Agenda Item 12.5

1

Integrated Healthcheck and Staffing Update

Public Board

30th November 2017

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

Key points

1. Healthcheck outcomes for August and September 2017

alongside nurse staffing information For Information

2. 4th consecutive month no red wards (score < 80%) For Information

3. Although wards were in escalation in August and September all were in first stage

For Information

4. Merger Acute Medicine and Urgent Care CSU has resulted in subsequent merger of all related Healthcheck data

For Information

5. Heather and Bilberry Wards at Wharfdale have modified monthly metrics

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 12.5

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1. Summary

This paper provides a review of Healthcheck and staffing data drawn from a number of sources for the period August and September 2017. It presents performance across a number of domains and considers this in the context of staffing, recruitment and ward/department performance within Healthcheck domains.

2. Background

Safe levels of nurse, midwifery and perioperative staffing are essential for the delivery of high quality nursing care. Within Leeds Teaching Hospitals Trust (LTHT), nurse establishments are calculated using a range of data as recommended in national guidance (NICE, 2014), including acuity/dependency, nurse: patient ratios, and professional judgement. Staffing information is reported nationally, weekly and monthly it incorporates both substantive LTHT staff and additional temporary staff (bank and agency).

The Ward Healthcheck has been rolled out incrementally since December 2013. It 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. Data for all areas is displayed in ward areas on standardised Patient Safety Boards and is visible to staff, patients and visitors.

3. Nursing and Midwifery Staffing

Since May 2016 LTHT has submitted workforce data to NHS Improvement (NHSI) for nursing and midwifery areas on;

Nurse Staffing Return (Hard Truths) - planned vs. actual registered and unregistered nurse staffing levels (section 3.1 and Appendix 1) - monthly

Care Hours Per Patient Day (CHPPD) submitted monthly alongside Hard Truths (section 3.2 and Appendix 2) - monthly

Temporary workforce - Bank and Agency fill rates and pay rate breaches - weekly.

3.1 Nurse Staffing Return (Hard Truths) - (see Appendix 1)

Reported levels for nurse staffing are based on the staffing levels achieved throughout the month against what was planned for that area. Data is extracted from e-roster for the included clinical areas and is validated by corporate and clinical teams. Figure 1 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. Seventeen (19.1%) and nineteen (21.6%) clinical areas reported staffing levels lower than the 80% threshold in August and September respectively.

The 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

In August and September, newly qualified starters, who are employed into Band 3 positions whilst awaiting registration with the NMC/HCPC, add to the unregistered count. The quality of reported data is dependent on:

The shift templates being up-to-date against budgeted establishments - this determines the plan.

Ward mangers updating the roster to reflect the day to day staffing- this is the actual . To date, 74% of the Healthroster templates have been updated in line with the 17/18 budgeted establishments with actions plans in place for those with outstanding reviews. To mitigate the risk to patients, nurse staffing is reviewed daily at the Operational meeting, and actions agreed, including:

proactively sending shifts to be filled by bank and agency workers,

Agenda Item 12.5

3

CSU staff being moved between clinical areas to meet 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

3.2 Care Hours per Patient Day (CHPPD)- (See Appendix 2)

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 presents ward level CHPPD –split by registered and unregistered staff and the combined total. Appendix 2 (Table 2) provides the CHPPD data for September 2017, showing both the mean and range of data for each CSU. Data is consistent with previous months. No national guidance on best practice CHPPD levels is currently available.

3.3 Clinical Service Units (CSU) Specific Staffing Issues

CSUs that continue to have registered nurse staffing pressures include:

Cardio-Respiratory

Emergency and Specialist Medicine

Institute of Neurosciences

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. Many of the areas are hard to recruit to nationally (complex medicine and orthopaedics), have high levels of acuity and dependency, or are areas that require highly specialist skills.

Actions taken to mitigate against vacancy gaps include:

Use of temporary staffing

Use of incentives to increase uptake of temporary staffing shifts

Implementing specialist training and preceptorship packages to attract staff and engage staff early in their development

Proactive recruitment, including presence at local and national events

Working with CSUs to develop incentives for recruitment and to review skill mix.

