Agenda Item 12.6

1

Integrated Healthcheck and Staffing Paper

Trust Board

27th September 2018

Presented for: Governance

Presented by: Professor Suzanne Hinchliffe CBE, Chief Nurse/Deputy Chief Executive

Author: Lorna Johnson, Head of Nursing, Professional Practice Safety Standards

Heather McClelland, Head of Nursing Workforce and Education

Previous Committees: NONE

Key points

1. Trusts are required to publish monthly CHPPD figures from July 2018 (NHSi)

For information

2. Fourteen (15.9%) and Seventeen (19.3%) areas reported staffing levels lower than 80% in July and August 2018 respectively

For Information

3. Data for July and August 2018 shows no direct correlation between shortfalls in nurse staffing and healthcheck metrics or new harms

For Information

4. There were seven wards in escalation in July 2018 and two in August. All wards in escalation were in first stage

For Information

Trust Goals

The best for patient safety, quality and experience

The best place to work

A centre for excellence for research, education and innovation

Seamless integrated care across organisational boundaries

Financial sustainability

Agenda Item 12.6

2

Summary

The Integrated Healthcheck and Staffing Paper, provides a review of staffing and Ward Healthcheck data

for the period July and August 2018. It presents performance across a number of domains and considers

this in the context of staffing, recruitment and ward/department performance within Healthcheck domains.

1. Background

Safe levels of nurse, midwifery and perioperative staffing are essential for the delivery of high quality

nursing care. Actual nurse establishments are calculated using a range of data with staffing updates

submitted nationally each month incorporating both substantive LTHT staff and additional temporary staff

(bank and agency).

The ward/department Healthcheck provides a systematic overview of performance across a range of key

areas that influence or reflect the standards of care, patient outcomes and experience of care delivered in

LTHT. The data can be viewed at organisational, CSU and ward level, providing both a local and strategic

picture.

Nursing and Midwifery Staffing

NHSi have determined that from July 2018 CHPPD is to be the national principal measure of nursing,

midwifery and healthcare support staff deployment on inpatient wards. Acute Trusts will continue to submit

workforce data to the NHSi, with CHPPD data being published on NHS Choices and the Trust internet.

2.2 Care Hours per Patient Day (CHPPD) (See Appendix 2)

Alongside clinical quality and safety outcome measures, CHPPD can be used to identify unwarranted

variation and support delivery of high quality, efficient patient care. CHPPD calculations are based on the

actual hours of registered and unregistered staff available against the ward activity, i.e. bed occupancy at

midnight. Table 1 (Appendix 1) includes overall ward level CHPPD and Figure 3 (Appendix 2) depicts the

Trust level CHPPD reporting January-August 2018. Table 2 presents CHPPD data for August 2018,

showing both the mean and range of data for each CSU. Data is consistent with previous months.

2.1 Nursing and Midwifery Staffing Return (Hard Truths) - (Appendix 1)

Figure 2 depicts the number of areas where actual staffing hours available fell below 80% of staffing hours

planned on the roster, this is the threshold established by NHSi. The number of clinical areas that reported

staffing levels lower than the 80% threshold were fourteen (15.9%) in July and seventeen (19.3%) in

August 2018.

Allied Health Professionals (Physiotherapists and Occupational Therapist) that are rostered on wards to

support the delivery of care have been included in the NHSI staff staffing returns. Data also portrays

actual staffing levels of greater than 130% against planned levels for unregistered staff in many areas.

These higher than planned levels are due to the deployment of unregistered staff to deliver:

enhanced care provided by clinical support workers for patients identified at risk

to mitigate risk for registered nursing shortfalls

During July 2018 all inpatient areas have reviewed their establishments and skill mix, to be able to

articulate the optimum, current and minimum safe staffing levels. Roster templates are in the process of

being adjusted to reflect current staffing levels.

Agenda Item 12.6

3

To mitigate the risk to patients, the overall nurse staffing is reviewed at the Trust daily operational

meeting. CSUs also review staffing daily at Matron Huddles and actions agreed, including:

Proactively requesting shifts to be filled by bank and agency workers

CSU staff being moved between clinical areas to mitigate the gaps and maintain patient safety

Increasing the number of CSWs on duty

Deploying non-ward based clinical staff, e.g. Matron or Clinical Educators, to these areas to

provide care and support to the ward teams

There is an arrangement between CSU’s to assist areas where recruitment of registered nurses

remains a challenge, e.g. Critical Care are buddied with Neurosciences, and Oncology with Acute

& Elderly Medicine.

