Nursing and Midwifery Establishments Report

Report: Ward Staffing. October, 2015

NURSING AND MIDWIFERY ESTABLISHMENTS REPORT

EXECUTIVE SUMMARY

This report confirms on-going compliance with the requirement to publish monthly aggregated nursing and care assistant staffing levels, in accordance with NHS England’s, The NQB’s and the CQC’s requirements.

Furthermore it provides outline detail in the context of local priorities for progression towards the utilisation of robust nurse roster data and information to support and evidence local staffing practice and national safe staffing guidance.

The Trust Board is requested to:

Receive this report,
Decide if any if any further actions and/or information are required.

NURSING AND MIDWIFERY ESTABLISHMENTS REPORT

1.PURPOSE OF THIS REPORT

The report on this topic presented to the Trust Board on 29 April 2015 was for information only following corrections made to the financial figures presented in section 2.1, of the report originally presented to Trust Board on 25 March 2015. That report advised the Trust Board of the next stages of investment in nursing and midwifery establishments and how this is to be managed.

The purpose of this report is to confirm on-going compliance with the requirement to publish monthly aggregated nursing and care assistant staffing levels, in accordance with NHS England’s, The NQB’s and the CQC’s requirements.

The Trust Board is requested to:

Receive this report,
Decide if any if any further actions and/or information are required.

2.EXPECTATION 7

Expectation 7 of the NQB’s standards requires Trust Boards to receive monthly updates[1] on workforce information, and that staffing capacity and capability is discussed at a Trust Board meeting in public at least every six months on the basis of a full nursing and midwifery establishment review.

The first specific requirement of Expectation 7 is for provider trusts to upload the staffing levels for all inpatient areas on a monthly basis into the national reporting database. These are then published via the NHS Choices Website alongside other quality indicators for each trust, with a hyperlink to each trust’s web page for more specific information.

The Trust Board is advised that the Trust continues to comply with the requirement to upload and publish the aggregated monthly nursing and care assistant (non-registered) staffing data for inpatient areas. The data within these represents only high level aggregated averages. However it can be contextualised to support an analysis of roster practice through an understanding of data and reasons for what appear as anomalies in some cases.

2.1 Analysis of aggregated monthly nursing and care assistant (non-registered)staffing data for inpatient areas October 2015

Inpatient staffing levels are aggregated by ward and site and provide an average overall fill rate against planned and actual staffing for registered nurses/midwives and care assistants for days and nights.

The high level aggregated averages are expressed in percentage terms which often translate as low whole time equivalent (wte) numbers.

The mix of average fill rates for registered midwives and care assistants on each ward is variable. These figures represent the skill mix between registrants and care assistants. A higher than planned percentage of care assistants often balances with a reduction in registered fill rates to provide available hours with a different, but safe skill mix.

Overall in October the Trust has under rostered against planned fill rates but is in an overspend position. This is a result of staffing to the agreed establishment uplift with temporary staff until recruitment to substantive posts can be made.

Further detail can be found in the attached report.

The aggregated data can be utilised within care groups to support challenges in roster practice through provision of Care Group specific reports for review and action.

The Unify staffing data is submitted to the Department of Health on a monthly basis. The information gathered is in relation to inpatient care across 45 wards and is split into the categories listed below.

Registered Nurse/Midwife hours; planned and actual for days
Registered Nurse/Midwife hours; planned and actual for nights
Unregistered care hours; planned and actual for days (Health Care Assistant/Midwifery Care Assistant/ Assistant Practitioners)
Unregistered care hours; planned and actual for nights (Health care Assistant/Midwifery Care Assistant/ Assistant Practitioners)

The planned staffing is based on the budgeted staffing hours. The uplift in registered staff has resulted in an expected drop for the average fill rate on days, especially the ALTC wards.

2.2 October 2015 Unify Staffing Submission.

The following graphs compare the planned against the actual. The unify data is categorised by registered/unregistered and day/nights hours. The graphs also display total hours across both staff groups as unregistered staff can often backfill registered hours. Positive numbers represent overstaffing and negatives understaffing when matching planned against actual.

2.3 Ward staffing analysis: CDDFT (45 Wards)

In relation to the planned against actual the Trust had understaffed by 14349 Registered hoursbutoverstaffed by 2867Unregistered hours; with a net understaffing of 11482hours in total for the month.

Registered Staff –the understaffing was expected in light of the newly uplifted staffing numbers and the greater difficulty backfilling vacant qualified hours.

On a month to month basis the registered staff hours have been consistent. When comparing October with previous months,in general, the correlation was almost identical, but with a marked drop in September that could possibly be seasonal in nature.

Unregistered Staff – the understaffing of these hours resulted from unregistered staff back filling registered duties whilst not being fully replaced by bank or agency themselves as much as previous months.

Registered and Unregistered combined

Areas identified as over staffing–the threshold is set at 120% of budgeted establishment.

There were no areas where the wards exceeded the threshold for registered staff.The previous month’s issues around the Richardson hospital had been resolved.