4. Ward Healthcheck

The ward Healthcheck is now undertaken in all adult and paediatric in-patient areas including Theatres, PACU and Emergency Departments. In recent months Bilberry and Heather Units at Wharfdale have been audited monthly as part of the Healthcheck. These wards are staffed by the Independent provider Villa Care. The questions and assessment for these wards have been modified to allow for different practices and documentation used by the Villa Care Team, however the expectation relating to outcomes remains the same as the wards managed by LTHT staff.

The ward Healthcheck for in-patient areas has an escalation process comprising of six KPI’s; Core Metrics, Friends and Family Test (response rates), Patient Experience, Staff Sickness, Safety Thermometer and Health Care Associated Infections (HCAI). The progressive escalation process (stage 1 - 4) is associated with these domains, with a focus of resolution at CSU level. Some wards progress beyond initial stages of escalation and they will have formal review meetings with the Corporate Operations Team. The final stage of the escalation process is an Executive Director led review.

Assurance visits, which encompass the key lines of enquiry used by the CQC, can be undertaken at any point and can be triggered by CSUs and/or Corporate Teams. These visits are undertaken by the Corporate Nursing Team who provide independent review and support with recommended areas for improvement or change. Visit feedback is within 5 working days (but usually sooner) with a visit summary also presented at the weekly Quality Meeting chaired by the Chief Medical Officer or Chief Nurse.

Agenda Item 12.5

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There are 91 in-patient wards included in the healthcare Healthcheck. The number of wards in escalation varies month on month (see Chart 1). The last 3 months has seen 11 wards in escalation. 3 wards are triggering 1st Stage escalation in September 2017 (J54, C03, J96). Staff sickness is a trigger for all 4 wards in escalation (threshold for sickness escalation is sickness more than 4%).

Chart 1

4.1 Clinical standards - Metrics

Heathcheck monthly audit programme focusses on processes at ward/department level for identifying and managing risk of harm rather than outcome (incidence of harm). There are 11 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 standards 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 metrics score by question group. August and September 2017 have shown some improvement particularly around positive identification of patients and resuscitation checks. A focus on processes for discharge and standards for documentation continue to be themes for improvement.

Appendix 4 (Table 6) highlights the overall score by Trust and CSU level. Some CSUs have worked hard engaging ward teams to improve performance across all the standards. Head and Neck and Chapel Allerton saw a drop in their standards for the months of August and September 2017. Data analysis suggested the wards needed to focus on assessment and documentation, particularly for observations. This was fed back to the teams, who have put action plans in place and will be monitored.

Review of the CSU’s with lower than 80% in the reported CHPPD (Appendix 1 Table 1) do not show a clear correlation between shortfalls in nurse staffing with a deterioration in reported metrics scores. The monthly Healthcheck scores over a 4 month period for these wards (Chart 2) show small percentage change which is normal statistical variation. Staffing and sickness maybe a contributing factor to this. Indeed the majority of wards have maintained or improved their Healthcheck scores.

0

1

2

3

4

5

6

May-17 Jun-17 Jul-17 Aug-17 Sep-17

Nu

mb

er

of

War

ds

May-17 Jun-17 Jul-17 Aug-17 Sep-17

No. of Wards 1 0 3 5 3

Number of Wards in Escalation May - September 2017

Agenda Item 12.5

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Ward June-17 July-17 Aug-17 Sept-17

J08 95.1 88.1 94.2 97.9

J14 96.7 95.8 94.6 98.9

J16 91.3 92.2 87.7 94.8

J17 88.9 85.2 87.2 89.3

J19 97.2 97.2* 96.9 96.9*

J21 98.9 97.1 92.0 91.0

J46 97.7 97.7* 95.4 95.4*

J82 97.5 89.4 92.9 84.3

J83 81.1 80.7 84.5 92.8

J92 97.3 97.3* 98.8 98.8*

L37 98.5 98.5* 99.5 99.5*

Chart 2

(* wards on bi-monthly Healthcheck audits)

There are a number of wards being supported by the Clinical Support Team. Overall there has been improvement across the Healthcheck and support continues in areas where there are specific concerns escalated by the CSU or by the Executive Team.