2.3 Clinical Service Units (CSU) Specific Staffing Issues

CSUs that continue to have registered nurse staffing pressures include:

Abdominal Medicine and Surgery

Cardio-Respiratory

Emergency and Specialist Medicine

Trauma and Related services

Not all wards within these CSUs are affected and some wards previously challenged are showing

improved staffing over the last six months, improved temporary solutions to support safe staffing fill rates

and new ways of working.

A large group of newly qualified nurses, midwives and theatre practitioners will commence employment in

September/October. At present there is 349 Band 5 staff in the recruitment pipeline.

2.4 Maternity Staffing

The current midwife:birth ratio for LTHT is 1:31, and will improve in September and October with new

graduates starting in post. The Birthrate Plus workforce acuity tool is in place on delivery suites with daily,

weekly and monthly monitoring within the CSU. From 1st October 2018 the acuity tool will also be in use

within inpatient maternity ward areas.

The CSU consistently provides 1:1 care in labour 100% of the time and the caesarean section rate of

23.6% in August 2018 compared to the national rate of 26.5%.

3. Ward Healthcheck

The ward/department Healthcheck is undertaken in all adult and paediatric in-patient areas including

Theatres, PACU, Emergency Departments and wards staffed by the Independent provider Villa Care.

An escalation process comprising of seven KPI’s is in place for all in-patient ward areas (excluding Villa

Care wards). In June the KPI’s were amended with staff sickness being removed (reported through the

workforce dashboard) and resuscitation equipment and overall metrics scores being added. These new

KPI’s are measures of safety and process at ward level. Removing staff sickness has helped to expedite

the collation of escalation data, providing wards and CSUs with time to formulate action plans to address

areas of concerns earlier.

There are 91 in-patient wards included in the ward/department Healthcheck. The number of wards in

escalation varies month on month (see Chart 1). The last two months has seen nine wards in escalation.

In August 2018, two wards triggered 1st stage escalation (L23 Head and Neck and J28 Emergency and

Agenda Item 12.6

4

Speciality Medicine). Assurance visits have been undertaken by the Corporate Nursing Team and a

summary of findings and recommendations discussed with the ward and Triumvirate Teams.

Chart 1

3.1 Clinical Standards - Healthmetrics

The Healthmetrics monthly audit programme focuses on processes at ward/department level for

identifying and managing risk of harm rather than outcome (incidence of harm). There are 15 standards

assessed against agreed criteria. A RAG rating is awarded based on percentage compliance with robust

assessment, consistent implementation of interventions, evaluation and documentation.

The individual standard scores are collated to give an overall score;

79.9% or below is Red

80-89.9% is Amber

90% and above is Green.

Appendix 3 (Table 5), illustrates a breakdown of Healthmetrics score by standard group. July and August

2018 have shown sustained improvement in the display of magnetic safety symbols and the planning and

recording of patient discharge information. Some CSUs have seen an improvement in emergency

equipment checks though further education and training is required to embed the changes made to this

standard group across all CSUs.

Appendix 4 (Table 6) highlights the overall score by Trust and CSU level. Head and Neck progressed to

first stage escalation in August and remain red on the Healthmetrics. An action plan is in place with the

CSU and additional support from the HoN and Clinical Educator has been given as part of this plan. The

ward have received an IPC and Executive Leadership walkround and feedback on the whole has been

positive and patient feedback has been good. September’s metrics has seen an improvement from 77.7%

in August to 89.8% (amber). A focus on discharge and some key elements of documentation will move the

CSU into green in October if current improvements can be sustained. Cardio-respiratory have received

support through the ‘Act on Amber’ programme and have focused on improving documentation. Further

education and training is required to embed emergency equipment checks on some wards within the CSU

but overall performance in the Healthmetrics has improved.

Review of the CSU’s with lower than 80% in the reported actual staffing (Appendix 1 Table 1) does not

show a clear correlation with a deterioration in reported metrics scores. Harm free care (new harms), falls

and Pressure Ulcer (PU) incidents have been triangulated with metrics scores and CSU’s with lower than

80% in the reported actual staffing. Appendix 1 Table 1 does not show any direct correlation.

