Monthly Nurse Safer Staffing Report January / February 2018

Board of Directors

14 March 2018

Dr Shelley Dolan

Chief Nurse /Chief Operating Officer

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Monthly Nursing Report

Introduction Following the investigation into Mid Staffordshire NHS Trust, the resultant Francis report NHS England (NHSE) and NHS Improvement (NHSi) requested that all Trust Boards receive monthly reports on the levels of planned and actual nursing and care staff.

This report provides evidence to the Board on the Nursing and Midwifery and care staff levels across the Trust January / February 2018 and provides details of the actual hours of Nursing, Midwifery and Health Care Assistant (HCA) on day and night shifts versus planned staffing levels. Care Hours Per Patient Day (CHPPD) are also being collected as mandated by NHS England (2016) and are benchmarked with other London and Shelford Trusts when the data is available through the Model Hospital (NHSi).

To ensure that this data is more meaningful this report at Kings has from January 2017 included nurse staffing levels in the context of care provision. Each wards staffing levels including CHPPD is therefore provided in the context of “harm free care” and patient experience.

Background The international evidence demonstrates that the six critical issues for safe staffing and quality patient care and experience are the following:

1.Expert clinical leadership at Sister /Charge Nurse and Matron level

2.Appropriate skill mix for the acuity and dependency of the patient group

3.Appropriate establishment for the size / complexity of the unit

4.Ability to recruit the numbers required to fill the establishment

5.Good retention rates , ensuring staff are experienced in the clinical speciality and context / environment

6.Ability to flex at short notice to fill with temporary staff when there are unplanned vacancies / or to use staff from other areas.

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Red Shifts & Hotspots

Red Shifts

A red shift occurs when there is a shortfall in the expected numbers of staff to manage the acuity and dependency of the patients of a ward / department. There is a trust wide daily alert, which highlights red shifts which in turn enables senior nursing staff to support wards that are flagging as red.

In January 2018 there were 119 red shifts, however this increased in February 2018 to a total of 153, with 86 recorded at the Denmark Hill Site and 67 at the Princess Royal University Hospital.

Key metrics demonstrate that staffing challenges remain across all sites. The acuity and dependency of patients remains high with a corresponding demand for additional staff to support enhanced care needs.

‘Hotspot’ areas for nursing/midwifery staffing in January / February 2018

The aggregate nursing and midwifery vacancy rate has continued to fall, however a number of “hotspot” wards / units with higher vacancy rates remain.

The nursing hotspot areas :

DH: Medicine, Neonatal Intensive Care Unit, Neurosciences, Theatres and Emergency Department

PRUH: AMU, Medicine, Surgery and Emergency Department.

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Nursing & Midwifery Vacancy and Turnover

• The graph below outlines the annual vacancy and turnover trend across the Nursing and Midwifery workforce , both of which continue to reduce.

Graph 1 . Nursing & Midwifery Turnover / Vacancy 2017 /18

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Networked Care Vacancy data January 2018

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Current Month: Jan 18

Sub-Division/Care Group

Groups

N&M and Support

Vacancy FTE NM Vacancy % NM Voluntary

Turnover % NM

Networked Care Operational Team 15.53 93.95%

Networked Care Operational Team 15.53 93.95%

Sub Division A 8.80 0.84% 16.10%

Cardiovascular Sciences 15.72 7.26% 16.52%

Critical Care, Radiology and MEP -39.22 0.00% 18.18%

Sub Div A Operational Team -3.00 0.00%

Variety Children's Hospital 35.30 9.26% 13.33%

Sub Division B 66.03 6.83% 12.43%

Cancer 4.20 23.60% 7.74%

Haematology and Precision Medicine 5.47 3.05% 10.04%

Liver and Renal 6.27 1.64% 11.29%

Neurosciences 53.09 13.70% 15.16%

Sub Div B Operational Team -3.00 0 27.91%

Networked Grand Total 90.37 4.46% 14.41%

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UPACS Vacancy data January 2018

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Current Month: Jan 18

Sub-Division/Care Group

Groups

N&M and Support

Vacancy FTE NM

Vacancy % NM Voluntary

Turnover % NM

Planned Care 87.72 8.66% 13.33%

Dental -0.60 0.00%

Planned Care Operational Team 3.40 37.78%

Planned surgery and Ophthalmology 9.01 3.97% 17.20%

Post-Acute and Planned - Planned Care -1.22 0.00% 12.44%

Theatres and Anaesthetics 59.05 16.04% 14.24%

Women's Health 18.08 5.06% 10.93%

Urgent and planned care operational team 0.00 0.00%

Urgent and planned care operational team 0.00 0.00%

Urgent Care 105.59 13.28% 17.68%

Acute and Emergency 40.55 10.12% 17.07%

Pharmacy

Post-Acute, Planned Medicine & Outpatients 62.91 17.11% 18.07%

Therapies 1.13 45.07% 97.30%

Urgent Care Operational Team 1.00 4.09% 12.00%

UPACS Grand Total 193.31 10.68% 15.13%

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PRUH Vacancy data January 2018

