D/Ns 95.14% N/A N/A 0 N/A 0 10 N/A N/A 0 0 0 N/A 0.00% 33.33% 1 N/A N/A Sandy Lane D/Ns 82.22% N/A N/A 1 N/A 0 2 N/A N/A 0 0 0 N/A 17.56% 0.00% -1 N/A N/A Tarleton D/Ns 88.29% N/A N/A 0 N/A 0 4 N/A N/A 0 0 0 N/A 4.81% 0.00% 1 N/A N/A Ainsdale D/Ns 96.20% N/A N/A 4 N/A 0 1 N/A N/A 0 0 0 N/A 1.99% 33.33% -1 N/A N/A Churchtown D/Ns 78.98% N/A N/A 0 N/A 0 8 N/A N/A 1 1 1 N/A 0.00% 25.00% 1 N/A N/A Curzon Road D/Ns 88.97% N/A N/A 0 N/A 0 1 N/A N/A 0 0 0 N/A 10.87% 0.00% 1 N/A N/A Formby D/Ns 83.46% N/A N/A 0 N/A 0 1 N/A N/A 0 0 0 N/A 13.98% 0.00% -1 N/A N/A Red <90% 15%> 15%> N/A 93%> N/A N/A 1+ 1+ N/A N/A N/A <80% 7%> 7%> N/A 1 15%> Amber 90-95% 10-15% 10-15% N/A 85-93% N/A N/A - - N/A N/A N/A 80-94% 4-7% 4-7% N/A - 10-15% Green 95%> <10% <10% N/A <85% N/A N/A 0 0 N/A N/A N/A 94%> <4% <4% N/A 0 <10%

Locations not above: Staffing Related Incidents Complaints Urgent Care Urgent Care 3 x Skelmersdale WIC 2 x Not Attributable to Specific Ward/Dept 1 x Skelmersdale 3 x WLHP WIC 1 x Not Attributable to Specific Ward/Dept. Women & Children s 1 x Outpatients 2 x Sexual Health Planned Care 1 x Paediatric Outpatients 1 x Orthopaedic OPD Planned Care 11 x Access & Community Booking 1 x Speech & Language Therapy 2 x Eye Clinic 1 x Urology Falls 1 x Not Attributable to Specific Ward/Dept. Women & Children s Community 4 x Pain 1 x Sexual Health Management Community 1 x Audiology 4 x Discharge Planning (Bluebell Lodge) 1 x Diabetes 2 x Adult Therapies 1 x MCAS 1 x Audiology 1 x Phlebotomy 1 x 1 x Falls Service Rehab 1 x Intermediate care 1 x Long Term Care Admin 1 x Manual Handling 1 x Neurological Rehab 1 x Occupational Therapy