0

5

10

Apr-18 May-18 Jun-18 Jul-18 Aug-18

No

of

clin

ical

are

as

Apr-18 May-18 Jun-18 Jul-18 Aug-18

Series1 1 5 2 7 2

Number of Clinical areas in Escalation 2018/2019

Agenda Item 12.6

5

Healthcheck overall scores are RAG rated. Chart 2 shows LTHT performance for the last 3 months.

Teams have continued to work hard to meet the agreed Healthcheck standards with only one ward (1%)

of the total number of wards reported as red in August (L23, Head and Neck). Documentation

masterclasses, support from the informatics team with edocs and a leadership buddy system has been put

in place to enable the team to work towards improving their scores and moving out of escalation.

Chart 2

3.2 Summary of Actions being Taken

From July 2018 CHPPD to be published by NHSi and on the Trust intranet pages, rather than

staffing fill rates.

All inpatient areas have reviewed their staffing establishments and skill mix to be able to articulate

the optimum, current and minimum safe staffing levels.

Monthly combined Staffing and Healthcheck data to be discussed by Professional Practice &

Safety Standards and Workforce & Education teams, any trends/risks identified and escalated to

Professor Suzanne Hinchliffe (Chief Nurse / Deputy Chief Executive).

Share Staffing & Healthcheck information with CSU’s to discuss at local governance meetings.

The ‘Act on Amber’ programme has been rolled out across all areas to help wards move from

amber to green.

The first ‘bundle’ of nursing edocumentation is being rolled out across all wards as part of a

phased implementation programme. The bundle includes the falls assessment and evaluation

form, Bristol stool chart and Purpose T (pressure ulcers). Alongside this the Nutritional Screening

tool has been released and the eNSA is in pilot.

The Villa Care wards are adopting LTHT nursing paperwork across their wards, this is being

phased in and there is a mix of electronic and paper documents at present. This will be mutually

beneficial, preventing duplication and will enable patients to be transferred between service

providers using standardised documents. The Clinical Support Team are supporting this

introduction using QI and Leeds Improvement Methodologies.

0%10%20%30%40%50%60%70%80%90%

100%

Jun-18 Jul-18 Aug-18

Jun-18 Jul-18 Aug-18

Red 1% 2% 1%

Amber 15% 10% 16%

Green 84% 88% 83%

RAG Rated Metrics Scores 2018/2019

Agenda Item 12.6

6

4. Publication Under Freedom of Information Act

This paper has been made available under the Freedom of Information Act 2000.

5. Recommendations

Trust Board is asked to:

Receive this report and note the Nurse Staffing and Healthcheck data for July and August2018.

Note developments relating to workforce and the ward Healthcheck.

Lorna Johnson Head of Nursing, Professional Practice Safety Standards Heather McClelland Head of Nursing Workforce and Education 13th September 2018

Agenda Item 12.6

7

Appendix 1

Nurse Staffing Return (Hard Truths)

The Trust reports staffing numbers to NHS England via a monthly Nurse Staffing Return (Hard Truths) for

87 inpatient areas. This report details the monthly staffing hours within a clinical area against their

planned. CHPPD data is recorded within the same report (Appendix 2)

Figure 1 presents the Trust wide planned against actual staffing (fill rate)

Figure 2 depicts the percentage of areas where actual staffing hours available fell below 80% of staffing

hours planned on the roster, this is the threshold established by NHS Improvement.

Figure 2 - Wards triggering < 80% staffing against planned

Data source: LTHT Workforce Intelligence

Table 1 (below) represents the integrated Nurse Staffing Return inclusive of CHPPD for the individual

areas and the overall score on Healthcheck for June 2018. The data includes, Falls Pressure Ulcer and

Harm Free Care data as collected through Safety Thermometer.

Day Registered Day Care staff Night Registered Night Care staff Total wards % of wards

