Hard Truths Commitments NHS England April 2014

1

The Royal Wolverhampton NHS Trust /
Trust Board Report
Meeting Date: / 24thNovember2014
Title: / Safe Staffing; Planned Versus Actual Staffing by Ward–October2014 data
Executive Summary: / NHS England issued guidance on how every NHS Trust must deliver the commitments detailed in ‘Hard Truths’ in particular to publishing staffing data regarding nursing, midwifery and care staff.
NHS Choices website has published this data since June 2014 in line with TDA and NHSE requirements.
This paper details the average fill rate by Registered Nurse/Health Care Assistant [HCA] /shift and ward for the month of October.
The paper details reasons when staffing hours are ≥ 120% or ≤ 80% by ward.
This report captures the October data for the Cannock Chase Hospital site to ensure the data was captured and reported and to use as abenchmark.
Action Requested: / The Board will receivethe report for information and to support them in fulfilling their responsibilitiesto monitor staffing capacity and capability.
Report of: / Cheryl Etches, Chief Nursing Officer
Author:
Contact Details: / Lynne Fieldhouse, Deputy Chief Nursing Officer
Resource Implications: / Nil
Public or Private:
(with reasons if private) / Public
References:
(eg from/to other committees) / The external facing Trust intranet page has a dedicated section on safe staffing
Appendices/
References/
Background Reading /

1. ‘Hard Truths’ Commitments NHS England April 2014
2. How to ensure the right people, with the right skills, are in the right place at the right time. National Quality Board Nov 2013

NHS Constitution:
(How it impacts on any decision-making) / In determining this matter, the Board should have regard to the Core principles contained in the Constitution of:

• Equality of treatment and access to services
• High standards of excellence and professionalism
• Service user preferences
• Cross community working
• Best Value
• Accountability through local influence and scrutiny

1.0Introduction

1.1As part of the implementation of the guidance on the delivery of the ‘Hard Truths’ commitments (March 2014) associated with publishing staffing data, this report provides the Board with monthly information on nursing and midwifery staffing.

1.2Staffing Information is provided by Senior Sisters/Charge Nurses and collated centrally. Matrons review data with their respective wards. Heads of Nursing contribute some analysis to the data.

1.3This staffing data is reported to the Senior Nurse Strategic Group and posted on the Trust intranet site.

1.4The Unify staffing data is published monthly on the Trust internet site.

2.0Planned staffing with actual ‘fill rate’ per shift with differentiation between Registered Nurses[RN] and Health Care Assistants.

2.1The table in Appendix 1 provides the percentage fill rate of September rostered ( planned) hours against actual hours worked.

2.2Tabulated fill rates of less than 80% or greater than 120% [national thresholds]are shaded amber and exceptions are reported in the comments box. Senior Sisters/Charge Nurses are required to indicate the reasons for their staffing levels being above or below those planned.

2.3New sections has been added this month to the Trust’s tabulated summary to begin to explore staffing levels correlating to selected nurse sensitive indicators. There is no requirement to report this additional data externally.

2.4The hours worked do not take into account the amount of bank or overtime that may have been used to fill the shifts, this can impact on quality of care so the paper only provides a quantative analysis, with qualitative data from selected nurse sensitive indicators

Results compared to September 2014 ( excluding the Cannock Chase site data for which we have no comparative data at this time) indicate continued improvements for the second consecutive month:

• 1 less ward reporting a registered nurse fill rate on day shifts below 80%.
• 1less ward reporting a HCA fill rate on day shifts below 80%
• 2 less wards reporting a registered nurse fill rate on night shifts below 80%-
• There were no reports of HCA night fill rated falling below 80%

2.5Monthly average Trust fill rate :

Sept / Oct
Registered nurses day / 87.5% / 91%
Registered nurses night / 84.1% / 89.2%
HCA day / 103.2% / 104%
HCA night / 118.1% / 112%

3.0 Supplementary information

3.1The situation has eased significantly during the last few weeks of European nurses gaining NMC PINs (52 of the 60)

3.2Nursing vacancies open for recruitment at October 2014 = 64.36 the lowest for 10 months.

3.3 Nursing Update - October

•Total Offers Made - 65

•Internal Offers Made - 17

•External Offers Made – 48

•Total Contracts Issued - 71

•Internal Contracts Issued - 23

•External Contracts Issued - 48

•Waiting to come in post - 126

•Waiting to come in post Internal - 18

•Waiting to come in post External - 108

•Face-to-face interviews - 71

•Total Live Adverts posted – 32

Total Contracts Issued – 95

TB/LF/FINAL NOV 2014Page 1

1

Appendix 1

The Royal Wolverhampton NHS Trust Inpatient staff planned with actual – October 2014

