Update on Trust Board Reporting of staffing requirements in line with
‘Hard Truths’ (November 2013)
1.0 Introduction
1.1 This paper sets out the actions required by the Board of Directors following the publication of Hard Truths in November 2013, the government’s response to the Francis report articulating the guidance for nurse staffing. It will also give an overview of the work undertaken to date to comply with the recommendations
2.0 Background
2.1 It is an expectation, set out in the National Quality Board (NQB) guidance published in November 2013, that Boards take full responsibility for the quality of care provided to patients, and as a key determinant of quality, take full responsibility for nursing, midwifery and care staffing capacity and capability. All reports to Trust Board must meet the requirements set out in the NQB guidance.
3.0 Expectations of the Board
3.1 Boards take full responsibility for the quality of care provided to patients and, as a key determinant of quality, take full and collective responsibility for nursing, midwifery and care staffing capacity and capability.
3.2 The guidance states that the Board will be advised of those wards where staffing capacity and capability frequently falls short of what is planned, the reasons why, any impact on quality and the actions taken to address gaps in staffing. This could be presented as an exception report, providing the Trust website publishes ward by ward data on actual versus planned numbers of staff by registered nurse / midwifery /care staff and day duty / night duty.
3.3 Responsibilities include:
- Managing staffing capacity and capability by agreeing staffing establishments
- Considering the impact of wider initiatives (such as cost improvement plans) on staffing
- Monitoring staffing capacity and capability through regular and frequent reports on the actual staff on duty on a shift-by-shift basis versus planned staffing levels
- Examining trends in the context of key quality and outcome measures
- Asking about the recruitment, training, skills and experience, and management of nurses, midwives and care staff and giving authority to the Director of Nursing to oversee and report on this at Board level.
4.0 What will be reported to the Board?
4.1 The Board should receive a report that outlines staffing capacity and capability. Published monthly, these updates should provide details of the actual versus planned. These reports are to also to highlight actions’ Trusts are taking to ensure when actual requirements fall short of planned.
4.2 As a minimum every six months the Board must receive a report on staffing capacity and capability. A Staffing review using where possible an evidence based tool triangulated with professional judgement and also by other indicator examples being:
Patient Experiences
Serious incidents
Complaints
It should also aim to be relevant to all wards and cover the following points:
- Demonstration of the use of evidence based tool(s) to determine acuity
- What allowance has been made in establishments for planned and unplanned leave
- The difference between current establishment and recommendations following the use of evidence based tool(s)
- The skill mix ratio before the review, and recommendations for after the review
- The difference between the current staff in post and current establishment and details of how this gap is being covered and resourced
- Details of any element of supervisory allowance that is included in establishments for the lead sister / charge nurse or equivalent
- Evidence of triangulation between the use of tools and professional judgement and scrutiny
- Details of any plans to finance any additional staff required
- Details of workforce metrics - for example, data on vacancies (short and long-term),sickness / absence, staff turnover, use of temporary staffing solutions (split by bank /agency / extra hours and over-time)
- Information against key quality and outcome measures - for example, data on safety thermometer or equivalent for non-acute settings, serious incidents, healthcare associated infections (HCAIs), complaints, patient experience / satisfaction and staff experience / satisfaction.
4.3 The paper must make clear its recommendations to the Board which must be discussed at a public Board meeting. It is anticipated the next review will be at the July Board meeting.
5.0 The Board Responsibilities and work to date
5.1 The Board should ensure that systems, policies and procedures are in place to support decision making for staffing decisions on a shift-by-shift basis. To comply with this the following actions are in place:
- Staffing is monitored on a daily basis supported by escalation procedures and agreed staffing
- Electronic Rostering is to be piloted in a small number of wards
- Any shifts that breach the minimum staffing levels are escalated to the Matrons and any residual shortfalls are reported on the risk management system
- An electronic file on the ‘S’ drive in place to closely monitor staffing until E-Rostering has been fully piloted and evaluated
- A full staffing review was presented at the Board of Directors meeting in October 2013, that included the recommendations for:
Supervisory ward managers
Uplift in identified nursing establishments -to wards of 550K, a further 124K in Critical Care and an investment of 285K in ED. Bringing the investment in to nursing 959K
- The Director of Nursing, through the Heads of Nursing, monitors staffing shift by shift and adjustments take place as required
- Weekly monitoring via Datix takes place at the Serious Incident panel meetings and remedial actions agreed
- Workforce data is presented via the Integrated Performance Report and via monitored relevant HR committees and Divisional Boards on a monthly basis
- Current Nurse Metrics (although under review) are monitored by the Heads of Nursing and remedial actions are taken as needed.
5.2 It is now a requirement that Trusts publish the planned and actual staffing and description of the team so that it is visible to patients and visitors at ward level, and in the future across all clinical areas. This is now in place; a board which is updated at the start of every shift displays planned and actual staffing available. There is also supplementary information about role and responsibilities
5.3 With the support of the communications team, a report is under development which will be uploaded onto our website and the NHS Choices webpage from June, it is expected that a template will be produced for Trusts to follow, this is likely to be part of the national ‘Open and Honest’ programme (monitoring and publishing key quality indicators)
5.4 Guidance has been issued on the 17th May from NHS England setting out how information needs to be reported on a monthly basis via UNIFY (the national information database). A Standard Operating Procedure has been developed articulating the data validation process. It is expected that Trusts will upload this data no later than the 10th of June, this will then be displayed publically on NHS choices from the 24th of June along with additional quality indicators. There will be an opportunity to add narrative to explain exceptions in staffing as required. With the support of the Information Team an electronic spreadsheet has been developed to facilitate the data collection.
6.0 Recommendation
The committee is asked to note the contents of the paper and action already taken. There has been great engagement from the senior nursing team to respond to this mandated national instruction in a timely manner.
The committee is also asked to confirm support for the publication of the information onto the Trust’s website monthly and be informed that the Director of Nursing will be signing off the data to be submitted to UNIFY on a monthly basis, this will be shared with Board members monthly.
Alison Kelly
Director of Nursing and Midwifery
June 2014
FIG Paper June 2014 Hard Truths Staff Publishing Page 1