Jul-17 8 4 4 2 14 15.9%

Aug-17 9 1 8 0 17 19.1%

Sep-17 11 0 9 0 19 21.6%

Oct-17 12 1 12 0 21 23.9%

Nov-17 4 1 4 0 8 9.0%

Dec-17 1 1 5 1 8 9.0%

Jan-18 4 5 6 1 14 16.1%

Feb-18 2 2 6 0 10 11.5%

Mar-18 3 1 11 2 17 19.5%

Apr-18 1 0 7 1 9 10.3%

May-18 0 0 7 0 7 8.0%

Jun-18 2 3 5 2 11 12.6%

Jul-18 2 2 12 0 14 15.9%

Aug-18 4 3 12 1 17 19.3%

Summary of the wards triggering <80% Staffing Fill Rates

Agenda Item 12.6

8

Table 1 Integrated data

Metrics

CSU Ward name

Average

fill rate -

registere

Average

fill rate -

care staff

Average

fill rate -

registere

Average

fill rate -

care staff

Registered

StaffCare Staff Overall

Healthcheck

ScoresFalls

Pressure

Ulcers

New

Harm

Free

J42 Urology 89.5% 113.9% 102.3% 107.0% 2.6 2.9 5.5 99.0% 5 100.0%

J43 Short Stay

Surgery80.0% 101.7% 108.9% 108.4%

98.7% 100.0%

J44 General Surgery 85.2% 110.1% 68.7% 137.2% 2.4 4.5 6.9 98.4% 3 100.0%

J45 General Surgery 87.4% 107.5% 67.7% 97.8% 2.6 4.0 6.6 85.8% 2 0 100.0%

J46 Colorectal

Surgery95.7% 99.7% 102.1% 107.5% 2.5 3.3 5.8

98.9% 3 2 100.0%

J47 Colorectal

Surgery91.7% 100.0% 100.8% 101.6% 3.1 4.3 7.4

97.1% 1 100.0%

J49 Renal Medicine

Male95.5% 104.7% 100.0% 123.0% 2.7 3.0 5.7

98.9% 2 100.0%

J50 Renal Medicine

Female100.6% 96.0% 101.8% 107.9% 2.8 2.9 5.7

96.4% 3 1 94.7%

J82 UGI & HPB

Surgery85.3% 88.8% 75.2% 105.5% 2.3 2.4 4.6

99.0% 1 1 96.9%

J91 Gastro 83.8% 99.2% 100.2% 116.3% 2.4 3.6 6.1 98.5% 2 100.0%

J92 Gastro 93.6% 102.3% 100.1% 107.4% 2.4 3.5 5.8 99.5% 3 1 100.0%

J83 Leeds Liver Unit 67.0% 83.9% 70.9% 169.6% 2.4 4.5 6.9 98.3% 0 100.0%

J54 Intensive Care

Ward88.7% 102.9% 86.6% 99.3% 25.6 3.8 29.3

93.0% 1 100.0%

J81 HDU 101.8% 84.0% 100.9% 94.4% 14.1 4.4 18.5 89.7% 1 3 100.0%

L3 ITU 102.7% 100.4% 100.4% 100.0% 26.3 4.9 31.2 99.1% 1 100.0%

L4 Cardiac ITU 95.6% 67.6% 93.6% 102.0% 23.1 2.6 25.7 97.5% 100.0%

L6 Neuro ICU 99.0% 98.4% 99.8% 97.8% 22.5 3.5 26.0 100.0% 0 100.0%

J10 Respiratory

Medicine85.8% 112.5% 85.1% 109.9% 4.5 4.5 9.0

88.8% 1 1 100.0%

J12 Respiratory

Medicine93.4% 112.3% 74.1% 151.3% 2.4 3.8 6.2

95.5% 4 100.0%

J6 Adult Cystic

Fibrosis84.1% 122.5% 100.0% 94.5% 6.0 3.3 9.2

98.0% 100.0%

J9 Respiratory

Medicine84.9% 100.7% 74.1% 146.2% 2.2 3.7 5.9

96.0% 0 1 100.0%

L14 Cardiology Day

Case115.1% 137.6% 117.6% 333.3%

1

L16 Cardiac Surgery 85.1% 104.9% 83.9% 163.1% 2.6 2.2 4.8 96.1% 3 1 100.0%

L18 Cardiology 82.0% 142.0% 106.8% 140.0% 1.9 4.6 6.5 94.1% 6 96.4%

L19 Cardiology 85.3% 128.8% 87.8% 100.1% 2.7 4.4 7.1 90.4% 3 0 100.0%

L20 CCU 98.0% 89.3% 93.9% - 8.4 2.1 10.5 93.5% 1 100.0%

C2

Dermatology/Rheum

atology

112.9% 116.8% 96.8% 120.0% 3.8 3.2 7.0

88.70% 4 100.0%

