Report to the Meeting of The s2

PUBLIC BOARD REPORT

Report to the Meeting of the

Oxford Health NHS Foundation Trust

Board of Directors

25 January 2017

Inpatient Safer Staffing Report

For Information

Introduction

This is a monthly report to the Board of Directors presenting the actual staff levels (registered and unregistered) on each ward against their required need on a shift by shift basis for a 4 week period from 5th December to 1st January 2017.

The national requirements on providers around being transparent on our monitoring and reporting staffing levels is continuing to increase. Ensuring sufficient staffing levels are in place is crucial to deliver safe, effective and high quality care.

Management of Staffing Levels

At a senior level we continue to monitor staffing levels by ward each week. Table 1 in the body of the report summarises the staffing position by ward. Each ward is taking a range of immediate actions on a daily basis to ensure safe staffing levels are maintained appropriate to the needs of patients.

When looking at the number of shifts which were fully staffed to expected levels, seven wards were identified as having the most difficulties across the last three months in achieving expected staffing levels on every shift. However all wards did maintain minimum staffing levels to remain safe to deliver patient care. The seven wards identified as struggling were; Chaffron, Highfield, Phoenix, Ruby, Sandford, Sapphire and Vaughan Thomas. Ashurst PICU, Highfield unit and Sandford ward. More detail is provided in the report.

The main reason wards have been unable to fully staff every shift is due to vacancies related to recruitment difficulties in some geographical areas and some specialties which we are giving more strategic attention to. Retention of staff is also a strategic priority. Details of the actions being taken are detailed in the report driven by the Workforce and Nursing Strategies.

Recommendations

The Board is asked to note:

v The processes in place to ensure safe staffing levels on all the wards in the organisation, those wards where there are concerns and the actions being taken to ensure safe staffing

Author and Title: Susan Haynes, Deputy Director of Nursing and Clinical Standards

Lead Executive Director: Ros Alstead, Director of Nursing and Clinical Standards

A risk assessment has been undertaken around the legal issues that this paper presents and there are no issues that need to be referred to the Trust Solicitors. This paper links to all of the five CQC Domains.

Inpatient Safer Staffing

Period: 5th December to 1st January 2017

Introduction

This report will be published on our website with a link from NHS Choices website.

Management of Staffing Levels

Escalation processes are in place to manage staffing safely on a shift by shift basis with senior staff giving appropriate support to ward teams. The staffing levels by ward are continually reviewed on each shift by ward staff and immediate managers, daily by modern matrons and weekly by the heads of nursing and Director of Nursing to ensure there is an appropriate level and skill mix of nursing staff to match the acuity and needs of patients to provide safe and effective care. Throughout December 2016 all wards were staffed to achieve safe staffing levels; however this has been achieved in some wards by our staff working additional hours and shifts, the high use of temporary staff both from the trusts internal bank ‘staffing solutions’ and external agencies, and reducing beds on some wards.

As reported previously Wantage community hospital ward was temporarily closed in early July 2016 and remains closed at the time of reporting..

To ensure safe staffing on every ward on a shift by shift basis a number of actions continue to be taken specific to each ward these included:

Ø Managing capacity and levels of agency staff by reducing bed numbers in wards temporarily

Ø Temporarily reducing beds on some wards and closing two community hospital wards

Ø Level of need has been taken into account when deciding which ward to admit patients

Ø Staff who are normally supernumerary to the nurse staffing numbers such as modern matron, ward manager and deputy ward manager have worked as part of the nursing shift numbers

Ø Staff were borrowed from other wards to increase the staff to patient ratio

Ø Staff worked flexibly, sometimes working extra hours at the beginning or end of a shift

Ø Increased use of temporary staff including the use of ‘long lines of work’ with agency staff

Ø Skill mix has been temporarily changed from the agreed establishment for a particular shift

Summary Position

Table 1 below shows the staffing levels by ward for 5th December 2016 to 1st January 2017 compared to the previous 8 weeks, and with a breakdown by day/ night shifts, alongside a series of other measures including skill mix and workforce indicators. The thresholds are based on trust/ national targets and used to highlight particular wards for further review.

Seven wards are highlighted as having fallen below 85% of shifts filled to the required numbers during this period. These are Chaffron, Highfield, Phoenix, Ruby, Sandford, Sapphire and Vaughan Thomas. For each of the highlighted wards two trend graphs are used below to show performance over time (regarding the % of roster shifts unfilled and % agency usage) on a week by week basis from 5th December 2016 to 1st January 2017.

Chaffron Ward: overall 80.9% of shifts were fully staffed, which is a reduction of nearly 8% from the previous month. Figures by registered and unregistered nurses show the ward has struggled over the last four weeks (45.6 % shifts registered), and sickness has been high at 11.4%. During the reported period there was a slight increase in the use of agency from nil to an average over the period of 11.4. This is the highest usage of agency since 17 October when the figure was 4.9%.