Chart 3 shows for the 4th consecutive month no wards have scored less than 80% in compliance with the agreed standards of the Healthcheck.

Chart 3

Apr 2017 May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017

Red 1% 2% 0% 0% 0% 0%

Amber 24% 18% 12% 22% 26% 13%

Green 75% 80% 88% 78% 74% 87%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pe

rce

nta

ge

RAG rated Healthcheck Scores

Agenda Item 12.5

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Summary of actions being taken:

Roster Template review –workforce systems are working with outstanding areas on their action plans to finalise this review.

CSU level reviews of workforce to identify opportunities for service development

Workforce metrics are under review to enhance ward to board visibility of key workforce indicators.

Monthly combined Staffing and Healthcheck data to be discussed by Professional Practice & Safety Standards and Workforce & Education teams, any trends/risks identified and escalated.

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

Proactive work with wards with low amber scores in the Healthcheck to help them recognise and achieve improvement.

Professional Practice and Clinical Standards team working closely with Villa Care team at Wharfdale to create adapted metrics which are now displayed on the dashboard. Once the Villa Care team are established on J30 and J31 the metrics standards will be applied to these areas as well.

QI work in Falls, Deteriorating Patient, Pressure Ulcer Reduction, Sepsis, Parkinson’s Disease, Infection Prevention and Enhanced Care continues.

Celebration programme has been agreed to recognise those wards that are consistently performing well in the Healthcheck audit. The programme commences in October 2017 and is a pre-cursor to an accreditation scheme

Healthcheck audit questions have been revised and updated with speciality colleagues ahead of sign off by Heads of Nursing.

Auditors completing the Healthcheck audit data collection changed in October 2017. The change provides impartiality and objectivity to the monthly Healthcheck.

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 Hard Truths and Healthcheck data for August and September 2017.

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 1st November 2017

Agenda Item 12.5

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

88 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 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 1 - Wards triggering < 80% staffing against planned

Data source: LTHT Workforce Intelligence

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%Percentage of wards reporting

Agenda Item 12.5

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Table 1 represents the Nurse Staffing Return inclusive of CHPPD for the individual areas and the overall

score on Healthcheck for September 2017. The data has been RAG rated, red data indicates less than

80% of planned staffing. Amber rated data is that where staffing is reported as over 130% of the planned.

Amber areas

Table 1– Ward Level Combined Staffing and Healthcheck Information

CSU Ward name

Average fill rate -

registered

nurses/midwive

s (%)

Average fill rate -

care staff (%)

Average fill rate -

registered

nurses/midwive

s (%)

Average fill rate

- care staff (%)