C1 Neuro

Rehabilitation105.0% 194.8% 100.0% 212.6% 3.2 5.6 8.8

95% 3 100.0%

C3 Orthopaedic

Centre135.8% 107.3% 102.1% 141.4% 6.0 3.2 9.2

95.50% 6 100.0%

W1 Day Unit, WGH 102.2% 116.3% - - -

L30 Childrens

Respiratory/Cystic

Fibrosis

80.7% 106.9% 87.4% 96.0% 7.5 4.1 11.6

98.1% 0 Exempt

L31 Childrens

Oncology86.3% 81.9% 99.5% 103.2% 14.6 2.6 17.3

96.6% Exempt

L40 Childrens General

Medicine100.3% 83.8% 94.6% 103.5% 6.8 2.1 8.9

98.4% Exempt

L41 Childrens Surgery 85.9% 95.2% 100.1% 99.9% 5.6 3.2 8.8 96.1% Exempt

L42 Paediatric

Surgery89.4% 103.0% 88.2% 93.3% 7.1 1.6 8.7

89.7% Exempt

L47 PICU 84.3% 98.9% 83.8% - 36.0 1.7 37.7 93.7% 0 Exempt

L48 Childrens HDU 92.6% 98.7% 89.9% 96.8% 16.0 6.5 22.5 94.4% -

L51 Childrens Cardiac

Surgery95.0% 84.3% 98.4% - 36.0 1.7 37.7

97.5% Exempt

L52 Childrens

Neurosciences95.0% 98.9% 100.0% 116.0% 16.0 6.5 22.5

94.1% Exempt

Transitional Care -

SJH104.0% 89.0% 112.0% 58.0% 21.5 10.1 31.6

100.0%

L9 Childrens Medicine 95.5% 90.0% 89.8% 89.8% 15.2 5.0 20.290.1% Exempt

J1 Neonatal Unit 105.8% 96.2% 101.7% 100.6% 7.1 1.3 8.3 94.30% Exempt

L43 Neonatal Unit 81.1% 119.4% 85.1% 85.0% 15.6 0.8 16.4 99.4% Exempt

L50 Childrens Liver &

Renal93.3% 126.0% 92.8% 95.2% 6.2 3.1 9.2

98.7% Exempt

Patient SafetyDay Night CHPPD

A M & S

Adult

Critical Care

Cardio-

Respiratory

Childrens

Chapel

Allerton

Agenda Item 12.6

9

Metrics

CSU Ward name

Average

fill rate -

registere

Average

fill rate -

care staff

Average

fill rate -

registere

Average

fill rate -

care staff

Registered

StaffCare Staff Overall

Healthcheck

ScoresFalls

Pressure

Ulcers

New

Harm

Free

J14 Older Peoples

Services87.0% 113.9% 56.0% 108.8% 1.4 6.2 7.6

82.7% 9 100.0%

J15 Older Peoples

Services80.6% 176.3% 94.1% 127.0% 1.8 4.0 5.8

91.3% 8 7 100.0%

J17 Older Peoples

Services80.7% 111.3% 97.3% 122.8% 2.1 3.5 5.5

100.0% 4 100.0%

J19 Acute Medicine 92.0% 115.5% 101.6% 105.0% 1.8 3.8 5.6 95.7% 5 1 93.1%

J20 Infection & Travel

Medicine101.7% 103.9% 93.2% 117.4% 2.5 2.8 5.3

95.2% 9 94.1%

J21 Acute Medicine 80.0% 118.0% 97.5% 118.0% 1.6 3.6 5.2 96.1% 1 0 100.0%

J26 Medical

Admissions Unit125.0% 116.3% 152.0% 148.1% 3.0 5.1 8.0

97.5% 7 1 100.0%

J27 General

Admissions93.5% 93.2% 97.0% 129.2% 2.6 4.2 6.8

93.2% 4 100.0%

J28 Elderly Short Stay

And Assessment81.3% 92.0% 73.0% 163.0% 2.3 5.1 7.4

84.5% 10 1 100.0%

J29 Elderly

Admissions74.9% 101.1% 72.0% 150.0% 2.1 4.5 6.6

95.3% 3 1 100.0%

J7 Older Peoples

Services122.0% 109.5% 100.1% 140.0% 1.8 3.1 4.9

89.6% 4 1 100.0%

J8 Older Peoples

Services116.0% 190.0% 96.7% 118.7% 1.7 3.3 5.0

91.6% 4 1 100.0%

J16 Medical

Discharge88.6% 102.3% 69.0% 97.5% 2.6 2.2 4.8