Table 1: Chaffron Ward – Shifts unfilled

Table 2: Chaffron Ward – Agency Usage

Highfield Unit (overall 79.6% of shifts were fully staffed) – this is worse than last month when the figure was 85.3%. The ward has used more unregistered staff (only 34.1% of shifts were covered by registered nurses) and staff were employed people on long working lines from agencies (34.1% agency use) to meet vacancies. The overall vacancies are currently 26.4WTE, which is currently the highest number of vacancies within an in-patient area in the Trust).

Table 3: Highfield - Shifts unfilled

Note axis goes from 0-60%.

Table 4: Highfield – Agency Usage (

The figures in table 4 indicates that the agency figures for the Highfield are fairly constant (around 40%) .

Phoenix ward

The overall number of shifts which were fully staffed was 78.4% of shifts) – this is worse than the previous month when the figure was 86.4%. The ward has used more staff and employed people on long working lines from agencies (14.1% agency use) to meet vacancies. The overall vacancies are currently are 7.5 WTE).

Table 5: Phoenix Ward – Shifts unfilled

Table 6: Phoenix – Agency Usage

Note axis goes from 0-25%.

Ruby Ward: (overall 81.3% of shifts were fully staffed) – this is worse than last month when the figure was 89.93%. The ward has used more unregistered to unregistered staff (with only 38.4% of shifts meeting the required 50% registered to unregistered ratio), and employed people on long working lines from agencies (25.3% average agency use) to meet vacancies. The overall vacancies are currently 9.7WTE).

Table 7: Ruby Ward – Shifts unfilled

Table 8: Ruby Ward –Agency Usage

Sandford Ward: The overall number of shifts (between 5/12/16 and 01/01/17) which were fully staffed was 83.5% of shifts) – this is worse than the previous month when the figure was 90%. The ward used more unregistered staff and employed people on long working lines from agencies (11% average agency use) to meet vacancies. The overall vacancies are currently are 11.9 WTE).

Table 9: Sandford– Shifts unfilled

Table 10: Sandford - Agency Usage

Sapphire Ward: The overall number of shifts (between 5/12/16 and 01/01/17) which were fully staffed was 82.9%) – this is worse than the previous month when the figure was 85.8%. The ward used more unregistered staff and employed people on long working lines from agencies (11% average agency use) to meet vacancies. The overall vacancies are currently are 9.4 WTE).

Agency

Vaughan Thomas Ward: The overall number of shifts (between 5/12/16 and 01/01/17) which were fully staffed was 84%) – this is worse than the previous month when the figure was 91.6%. The ward used more unregistered staff (43.1% registered) and employed people on long working lines from agencies (16.5% average agency use) to meet vacancies. The overall vacancies are currently are 7.1 WTE).

The other wards to note that have high vacancies so have therefore had to use high amounts of agency staff to maintain safe staffing levels;

· Allen ward (29.9% agency use)

· Ashurst (33.8% agency use)

· Kestrel ward (50.5% agency use)

· Kingfisher ward (29.1% agency use)

· Wallingford (25.6% agency use).

· Marlborough House Swindon ward (23% agency use)

Update on recruitment

The Trust has recently successfully recruited and started a high number of Support workers for the Highfield Unit and recruitment is taking place regularly to hire qualified staff to replace agency workers.

Adverts are out to attract nurses and other professionals who will be qualifying in 2017, with district nurses, Abingdon wards 1 & 2 and Thames House remaining a priority.