Cumulative

count over the

month of

patients at 23:59

each day

Registered

midwives/

nurses

Care Staff OverallWard

Healthcheck

J42 Urology 88.9% 103.9% 112.1% 96.9% 821 2.4 2.5 4.9 98.3%

J43 Short Stay Surgery 80.3% 99.5% 111.7% 114.3% 452 3.3 3.0 6.3 97.5%

J44 General Surgery 82.4% 108.0% 113.5% 100.0% 795 2.3 2.7 5.0 93.2%

J45 General Surgery 84.3% 103.3% 93.8% 137.7% 718 2.5 3.4 5.9 87.7%

J46 Colorectal Surgery 75.0% 132.9% 96.8% 173.3% 743 2.3 3.4 5.6 95.4%

J47 Colorectal Surgery 86.2% 93.8% 103.8% 105.4% 644 2.9 3.1 6.1 90.3%

J49 Renal Medicine Male 115.5% 127.2% 100.0% 150.0% 617 2.7 3.2 5.9 96.9%

J50 Renal Medicine Female 91.0% 113.3% 100.0% 104.9% 590 2.8 2.8 5.6 98.1%

J82 UGI & HPB Surgery 75.8% 116.7% 73.3% 104.4% 937 2.2 2.6 4.7 84.3%

J83 Leeds Liver Unit 75.4% 107.1% 73.6% 106.6% 839 2.5 2.9 5.3 92.8%

J91 Gastro 80.8% 93.3% 100.0% 97.0% 685 2.6 2.6 5.1 95.1%

J92 Gastro 75.0% 98.9% 101.3% 96.6% 720 2.5 2.4 4.9 98.8%

J7 Older Peoples Services 85.3% 172.3% 98.3% 192.7% 963 1.6 3.2 4.8 91.3%

J8 Older Peoples Services 72.2% 244.1% 101.8% 207.4% 877 1.6 3.8 5.4 97.9%

J14 Older Peoples Services 75.5% 90.4% 103.3% 165.5% 736 1.1 5.2 6.3 98.9%

J15 Older Peoples Services 86.4% 151.8% 93.3% 170.9% 828 1.7 3.3 5.0 83.4%

J16 Medical Discharge 67.7% 183.8% 113.3% 151.1% 641 1.4 5.1 6.5 94.8%

J17 Older Peoples Services 72.4% 162.2% 98.6% 185.4% 757 1.9 3.9 5.8 89.3%

J19 Acute Medicine 72.6% 127.6% 98.5% 155.8% 823 2.0 3.8 5.8 96.9%

J20 Infection & Travel Medicine 88.4% 123.6% 93.2% 154.0% 502 2.7 2.6 5.3 100.0%

J21 Acute Medicine 59.1% 165.8% 96.8% 130.4% 840 1.8 3.6 5.4 91.0%

J26 Medical Admissionst 86.8% 122.7% 86.5% 173.9% 693 2.9 3.3 6.2 100.0%

J27 General Admissions 99.2% 103.8% 81.6% 116.3% 829 2.8 4.0 6.8 94.4%

J28 Elderly Short Stay 91.8% 104.7% 99.0% 113.6% 819 2.5 4.1 6.6 94.1%

J29 Elderly Admissions 89.7% 123.3% 88.5% 156.8% 823 2.5 3.8 6.3 84.5%

J30 Resilience Ward 100.0% 110.8% 100.0% 122.2% 995 1.4 3.0 4.4 94.0%

J54 Intensive Care Ward 105.4% 104.0% 104.3% 99.4% 415 27.5 3.3 30.8 97.1%

J81 HDU 100.2% 93.3% 99.7% 96.7% 303 15.0 4.9 20.0 97.2%

L3 ITU 108.6% 85.6% 101.3% 89.2% 198 29.3 4.3 33.6 100.0%

L4 Cardiac ITU 106.0% 120.1% 104.9% 109.5% 316 24.5 2.4 26.9 98.4%

L6 Neuro ICU 107.0% 110.7% 105.3% 103.5% 361 21.8 3.8 25.6 95.2%

C2 107.1% 111.0% 100.0% 100.0% 442 3.8 4.0 7.8 92.0%

C3 Orthopaedic Centre 130.4% 116.2% 105.6% 107.1% 648 6.1 3.3 9.5 84.1%

Ward 1 - WGH 115.3% 100.1% - -

J6 Adult Cystic Fibrosis 80.0% 106.9% 100.3% 97.4% 327 5.6 2.5 8.0 96.6%

J9 Respiratory Medicine 82.7% 131.8% 78.9% 148.8% 851 1.9 4.1 6.0 87.4%

J10 Respiratory Medicine 94.6% 135.8% 85.9% 127.4% 651 4.8 5.6 10.4 87.9%

J12 Respiratory Medicine 86.0% 102.5% 70.0% 137.8% 825 2.2 3.7 5.9 94.0%

L14 Cardiology Day Case 127.2% 120.7% 110.9% 100.0% 249 4.4 2.2 6.6

L16 Cardiac Surgery 85.7% 97.2% 80.6% 135.0% 805 2.7 1.9 4.6 96.5%

L18 Cardiology 82.0% 115.4% 72.0% 164.0% 816 2.4 4.1 6.5 92.7%

L19 Cardiology 92.0% 103.0% 99.9% 126.1% 724 3.0 3.5 6.5 94.9%

L20 CCU 89.9% 130.4% 80.2% 100.0% 263 7.1 2.7 9.9 97.4%

Day Night Care Hours Per Patient Day (CHPPD)

Safer Staffing Return & CHPPD September

2017

Adult Critical Care

C A H

Cardiorespiratory

A M & S

Emergency and

Specialist Medicine

Agenda Item 12.5

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CSU Ward name

Average fill rate -

registered

nurses/midwive

s (%)