Ward / Amber = Fill rate ≥ 120% or ≤ 80% / Rationale / Nurse Sensitive Indicators / Comments
Average fill rate –RN’s /midwives Day / Average fill rate - HCADay / Average fill rate –RN’s /midwives Night / Average fill rate - HCANight / HCA instead of RN
 / Bank Unable to fill
 / Falls with Harm / Late Obs
% / Avoidable PU’s / Staffing Breaches
A5 / 87.5% / 101.6% / 84.9% / 95.2% / 0 / 12 / 2 / 12 / 12 breaches ,did not trigger an amber as staff were sent to work from the critical care unit on the ward.
A6 / 83.5% / 149.7% / 68.8% / 232.3% / 0 / 11 / 1 / 9 / HCA’s look high as these numbers include overseas nurses awaiting their NMC PIN numbers.
A7 / 83.6% / 143.2% / 91.4% / 137.1% / 0 / 8 / 1 / 1 / Additional HCAs required to provide 1:1 for patients with or awaiting assessment for DOLS
A8 / 65.1% / 96.8% / 93.5% / 101.6% /  / 1 / 4 / 0 / 0 / Senior sister worked clinically rather than supervisory and cross cover from A7, safety maintained
A9 / 95.6% / 60.5% / 83.9% / 112.9% / 0 / 8 / 0 / 1 / Low HCA numbers due to long term sickness and maternity. HCA used on nights to support RN deficits.
A12 / 88.2% / 98.7% / 71.0% / 196.8% / 0 / 11 / 1 / 3 / Overfill of HCA on nights as utilising HCA to replace RN due to shortages. Staff also moved to provide cover in other areas of trust.
A14 / 91.0% / 100.0% / 77.4% / 174.2% / 0 / 6 / 0 / 0 / Overfill of HCA on nights to support RN deficits due to inability to fill shifts.
A23 / 84.9% / 87.1% / 96.8% / 100.0% / 0 / 4 / 0 / 0
B7 / 92.8% / 119.4% / 79.6% / 187.1% /  / 0 / 4 / 0 / 0 / Additional HCA required to
special confused wandering patient high falls risk and self-harm, Also bank unable to fill with trained
Bey SS / 81.9% / 73.5% / 100.0% / 83.9% / 0 / 5 / 0 / 0 / Unable to access HCA via bank, staff moved from other areas to assist.
C16 / 106.5% / 100.6% / 71.0% / 103.2% /  / 1 / 18 / 0 / 3 / Unable to provide 3 RNs at night due to status of newly recruited overseas nurses, bank unable to fill. 3 RNs from November 2014
C17 / 89.9% / 101.1% / 96.8% / 96.8% / 0 / 10 / 0 / 0
C18 / 94.1% / 101.6% / 93.5% / 88.7% / 0 / 5 / 1 / 0
C19 / 83.6% / 121.8% / 72.0% / 121.0% /  / 0 / 11 / 0 / 0 / Awaiting new recruits to start, bank unable to fill RN gap with RN
AMU (A21) / 91.7% / 93.3% / 90.7% / 96.8% / 0 / 9 / 0 / 2
C22 / 92.9% / 108.4% / 100.0% / 145.2% / 1 / 9 / 0 / 3 / Additional HCAs required to provide 1:1 for patients with or awaiting DOLs assessment
C24 / 89.5% / 96.8% / 78.5% / 103.2% /  / 0 / 8 / 3 / 1 / Unable to provide 3 RNS at night due to vacancies and sickness, bank unable to fill. Where possible backfilled with HCA to maintain patient safety. 3 RNs from November 2014
C25 / 103.6% / 99.4% / 80.6% / 104.8% / 0 / 8 / 1 / 1
CHU / 107.8% / 83.9% / 98.9% / 90.3% / 0 / 5 / 0 / 1
Deansley - C35 / 91.1% / 100.0% / 100.0% / 100.0% / 0 / 4 / 0 / 0
Maternity – D10 / 93.5% / 96.6% / 87.9% / 109.7% / 0 / N/A / 0 / 1
Cardiology – B14 / 90.3% / 91.9% / 87.1% / 100.0% / 2 / 5 / 0 / 3
Cardiothoracic – B8 / 86.3% / 93.5% / 86.6% / 87.1% / 1 / 5 / 0 / 2
West Park 1 / 89.0% / 107.0% / 71.0% / 180.6% /  / 0 / N/A / 0 / 0 / Additional HCAs required to provide 1:1 for patient
West Park 2 / 77.4% / 112.9% / 96.8% / 122.6% /  / 0 / N/A / 0 / 1 / Additional HCAs required on nights to provide 1:1 for patient
West Park 3 / 77.4% / 118.9% / 98.4% / 101.6% /  / 0 / N/A / 0 / 0
NRU / 87.1% / 132.3% / 100.0% / 200.0% /  / 0 / N/A / 0 / 0 / Additional HCAs required on nights to provide 1:1 for patient
Neonatal Unit / 108.5% / 51.6% / 106.5% / 141.9% / 0 / N/A / 0 / 0 / HCAs used on nights to provide additional staffing to provide low level care
A21 / 102.6% / 174.2% / 73.5% / 100.0% / 0 / N/A / 0 / 1 / Additional HCAs on days required to provide 1:1 for patient
ASU - B12 / 73.1% / 111.8% / 88.2% / 71.0% /  /  / 1 / 7 / 0 / 0
C15 / 104.6% / 148.4% / 72.0% / 190.3% /  / 0 / 4 / 0 / 0
D7 / 106.9% / 112.9% / 77.4% / 207hrs* / 0 / 4 / 0 / 1
ICCU / 98.9% / 82.4% / 99.3% / 85.5% / 0 / N/A / 0 / 2
A10 / 73.3% / 95.2% / 100.0% / 96.8% /  / 0 / N/A / 0 / 0
Fairoak - Cannock Hospital / 94.5% / 119.4% / 100.0% / 130.6% / ** / ** / ** / ** / ** No data currently available
Hilton Main - Cannock / 108.9% / 89.7% / 138.7% / 106.5% / ** / ** / ** / ** / ** No data currently available
PACU - Cannock / 71.0% / 62.9% / 67.7% / 58.1% / ** / ** / ** / ** / ** No data currently available
The PACU currently functions from the Hilton Main staffing establishment and is staffed when activity requires, these are patients from Hilton Main cared for in this area for 24hrs post-surgery before moving back into the ward area. They currently operate a flexible working pattern which is activity led.

Note

* This ward does not plan to roster HCAs for night duty but use them if there is a shortfall in RN cover

N/A for late observations = areas not on VitalPAC system

TB/LF/FINAL NOV 2014Page 1