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Current Month: Jan 18

Sub-Division/Care Group

Groups

N&M and Support

Vacancy FTE NM Vacancy % NM Voluntary

Turnover % NM

Acute and Emergency Care 35.83 16.29% 17.94%

Post-Acute Medicine 84.97 13.11% 13.68%

PRUH Operational Team 1.27 3.30% 5.17%

Surgery, theatres, Anaesthetics and Endoscopy 64.65 12.94% 12.01%

Women's & Children's and core services 9.94 2.56% 13.34%

PRUH Grand Total 196.66 10.96% 13.44%

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Denmark Hill Site

• A Medicine specific open day took place on the 30th January 2018 , with some success and key learning for future events

• Recruitment via Sterling Cross recruitment agency continues

• There is continued work with ID Medical, this is part of an ongoing arrangement to deliver 20 placements across DH & PRUH

• Social Media Campaign is in progress

• Significant communication engagement (new video and training programme leaflet) initiated in Neurosciences

• The use of a bespoke Guardian Jobs campaign to supplement the existing work in for Neurosciences is being scoped

• An incentive offer on ED adverts is being used (3 months accommodation) to attract candidates from outside of London

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Recruitment events

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PRUH

• A full year rolling Guardian campaign is planned for the whole of the PRUH

• Review of the upcoming university open events and internal advertising to support attraction of NQNs

• 23 Nurses in attendance at Open Day 15th February 2018

• A recruitment strategy for B5 and B6, prioritising ED, Acute and Post-Acute has been developed with HoNs during February 2018

• Booked to attend (nb: currently exploring events/ career fair for PRUH)

• University of West London on 31st January 2018

• King’s College London on 23rd March 2018

• 6 Nursing Times Events over the year in London (X2), Leeds, Manchester, Birmingham and Bristol.

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Recruitment events

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International Recruitment Update

Australia

• Of the initial set of offers made (58), 42 were confirmed by candidates, 8 have declined, and 8 are currently unresponsive. 1 candidate started in January 2018, with 7 more aiming for start dates February-March 2018

• The Trust will be returning to Australia in June 2018, with job fairs booked for Melbourne, Sydney, and Brisbane through Health Sector Jobs.

Other countries

• Additional recruitment events are planned for March 2018 and include Dubai and Ireland.

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Staffing Position

The number of staff required per shift is calculated using an evidence based tool, dependent on the acuity level of the patients. This is further informed by professional judgement, taking into consideration issues such as ward size and layout, patient dependency, staff experience, incidence of harm and patient satisfaction and is in line with NICE guidance. This provides the optimum planned number of staff per shift.

For each of the 79 clinical inpatient areas in, the actual number of staff as a percentage of the planned number is recorded on a monthly basis.

The table below represents the high level summary of the planned and actual ward staffing levels reported for January 2018.

Some clinical areas were unable to achieve the planned staffing levels due to vacancies and sickness, staffing levels are however maintained through the relocation of staff, use of bank staff and where necessary agency staff.

Day & Night Care Hours Per Patient Day

(CHPPD)

Site Average fill rate-

RN/Midwives (%)

Average fill rate -

Care staff (%)

Reg.

midwives/

nurses

Care

Staff

Total

CHPPD

DH 93%

146% 8.6

2.9 11.5

PRUH & South Sites 96% 107% 5.1

2.9 8.5

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Recommendations & Next Steps

• There is a project underway to link the Quality and Workforce Scorecards to enable review of the data more seamlessly.

• An establishment review is planned fro March 2018, which will be completed in all Adult and Children’s Inpatient areas across the Trust.

• A staffing paper reviewing the headroom or uplift in nursing budgets has been completed and was presented to the Board in December 2017. The Board will need to decide as part of its planning for 18/19 what percentage the Trust can afford to implement of the nursing headroom, it would be recommended that the ED headroom be implemented first.

• E- Roster review meetings have been reviewed and strengthened to ensure robust action is taken to reduce agency and bank spend and ensure there is good housekeeping in relation to the roster management.

• The Chief Nurse, Director of Workforce and NHSi are working together to ensure that there are robust processes around rostering, recruitment and retention. The initial meeting occurred in February 2018 and there is a plan of work developing to support this.

• The Trust is also part of an NHSI retention pilot. Colleagues from NHSi reviewed the current retention plan and visited some clinical areas in December 2017. Key highlights from the feedback received were: refine the retention plan to be aligned with the London wide retention target, good illustration of workforce flow within the plan, the Trust demonstrated effective understanding of key retention challenges, impressed by the passion and drive and engagement demonstrated by frontline staff.

• The key new recruitment and retention initiative which commenced in December 2017 is to promote flexible working and attract nurses who are only able to work specific shifts for example term time only, holiday time only, weekends only. This initiative is in recognition of the decreasing pool of nurses available and the need to remain and enhance Kings as an attractive employer.

The Board of Directors are asked to note the information contained in this briefing: the use of the red flag system to highlight concerns raised and the continued focus on recruitment, retention and innovation to support workforce utilisation and reporting.

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