Average fill rate -

care staff (%)

Average fill rate -

registered

nurses/midwive

s (%)

Average fill rate

- care staff (%)

Cumulative

count over the

month of

patients at 23:59

each day

Registered

midwives/

nurses

Care Staff OverallWard

Healthcheck

J1 Neonatal Unit 95.0% 99.7% 94.0% 81.1% 504 7.6 1.8 9.5 97.1%

L9 Childrens Medicine 116.1% 128.7% 117.5% 90.0% 316 12.7 3.7 16.4 94.8%

L30 Childrens Respiratory 96.6% 99.5% 100.0% 96.6% 256 8.4 3.5 11.9 97.4%

L31 Childrens Oncology 86.6% 94.0% 96.1% 105.1% 581 8.5 1.6 10.1 89.7%

L40 Childrens General Medicine 101.9% 97.0% 90.5% 100.0% 335 5.4 2.1 7.5 97.9%

L41 Childrens Surgery 93.3% 101.6% 93.0% 103.3% 309 5.2 2.9 8.1 91.4%

L42 Paediatric Surgery 105.0% 130.0% 81.1% 100.0% 457 5.6 1.8 7.4 95.8%

L43 Neonatal Unit 87.0% 109.1% 87.0% 133.3% 731 14.2 0.7 14.9 85.4%

L47 PICU 110.0% 98.0% 102.0% - 311 28.6 1.2 29.8 91.1%

L48 Childrens HDU 97.2% 129.8% 99.9% 120.0% 116 12.0 7.4 19.4 96.3%

L50 Childrens Gastro 108.0% 52.8% 91.6% 93.6% 300 6.6 2.8 9.4 94.2%

L51 Childrens Cardiac Surgery 95.8% 96.6% 85.8% 233.3% 338 8.4 1.8 10.3 96.7%

L52 Childrens Neurosciences 99.9% 118.9% 99.9% 100.0% 263 6.6 2.9 9.4 97.5%

Transitional Care - SJH 84.0% 101.9% 79.0% 102.3% 109 19.3 10.5 29.8 96.5%

Head & Neck L23 ENT/Spines 100.7% 102.2% 91.3% 100.0% 608 3.3 2.8 6.1 91.3%

C1 Neuro Rehabilitation 105.9% 183.8% 100.0% 303.9% 651 3.1 5.3 8.3 93.7%

L12 Stroke Rehab 104.1% 107.7% 100.0% 104.4% 826 2.6 2.7 5.4 98.3%

L17 Neurology 98.2% 119.2% 100.0% 150.0% 612 3.0 3.6 6.6 100.0%

L21 Acute Stroke Unit 82.7% 120.0% 90.5% 219.6% 882 3.5 5.2 8.7 99.4%

L24 Neuro/Spines 84.0% 121.6% 84.6% 186.9% 852 2.9 4.5 7.4 98.8%

L25 Neuro/Spines 91.0% 162.5% 90.0% 283.9% 883 2.9 5.2 8.1 91.9%

L28 Surgical Day Unit 100.3% 88.3% 80.0% 100.0%

J23 Breast Surgery 94.3% 123.8% 80.8% 100.0% 351 5.3 4.5 9.7 94.8%

J84 Thoracic Surgery 91.4% 125.1% 94.4% 124.3% 905 3.8 2.3 6.1 95.9%

J88 Haematology 84.8% 127.2% 100.0% 190.6% 587 3.0 2.5 5.5 93.3%

J89 Haematology BMTU 88.5% 91.7% 100.0% 101.7% 596 3.6 2.3 6.0 94.2%

J93 Oncology 80.5% 115.6% 100.0% 111.1% 708 2.2 2.4 4.6 86.3%

J94 Young Adults Unit 85.1% 104.0% 78.3% 100.0% 263 5.6 2.8 8.4 92.2%

J96 Oncology Assessment 81.3% 90.4% 72.2% 105.0% 576 3.4 2.7 6.1 93.8%

J97 Oncology 82.1% 117.2% 100.0% 116.2% 712 2.6 2.4 5.0 90.4%

J98 Gynaecology 108.5% 121.0% 100.0% 100.0% 724 2.4 2.3 4.8 94.6%

L8 Orthoplastic HDU 92.9% 108.6% 98.9% 118.2% 167 12.1 4.3 16.4 90.4%

L10 Major Trauma Ward 87.8% 112.2% 82.3% 104.4% 574 3.1 6.1 9.3 92.5%

L15 Vascular 99.2% 105.9% 106.6% 128.3% 749 2.3 3.8 6.0 90.8%