96.4% 6 100.0%

Head &

NeckL23 ENT/Spines 88.5% 101.8% 98.4% 104.4% 2.8 3.4 6.2

77.7% 0 0 100.0%

L12 Stroke Rehab 84.3% 98.7% 96.9% 109.6% 2.8 3.1 5.9 96.3% 5 0 96.3%

L21 Acute Stroke Unit 82.1% 124.5% 93.7% 164.6% 4.6 7.3 12.092.5% 5 1 100.0%

L10 Major Trauma

Ward87.0% 111.2% 101.9% 118.8% 5.5 9.6 15.0

100.0% 3 1 100.0%

L24 Neuro/Spines 82.7% 161.2% 90.3% 285.0% 2.6 4.6 7.2 93.9% 3 0 100.0%

L25 Neuro/Spines 91.6% 125.0% 84.8% 167.3% 3.0 4.7 7.7 93.8% 3 2 96.8%

L17 Neurology 81.1% 162.3% 96.8% 136.4% 2.6 3.9 6.5 96.3% 2 95.5%

L28 Surgical Day Unit 131.4% 119.7% 206.2% 1083.3% 91.2% 2 100.0%

J84 Thoracic Surgery 92.5% 132.2% 84.7% 115.0% 4.2 3.3 7.5 86.7% 3 2 100.0%

J88 Haematology 87.4% 114.0% 98.3% 113.0% 3.1 2.6 5.7 99.1% 4 1 100.0%

J89 Haematology

BMTU84.0% 106.4% 80.0% 219.7% 4.1 2.4 6.5

100.0% 100.0%

J93 Oncology 82.3% 114.3% 98.4% 141.0% 2.7 3.1 5.8 94.7% 7 1 95.2%

J94 Young Adults Unit 93.5% 97.1% 93.0% - 6.0 1.7 7.794.7% 0 100.0%

J96 Oncology

Assessment80.2% 101.8% 82.7% 112.9% 3.6 3.0 6.6

94.7% 2 100.0%

J97 Oncology 105.3% 112.6% 100.0% 148.3% 2.7 2.9 5.5 97.6% 6 1 100.0%

J98 Gynaecology 129.0% 122.6% 124.8% 290.2% 2.6 2.8 5.4 89.4% 2 0 100.0%

J23 Breast Surgery 80.7% 113.2% 7610.0% 104.0% 6.7 7.0 13.7 92.3% 1 100.0%

TheatresDavid Beevers Day

Unit - SJH82.3% 71.0% 106.0% 113.3%

0

L15 Vascular 89.0% 129.6% 80.7% 146.0% 2.4 4.6 7.0 95.9% 3 5 100.0%

L35 Orthopaedic

Trauma/Vascular76.0% 76.5% 91.9% 88.1% 2.1 4.5 6.6

98.2% 5 100.0%

L37 Female Trauma

Orthopaedics79.0% 95.8% 93.1% 107.0% 2.2 4.2 6.4

85.9% 3 0 100.0%

L22 Plastics 82.5% 83.7% 94.9% 97.0% 3.8 5.4 9.2 89.5% 2 100.0%

L34 Orthopaedic

Trauma83.6% 119.0% 100.4% 121.4% 2.4 4.8 7.2

93.8% 3 1 100.0%

L8 Orthoplastic HDU 96.3% 90.1% 74.0% 91.0% 10.0 6.4 16.5 94.7% 1 1 100.0%

J24 Gynaecology 99.8% 179.3% 171.6% 175.2% 0

J5 Obstetrics 80.6% 91.1% 69.9% 106.5% 3.5 3.1 6.6 88.5% 100.0%

L36 Maternity 88.4% 95.7% 81.6% 108.4% 2.7 2.2 4.9 97.0% 100.0%

L44 Maternity 80.8% 112.7% 82.0% 93.5% 9.7 4.2 13.9 96.4% 100.0%

J3 Delivery Suite 81.9% 88.0% 89.8% 82.2% 28.6 6.0 34.7 94.6 100.0%

J4 Ante Natal 89.7% 99.8% 100.4% 80.6% 9.6 4.1 13.7 98.4 100.0%

L45 Delivery Suite 91.4% 98.0% 87.0% 101.6% 25.8 5.8 31.6 92.5% 1005.0%

Patient SafetyDay Night CHPPD

Womens

Oncology

T & R S

E & S M

Neuro

sciences

Agenda Item 12.6

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Appendix 2

Care Hours per Patient Day (CHPPD)

CHPPD is calculated using actual registered and unregistered staffing alongside ward activity (bed

occupancy at midnight). This generates the number of hours of care available for patients per day. David

