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Seize the Opportunity

NQB Safer Staffing Event – 25th March 2014 Mike Wright - Executive Director of Nursing & Patient Experience

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Content

National Context:Key RCN documentsReviewing staffing levels in face of serious supply and demand concerns

NQB – Ensuring the right people, with the right skills are in the right place at the right time

Share approach taken at CDDT – the story so far and next steps – ‘warts and all’

Lessons learned

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Context

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Context cont.Growing body of evidence of links between RN to patient ratios and risk of increased harm/mortality

Calls for nationally-mandated minimum nurse staffing levels, which have not been supported by CNO and government

National ‘minimum’ could become ‘maximum’ in financially-challenged times, when there is a need for nursing/care staffing levels to be flexible sometimes to match patient acuity and flow

Difference between ‘minimum safe’ and ‘optimum’

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Context

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Requirements of NHS Trust Boards

Ten ‘Expectations’

9 for trusts; 1 for commissioners

A significant opportunity for nursing and midwifery to get this right

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Process adopted at CDDFT

Board seminar January – presented RCN findings, supply/demand issues and NQB requirements

Undertaken full review of all Nursing, Midwifery, Health Visiting and School Nursing posts

Used ‘validated tools’ where they exist as a guide

Involved Finance, HR, Operations and N&M colleagues – from the start!

It’s been a ‘journey of discovery’ !

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Findings

Baseline information was poor and inconsistent

Understanding was variable and inconsistent across all staff groups (Finance, N&M, HR)

Different information from ESR and Finance ledger (for same period)

When is a vacancy a reported vacancy?

Budgets set at mid-incremental point or one below for all bands

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Findings cont.

60.17% RN/RM at top incremental point

62.71% of HCA’s at top incremental point

Establishment mark-up – range from 17%-23% (average 20%)

Different understanding of what the ‘mark-up’ comprises, e.g. annual leave or not, how much study leave, etc.

Some manoeuvring by some senior nurses!

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The ‘Mark-up’ conundrumCategory Days Allowance

based on starting point of 260 possible

working days p.a. (7.5 hrs) (per wte)

Percentage Allowance

Annual Leave 33 13%Bank Holidays 8 3%Sickness (4%) 10 4%Training 6 2%

TOTALS 57 22%

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Accountability and Responsibility

Expectation 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

Expectation 2: Processes are in place to enable staffing establishments to be met on a shift-to-shift basis. [Need written escalation policy]

 

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Evidence-Based Decision MakingExpectation 3: Evidence-based tools are used to inform nursing, midwifery and care staffing capacity and capability [where they exist]

Supporting & Fostering a Professional EnvironmentExpectation 4: Clinical and Managerial leaders foster a culture of professionalism and responsiveness, where staff feel able to raise concerns [reviewing all mechanisms against which staff can raise concerns]

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Expectation 5: A multi-professional approach is taken when setting nursing, midwifery and care staffing establishments

Expectation 6: Nurses, midwives and care staff have sufficient time to fulfil responsibilities that are additional to their direct caring duties [setting baseline budgets and final mark-up still to be resolved although agreed in principle]

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Openness and Transparency

Expectation 7: Boards receive monthly updates on workforce information, and staffing capacity and capability is discussed at a public Board meeting at least every six months on the basis of a full nursing and midwifery establishment review.

Expectation 8: NHS providers clearly display information about the nurses, midwives and care staff present on each ward, clinical setting, department or service on each shift [in place from April 1st]

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Planning for future workforce requirements

Expectation 9: Providers of NHS services take an active role in securing staff in line with their workforce requirements

The role of commissioning

Expectation 10: Commissioners actively seek assurance that the right people, with the right skills, are in the right place at the right time within the providers with whom they contract [yet to be confirmed]

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Preliminary resultsCare Group Additional wte Provisional

Additional Requirement (before unsocial hours mark-

up)Acute and Long Term Conditions

46.25 x RN54.23 x HCA

£2,483,821

Surgery & Diagnostics

17.5 RN3.5 HCA

£577,888

Care Closer to Home

47.19 RN/RM18.6 HCA

£1,867,782

Total 187.27 £4,929,492 (basic)£6,901,298 (x 1.4)

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Other factors to be resolvedCurrent spend on agency = £7m + other variable pay

Cost of setting baseline budgets & ‘mark up’ properly

Reconciliation of filling existing vacancies

Supervisory Ward Sister-Charge Nurse/Team Leader

Establish a sensitivity ‘risk rating’ – proportion away from desired numbers

Supply and demand issues

How to fill the workforce vacancies – new types of practitioner

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Summary

It’s challenging to get right but very necessary

Time to stand and be counted

Significant opportunity for nursing and midwifery

Not without its challenges in terms of recruitment and future supply

Need to consider alternatives to the Registered Practitioner (inc. foundation degrees, apprenticeships, assistant practitioner, ward personal assistants, ward hygienists, etc.)

Good Luck!