PUBLIC BOARD REPORT

Table 1. Staffing from 5th December 2016 to 1st January 2017

% of shifts filled against required numbers (highlighted amber if less than 85%)
Latest 4 week period - 5th Dec 16 to 1st Jan 17 / Latest 4 week period - 7th Nov to 4th Dec 16 / Latest 4 week period - 10th Oct to 6th Nov 16 / Latest 4 week period - 5th Dec to 1st Jan 2017
Ward / % Registered day shifts filled by nurses (submitted to NHS England) / % Unregistered day shifts filled by nurses (submitted to NHS England) / % Registered night shift filled by nurses (submitted to NHS England) / % Unregistered night shifts filled by nurses (submitted to NHS England) / % Registered Skill Mix (target 50% or more) / % Agency Use
(thresholds based on Trust targets, 5%) / % Sickness
(thresholds based on Trust targets, 3.5%) / Vacancies Vs Budget (WTE)
(thresholds based on Trust targets, 9%)
Abingdon Ward 1 / 99.8% / 100.0% / 97% / 100% / 110% / 100% / 100% / 48.3% / 9.0% / 0.6% / 5.7
Abingdon Ward 2 / 97.2% / 99.1% / 96% / 100% / 99% / 100% / 100% / 51.5% / 12.2% / 3.0% / 9.1
Allen / 92.2% / 94.3% / 90% / 91% / 95% / 102% / 100% / 45.8% / 29.9% / 8.2% / 13.6
Amber / 96.9% / 97.9% / 99% / 105% / 99% / 102% / 97% / 39.8% / 7.9% / 7.4% / 9
Ashurst (PICU) / 89.4% / 89.8% / 86% / 88% / 124% / 87% / 115% / 35.6% / 33.8% / 5.8% / 12
Bicester / 99.8% / 100.0% / 100% / 115% / 109% / 100% / 100% / 53.8% / 1.1% / 7.9% / 3.7
Cotswold House Marlborough / 91.2% / 97.9% / 98% / 102% / 102% / 164% / 67% / 46.1% / 8.8% / 0.3% / 7.5
Cotswold House Oxford / 86.8% / 86.7% / 95% / 109% / 78% / 100% / 95% / 40.3% / 4.5% / 5.1% / 1.3
Chaffron / 80.9% / 88.8% / 91% / 147% / 87% / 104% / 96% / 45.6% / 0.7% / 11.4% / 3.7
Cherwell / 92.3% / 92.1% / 93% / 84% / 91% / 99% / 102% / 47.8% / 7.2% / 12.1% / 4.9
City / 98.6% / 94.0% / 88% / 100% / 97% / 99% / 100% / 49.0% / 12.7% / 1.6% / 11.4
Didcot / 99.2% / 87.3% / 93% / 112% / 99% / 99% / 96% / 49.2% / 11.5% / 1.1% / 0.2
Glyme / 86.6% / 91.9% / 95% / 84% / 96% / 57% / 166% / 38.4% / 0.3% / 8.3% / 5.4
Highfield (CAMHS) / 79.6% / 85.3% / 82% / 99% / 102% / 171% / 75% / 37.5% / 34.1% / 4.2% / 26.4
Kennet / 98.1% / 96.4% / 98% / 117% / 90% / 99% / 98% / 36.1% / 11.0% / 2.3% / 6.2
Kestrel / 88.9% / 89.8% / 91% / 88% / 84% / 108% / 87% / 30.4% / 50.5% / 6.4% / 18.6
Kingfisher / 86.7% / 88.5% / 90% / 98% / 83% / 97% / 89% / 35.3% / 29.1% / 14.2% / 15
Lambourne House / 94.2% / 93.7% / 90% / 129% / 98% / 101% / 100% / 50.3% / 0.8% / 3.0% / 0.8
Linfoot Witney / 96.0% / 97.7% / 98% / 95% / 95% / 102% / 97% / 52.0% / 15.3% / 5.7% / 10.6
Marlborough House Swindon (CAMHS) / 93.8% / 97.0% / 97% / 105% / 91% / 92% / 99% / 46.8% / 23.0% / 4.7% / 6.4
Opal (Rehabilitation) / 87.9% / 91.1% / 93% / 76% / 97% / 89% / 105% / 48.6% / 0.6% / 3.6% / 7
Phoenix / 78.4% / 86.4% / 91% / 101% / 86% / 100% / 98% / 51.9% / 14.1% / 8.9% / 7.5
Ruby / 81.3% / 89.9% / 92% / 86% / 96% / 99% / 98% / 38.4% / 25.3% / 8.1% / 9.7
Sandford / 83.5% / 90.6% / 82% / 91% / 91% / 98% / 99% / 49.1% / 23.8% / 12.3% / 11.9
Sapphire / 82.9% / 85.8% / 88% / 70% / 90% / 100% / 100% / 43.5% / 11.0% / 1.8% / 9.4
Vaughan Thomas / 84.0% / 91.6% / 91% / 100% / 105% / 97% / 96% / 43.1% / 16.5% / 3.3% / 7.1
St Leonards Wallingford / 95.1% / 97.4% / 98% / 97% / 104% / 100% / 99% / 46.8% / 25.6% / 4.0% / 0.3
Watling / 96.4% / 96.5% / 99% / 108% / 108% / 118% / 102% / 30.1% / 13.1% / 10.0% / 9.7
Wenric / 87.5% / 85.9% / 99% / 105% / 98% / 107% / 96% / 37.8% / 16.1% / 7.6% / 8.2
Wenrisc Witney / 88.5% / 90.9% / 90% / 92% / 89% / 107% / 88% / 57.9% / 5.7% / 7.0% / 7
Wintle / 95.0% / 97.0% / 97% / 70% / 129% / 96% / 105% / 43.3% / 2.9% / 2.4% / 8.1
Woodlands / 98.2% / 99.2% / 99% / 95% / 94% / 104% / 97% / 45.9% / 5.0% / 9.1% / 4.6

Data source: electronic rostering system