As with previous months a number of areas exceeded the 120% in relation to unregistered staff.

Areas identified as understaffed -the threshold was set at 80% of budgeted establishment.

Reasons for over and under staffing

In October the Trust Board continues with the plans to improve the consistency of ward staffing through:

Active local recruitment abroad – There has been 2 phases of recruitment of Italian nurses with the result that 23 nurses from Phase 1 and 22 nurses from Phase 2 are being employed in the trust. Italian nurses from Phase 1 are due to start in February 2016. Currently, there is insufficient numbers of required Romanian nurses to make a trip viable and this is currently still under consideration.
Newly qualified nurses commencing employment from the beginning of October following completion of their degree from Teesside University. As discussed last month, they have inflated the HCA hours in October until they attain registration from the NMC.
There are currently over 100 WTE vacancies but we do have at least 51 WTE currently in the HR process with a further 17 WTE awaiting induction/start dates.
The Nurse bank is still being developed. The Bank team are actively promoting the employment of staff through recruitment days etc..
New Monitor rules on the use of Agency nurses are aimed at improving the reliability and consistency of supply from partner agencies through the development of framework agreements. The neutral vendor process is well underway. This is to ensure the trust conforms with Monitor wishes as prices on agency fees are capped. It is planned that this new framework will go live in January 2016.
More intensive support of nurses on sick leave.
A more considered approach to back filling nurses on maternity leave.
Improved business planning for nursing services to better capture demand and supply issues
eRostering, safer staffing and temporary staffing Policies are all nearing completion and will support and advise in promoting overall better management of staffing within the trust.
The eRostering lead, Brian Nicholson (BN) will be conducting a further Safer Nursing Care Tool Audit throughout the trust during the whole month of January 2016 and this will further assist in identifying staffing issues. BN is working in partnership with the NerveCentre system lead Paul Latimer to bring a more automated and real-time feel to this process in 2016.
Between January 2016 and March 2016, BN will also work in partnership with Allocate and other trust leads to move the community areas onto the latest version 10 of HealthRoster, allowing for a more manageable system with additional benefits to management and staff alike.

How the wards were staffed – temporary workers include both bank and agency

Total substantive hours increasedfrom September to October. Applying Octobers figures to a 30 day period would see total substantive staffing increase to 153261 hours as opposed to the 31 day 158370 hours. An increase of over 3263 hours compared to September.

Breakdown of substantive hours by month

Breakdown of temporary worker hours by month

Bank hours increased in October when compared to previous months.This would have been used to

off-set the substantive hours across the trust.

The agency increased by of 3,026 hours after extrapolating October’s hours over a 30 day period.

Backfilling vacant hours for October 2015

2.4 Paperless Real time rosters

Nursing rosters are currently produced on the Healthroster system and a hard copy printed out. The hard copy is where adjustments are annotated. These are retrospectively inputted back into the system for payroll and staffing information purposes at the end of each month. As a consequence the electronic version is a retrospective reflection of those amendments.

It is intended to move towards a position of paperless (real time) rosters which affords the Trust an opportunity to manage both substantive staff and bank workers more effectively, thereby significantly reducing the requirement for agency workers in the process. Implementation of real time rosters will ensure:

Rosters are reviewed in real time in line with newly agreed establishments the need to roster within establishments.
Rosters are accurate and reviewed to enable focussed effort in areas of bad rostering practice and the sharing of good rostering practice.
An accurate overview of Bank worker demand.
The Temporary Worker Service can be confident that bank requests on the system are at all times accurate.
The Temporary Worker Service can proactively manage the sourcing of agency duties.
Bank workers can book directly into available bank duties without the need to contact the wards or bank office
Substantive workers can book directly in to the available bank duties for extra hours
Staffing levels are transparent in real time affording the opportunity to match demand with supply more accurately and redeploy to areas where staffing is lower to improve patient safety and staff support

A pilot for ‘Paperless Rosters’ has successfully been undertaken on AMU UHND with further rollout planned across the acute wards. A business case has been approved to support paperless rostering.

Rollout of Paperless Rostering

Phase 1 November 2015 - COMPLETED

Phase 2 November 2015/December 2015 - UNDERWAY

Phase3 December2015 /January 2016

Phase 4 January 2016

3.SUMMARY

The Trust continues to meets its obligations as set out by NHS England, the CQC and the National Quality Board to review and report ward based nursing and midwifery staffing levels. Overall staffing levels are within tolerance, however wards which are reporting understaffing in any category are subject to active recruitment and retention plans to fill gaps and sustain better continuity of care. The Trustis also aiming to utilise this data to inform and challenge roster practice.Progress toward real time paperless rosters will continue.The Trust Board will continue to be advised of developments in the nursing and midwifery staffing arena.

Noel Scanlon Brian Nicholson

Executive Director of Nursing Matron: E-Rostering Lead October 2015

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[1] Where Trust Boards do not meet in public monthly, this is to be presented at every Trust Board meeting in public when they occur.