L22 Plastics 93.3% 119.4% 93.6% 146.6% 710 2.3 3.0 5.3 93.0%

L34 Orthopaedic Trauma 83.0% 83.4% 88.3% 109.8% 669 2.2 4.4 6.6 84.5%

L35 Orthopaedic Trauma/Vascular 80.0% 105.0% 101.7% 114.8% 829 2.1 3.6 5.8 98.9%

L37 Female Trauma Orthopaedics 79.0% 103.6% 99.0% 121.1% 794 2.1 4.0 6.1 99.5%

Theatres David Beevers Day Unit 88.3% 100.0% 75.0% 100.0%

J3 Delivery Suite 98.3% 95.4% 88.6% 94.3% 204 30.9 6.9 37.7 95.5%

J4 Ante Natal 93.6% 96.7% 100.1% 100.0% 291 9.7 4.1 13.8 94.6%

J5 Obstetrics 92.5% 87.5% 97.7% 96.5% 501 3.9 3.1 7.0 100.0%

L36 Maternity 104.3% 94.3% 93.2% 93.1% 555 4.3 2.8 7.2 96.4%

L44 Maternity 83.0% 100.0% 94.3% 105.9% 377 8.0 4.4 12.4 100.0%

L45 Delivery Suite 88.8% 84.1% 89.9% 108.6% 227 28.1 6.8 34.8 94.2%

Day Night Care Hours Per Patient Day (CHPPD)

T R S

Womens

Safer Staffing Return & CHPPD September

2017

Childrens

Neurosciences

Oncology

Agenda Item 12.5

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Appendix 2

Care Hours per Patient Day (CHPPD)

CHPPD is calculated using data collected for the Nurse Staffing Return. It is based on 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, L28 and W1 have been excluded

as they do not have beds open consistently at 12 midnight consistently over 7 days

The data in Table 1 above and 2 below does show variation 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 – September 2017

CSU Mean CHPPD Range Comments

Abdominal Medicine & Surgery 5.5 ↓ 4.7-6.3

Emergency and Specialist Medicine 5.8 ↑ 5.2-6.9

Adult Critical Care 27.4 ↑ 20-33.6 Includes HDU and ICU

CAH 8.6 ↑ 7.8-9.5

Cardio-Respiratory 7.1 ↓ 4.6-10.4 Inc. CCU and RCU

Children’s 13.8 ↓ 7.4-29.8 Inc. PICU and Neonates

Head & Neck 6.1 → 6.1

Institute of Neurosciences 7.4 ↑ 5.4-8.7

Oncology 6.2 ↓ 4.6-9.7

Trauma & Related Services 7.9 ↑ 5.3-16.4 Inc. HDU

Women’s 18.8 ↑ 7.0-37.7 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 12.5

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Appendix 3 - Overall Healthmetrics Score August and September 2017 by Question Group

Table 5

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

Medicines Management 94.5% 97.2% 94.0% 88.9% 100.0% 92.6% 93.0% 92.3% 95.6% 86.2% 93.3% 98.30%

Patient Observations 94.6% 100.0% 96.4% 96.2% 76.9% 98.7% 94.5% 87.0% 88.0% 89.2% 98.9% 90.40%

Falls Assessment 96.1% 98.7% 97.9% 92.8% 88.6% 98.2% 95.0% 100.0% 93.4% 98.3% 100.0% N/A

Infection Prevention 88.8% 96.4% 88.7% 92.9% 100.0% 95.3% 91.0% 50.0% 91.7% 96.6% 83.7% 93.00%

Pressure Area Care 99.3% 98.0% 95.6% 88.0% 67.6% 91.5% 90.3% 100.0% 91.9% 94.7% 87.9% 97.80%