Beevers Day Unit, J43, L14, L28 and W1 have been excluded as they do not have beds open consistently

at 12 midnight consistently over 7 days

Figure 3 CHPPD - Trust level data

The data in Tables 1 and 2 does show variation in CHPPD which is caused by a number of factors

including:

Acuity and dependency

Enhanced care support is not captured on planned staffing templates

Units that reduce base bed at night

Bed occupancy (activity) data is based on PAS information of which is not always consistently

updated

Table 2 CHPPD – June 2018

CSU Mean CHPPD Range Comments

Abdominal Medicine & Surgery 6.1 ↑ 4.6-7.4

Emergency and Specialist Medicine 6.0 → 4.8-8.0

Adult Critical Care 26.1→ 18.5-31.2 Includes HDU and ICU

CAH 8.3↑ 6.8-12.0

Cardio-Respiratory 7.4 → 4.8-10.5 Inc. CCU and RCU

Agenda Item 12.6

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Children’s 18.7↑ 8.3-37.7 Inc. PICU and Neonates

Head & Neck 6.2→

Institute of Neurosciences 9.7↑ 6.5-15.0

Oncology 6.3↓ 5.4-7.7

Trauma & Related Services 8.8→ 6.4-16.5 Inc. HDU

Women’s 17.6 ↓ 4.9-34.7 Inc. Delivery Suites

(HDU – High Dependency Unit, ICU – Intensive Care Unit, , CCU – Coronary Care Unit, PICU – Paediatric

Intensive Care Unit)

Arrows indicate the movement in CHPPD since the previous report. In general the data is relatively stable

month on month. At CSU-level the data is skewed by the inclusion of HDU and ICU areas, with high

patient care requirements. The workforce team are currently reviewing the metrics available in the

workforce dashboard; CHPPD will be reported as part of this in the future. In the interim, the data has

been correlated with ward metric data to identify any trends (Table 1). No correlation has been identified

between CHPPD and Healthcheck information.

Agenda Item 12.6

12

Appendix 3 - Overall Healthmetrics Score April to June 2018 by Question Group

Table 5

Aug-18

Question Group

Abdominal Medicine

and Surgery

Adult Critical Care

Cardio- Respiratory

Centre for Neurosciences

Chapel Allerton Hospital Childrens

Emergency and

Specialty Medicine

Head & Neck

Institute of Oncology

Trauma and

Related Services Womens Theatres ED OPD

Medicines Management 87.1% 86.4% 93.7% 91.8% 95.8% 94.5% 92.9% 80.0% 87.8% 81.1% 84.8% 97.4% 82.9% 97.0% Patient Observations 96.7% 98.5% 96.6% 96.2% 97.8% 96.8% 97.7% 83.3% 99.3% 95.2% 98.9% 96.7% 95.8% Falls Assessment 96.9% 97.6% 93.6% 89.6% 87.7% 99.4% 92.8% 78.6% 99.4% 96.3% 100.0% N/A 100.0% Infection Prevention 95.2% 96.4% 90.2% 89.1% 100.0% 97.6% 91.7% 90.0% 97.0% 89.5% 92.1% 90.9% 96.0% 100.0% Pressure Area Care 92.9% 95.0% 88.9% 97.1% 91.9% 85.4% 85.9% 63.6% 94.8% 90.2% 97.7% 98.3% 100.0% Continence 91.7% 98.8% 90.0% 92.6% 100.0% 96.3% 84.6% 100.0% 100.0% 96.7% 100.0% Nutrition 96.4% 98.4% 91.8% 90.4% 98.4% 96.3% 82.1% 90.5% 91.4% 83.2% 100.0% Hydration 91.9% 96.1% 88.3% 94.2% 100.0% 96.7% 79.7% 75.0% 92.0% 98.1% 83.3% Pain Management 96.0% 98.2% 100.0% 95.3% 100.0% 99.0% 98.9% 100.0% 97.6% 96.6% 97.6% 100.0% Patient Dignity 98.8% 97.9% 97.4% 96.7% 97.3% 97.9% 98.9% 96.0% 98.1% 100.0% 94.7% 94.6% 87.1% 99.7% Discharge 96.1% 90.9% 78.3% 82.5% 92.7% 82.1% 96.3% 90.0% 85.3% 87.2% 100.0% N/A 40.0% NA Documentation 97.2% 93.6% 88.2% 83.9% 76.0% 91.2% 90.8% 76.0% 95.6% 93.3% 99.3% 93.0% NA 97.5% Emergency Equipment 97.9% 100.0% 84.4% 94.7% 88.9% 91.4% 95.8% 66.7% 82.4% 92.3% 66.7% 89.2% 66.7% 96.2% Patient Identification 97.7% 100.0% 98.2% 100.0% 100.0% 88.0% 97.1% 100.0% 98.3% 97.8% 97.6% Magnetic Symbols 100.0% 100.0% 71.4% 66.7% 100.0% 50.0% 93.3% 100.0% 77.8% 85.7% - Controlled Medicines 93.0% 93.8% Transfer From Theatre 98.6% Theatre Safety 92.5% Medicine Prescribing Outpatient Prescription 99.6% Environment 91.4% Information Governance 98.1%

Question Group

Abdominal Medicine

and Surgery

Adult Critical Care

Cardio- Respiratory

Centre for Neurosciences

Chapel Allerton Hospital Childrens

Emergency and

Specialty Medicine

Head & Neck

Institute of Oncology

Trauma and

Related Services Womens Theatres ED OPD

Medicines Management 96.1% 93.8% 85.7% 95.2% 75.0% 94.6% 87.8% 75.0% 97.1% 95.8% 66.7% 94.9% 100.0% 97.0% Patient Observations 92.8% 93.4% 97.4% 98.0% 96.0% 95.2% 90.1% 28.6% 95.7% 93.3% 85.0% 97.6% 100.0% Falls Assessment 95.6% 89.2% 95.0% 86.5% 88.9% 87.7% 91.4% 88.9% 91.1% 93.5% 76.9% N/A 100.0% Infection Prevention 99.1% 100.0% 98.9% 99.3% 100.0% 98.8% 98.4% 100.0% 98.6% 99.4% 93.3% 87.0% 98.0% 99.5% Pressure Area Care 100.0% 98.7% 100.0% 86.0% 96.4% 97.7% 88.7% 88.9% 94.8% 96.7% 96.9% 91.9% 83.3% Continence 94.7% 100.0% 86.6% 94.5% 100.0% 90.2% 95.4% 90.9% 90.7% 94.3% 100.0% Nutrition 98.4% 98.8% 96.1% 97.7% 95.4% 98.2% 96.4% 71.4% 98.3% 93.5% 100.0% Hydration 96.6% 96.7% 90.5% 91.0% 93.4% 96.6% 87.2% 78.3% 94.7% 89.0% 100.0% Pain Management 98.2% 99.1% 99.3% 99.2% 91.3% 99.0% 97.5% 95.5% 98.7% 98.1% 99.1% 100.0% Patient Dignity 94.1% 90.6% 96.6% 92.9% 92.0% 96.4% 98.0% 72.7% 96.2% 98.2% 97.9% 91.5% 100.0% 98.8% Discharge 98.8% 98.3% 92.3% 97.7% 92.7% 95.8% 90.1% 41.7% 97.7% 85.2% 92.1% N/A NA NA Documentation 96.2% 92.7% 89.7% 86.0% 81.3% 95.1% 91.7% 76.0% 88.8% 92.6% 98.6% 92.4% NA 99.4% Emergency Equipment 100.0% 100.0% 42.9% 100.0% 100.0% 81.8% 93.3% 100.0% 88.9% 100.0% 50.0% 89.2% 66.7% 96.2% Patient Identification 99.0% 100.0% 96.4% 97.6% 100.0% 97.2% 98.1% 71.4% 98.4% 95.8% 100.0% Magnetic Symbols 98.5% 94.2% 89.7% 93.1% 96.3% 95.3% 82.0% 63.6% 91.5% 94.5% 100.0% Controlled Medicines 90.8% 93.8% Transfer From Theatre 97.3% Theatre Safety 90.5% Medicine Prescribing Outpatient Prescription NA Environment 93.8% Information Governance 97.3%

N/A

N/A N/A N/A

N/A N/A

N/A Incorporated into Medicines Management Standard Only Applicable to Theatres N/A

Only Applicable to Out-Patients

Only Applicable to Out-Patients

N/A

N/A

N/A Incorporated into Medicines Management Standard

N/A

N/A N/A

N/A

Only Applicable to Theatres N/A

Jul-18

Agenda Item 12.6

13

Appendix 4: Accumulated Metrics Score by Trust and CSU April - June 2018

Table 6

H

ealthch

eck G

oal