Continence 96.4% 100.0% 98.1% 100.0% 100.0% 97.3% 96.7% 100.0% 100.0% 98.3% 100.0% N/A

Nutrition & Hydration Assessment 94.4% 97.8% 87.7% 96.7% 95.5% 97.3% 93.0% 100.0% 96.9% 92.0% N/A N/A

Pain Management 96.9% 100.0% 97.8% 100.0% 100.0% 97.2% 97.3% 100.0% 100.0% 98.7% 97.8% N/A

Patient Dignity 99.2% 97.4% 98.7% 99.2% 92.5% 97.3% 99.2% 100.0% 97.2% 94.0% 95.1% 93.30%

Discharge 88.0% 95.7% 93.3% 91.3% 86.4% 94.7% 93.4% 50.0% 83.3% 86.3% 100.0% N/A

Documentation 87.7% 91.0% 88.1% 94.1% 82.5% 91.7% 78.6% 95.0% 88.6% 81.7% 91.0% 88.00%

Resuscitation Equipment 92.3% 80.0% 87.5% 100.0% 100.0% 93.8% 93.8% 100.0% 100.0% 85.7% 66.7% 82.80%

Patient Identification 96.0% 88.9% 100.0% 100.0% 100.0% 100.0% 97.2% 100.0% 100.0% 100.0% 100.0% N/A

Magnetic Symbols 91.7% 80.0% 57.1% 83.3% 50.0% 75.0% 94.1% 0.0% 66.7% 71.4% N/A N/A

Transfer From Theatre 100%

Theatre Safety 90.50%

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

Medicines Management 92.3% 94.4% 94.3% 98.7% 95.5% 89.0% 92.1% 95.7% 91.9% 85.8% 90.5% 94.40%

Patient Observations 95.3% 100.0% 92.6% 98.2% 70.0% 96.8% 94.2% 100.0% 86.7% 93.3% 98.9% 92.90%

Falls Assessment 96.2% 98.7% 97.3% 94.4% 91.4% 96.0% 92.8% 76.9% 93.1% 97.5% N/A N/A

Infection Prevention 93.6% 96.4% 92.8% 97.6% 100.0% 92.5% 87.5% 85.7% 88.8% 90.0% 94.7% 94.00%

Pressure Area Care 93.6% 99.0% 93.1% 93.8% 83.9% 92.1% 91.3% 100.0% 99.2% 98.2% 87.9% 95.30%

Continence 100.0% 100.0% 94.8% 100.0% 100.0% 96.5% 95.6% 100.0% 97.0% 100.0% 100.0% N/A

Nutrition & Hydration Assessment 94.8% 97.9% 91.4% 97.0% 80.0% 97.2% 94.1% 100.0% 95.9% 94.0% 100.0% N/A

Pain Management 100.0% 100.0% 93.3% 100.0% 95.1% 97.3% 99.3% 100.0% 99.5% 98.1% 100.0% N/A

Patient Dignity 97.2% 100.0% 99.4% 99.1% 94.6% 96.3% 98.4% 95.0% 95.8% 96.4% 97.4% 96.00%

Discharge 85.8% 95.7% 88.8% 94.4% 77.3% 94.4% 95.2% 63.6% 86.2% 86.1% 100.0% N/A

Documentation 89.1% 91.0% 86.9% 95.7% 92.5% 91.9% 85.8% 85.0% 89.4% 85.0% 97.4% 94.60%

Resuscitation Equipment 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 93.8% 100.0% 90.0% 100.0% 83.3% 86.70%

Patient Identification 92.0% 88.9% 100.0% 100.0% 100.0% 93.5% 96.9% 100.0% 100.0% 100.0% 100.0% N/A

Magnetic Symbols 83.3% 100.0% 71.4% 66.7% 50.0% 75.0% 81.3% 0.0% 80.0% 42.9% N/A N/A

Transfer From Theatre 99%

Theatre Safety 85.10%

Only Applicable to Theatres

Aug-17

Sep-17

Only Applicable to Theatres

Agenda Item 12.5

12

Appendix 4: Accumulated Metrics Score by Trust and CSU June 2017 - Sept 2017

Table 6

H

ealthch

eck G

oal