NURSING and MIDWIFERY MAY 2017 STAFFING REPORT- Bedford Hospital NHS Trust

NURSING AND MIDWIFERY MAY 2017 STAFFING REPORT- Bedford Hospital NHS Trust 1. Introduction

This is the monthly Nursing and Midwifery staffing report outlining:  May 2017 staffing data submitted via the UNIFY portal, including Care Hours Per Patient Day (CHPPD)  Vacancy and recruitment update  May 2017 temporary staffing usage and progress against agency cap  Update on Safe Staffing work streams

2. May 2017 Staffing Data

Nineteen wards reported staffing data for May with an overall fill rate of 101.03% which include specials (3.27%). May 2017 April 2017 % of Registered nurse day 96.1% of planned level 96.8% of planned level hours filled as planned % of Unregistered care staff 105.6% of planned level 100.8% of planned level day hours filled as planned % of Registered nurse night 102% of planned level 101% of planned level hours filled as planned % of Unregistered care staff 106.9% of planned level 106.9% of planned level night hours filled as planned

Percentage allocated for 3.27% 3.5% Enhanced Patient Observation (Specials)

Figure 1 Monthly staffing level fill rate summary April / May2017

Figure 2 – CHPPD trends CHPPD is a measurement for benchmarking developed following Lord Carter’s workforce review. The range identified was 6 to 15 hours. Utilisation of this metric will increase as guidance from NHSI and the Lord Carter review is shared in coming months. The overall figure is influenced by the higher staff to patient ratios within ED, Critical Care, Maternity and Paediatric services. In May 2017, the overall rate was 7.6 care hours across all patient wards (BHT), within a range of 7.3 to 7.9 CHPPD (previous 10 months). The decrease this month is attributed to higher bed occupancy during May 2017 than in April 2017. 3. Permanent Recruitment Update

Registered Nurse recruitment summary

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1 WTE Vacancies (Band 5 and % rate of vacancies against Month 6) - ESR establishment June 1st 17 87.50 13% May 1st 17 85.41 13% April 1st 17 94.51 14% March 1st 17 92.03 14%

Figure 3 – Registered Nurse / Midwife/Theatre Practitioner WTE Vacancies

Starters Details European / Overseas Newly Qualified UK Recruitment (External Only) Recruitment Nurse Recruitment 36 (32 Euro / 4 overseas) 17 (Inc. 2 currently 67 (Inc. 14 currently working 14 working as PRP’s) as PRP’s, 22 yet to start)

Figure 4 – Registered Nurse / Midwife/Theatre Practitioner WTE Starters

Based on the information in figure 3 and 4 the trust has a net projected vacancy rate of 20.50 with regards to Band 5 and Band 6 nurses, by March 2018. This projection does not include actual leavers. The clinical areas with a RN vacancy level higher than 5 WTE based on the June 1st data include:  AAU.  A and E.  Russell.  Shand.  Maternity Services.  Critical Care.  Theatres. Please note that 14 Euro/Overseas nurses and 14 newly qualified nurses have not been allocated wards yet, so some of the above areas of concern will be addressed by these allocations. These vacancies are being addressed in the following ways;  A specific campaign for AAU was conducted from 1st May to 1st June. Six applications were received with potentially 2 of these to interview stage.

 Overseas nurses (recommended by current colleagues) – 3 in total being progressed. These are in addition to those described in figure 4.

 Targeting prospective European nurses who have passed the IELTS 7 exam, in order to recruit and progress them quickly into registered nurse roles as they arrive in the UK.

 Further European recruitment interviews are to take place for November start dates. 10 WTE Registered nurses will be appointed. The Graph below represents the recruitment stages that other Nursing and Midwifery roles are at. (As of 16th June 2017, the appointed candidate is where a start date has not yet been agreed)

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2 Figure 5 – Registered Nurse and CSW Recruitment stage status

CSW recruitment summary % rate of vacancies against Month WTE Vacancies establishment June 1st 17 37.34 13% May 1st 17 42.04 14% April 1st 17 42.09 15% March 1st 17 41.94 15%

Figure 6 – CSW WTE Vacancies

Based on the recent assessment centre (May 2017) and ongoing recruitment through traditional channels (NHS Jobs) there are 11 projected starters are due to join 3 rd July 2017 and be working on the rota as of 17th July 2017. A further campaign will be run in due course to address the Projected Net figure of 26.34 WTE vacancies. From the 1st June figures, areas of concern for CSW’s include;  AAU  Elizabeth  Harpur  Russell The very small differential in WTE vacancy figures over the last 4 months has been due to a change in the establishment figures increasing.

4. Temporary Staffing Update

Registered Nursing During May 2017, a total of 15,763.30 hrs was worked by Qualified Nursing staff (both bank and agency) The highest booking reasons were;  Vacancy – 10560.32 hrs ( Increase of 220.74 hrs on April 17 figure)  Service demand – 1653.42 hrs (increase of 193.17 hrs on April 17 figure)  Sickness – 1434.23 (Increase of 134.30 hrs on April 17 figure) CSW

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3 During May 2017, a total of 9913.25 hrs was worked by Clinical Support Workers (both bank and agency) The highest booking reasons were;  Vacancy –4378.73 hrs (decrease 1324.62hrs on April 17 figure)  Specials – 2378.83 (decrease of 83.89 hrs on April 17 figure)  Service Demand 954.63 (increase 420.65 hrs on April 17 figure) NHSI Data Agency Breaches - Registered Nurse shifts are released to agencies via a cascade agreed with the Hertfordshire and Bedfordshire collaborative. Agency breaches were only registered against those shifts agencies classify as critical (ED, Paediatrics and chemotherapy nurses). There have been no shift breaches in the last three months for staff working within general wards.

Figure 7 - Agency Price and Wage Cap overrides December 2016 to May 2017 Trust Nursing Nursing Controls compliance w /c 01 May w /c 08 May w /c 15 May w /c 22 May w /c 29 May Trend Line 2017 2017 2017 2017 2017 No. of Shifts over Price Cap only 7 7 9 8 9

No. of Shifts over Wage Cap only 0 0 0 1 0

No. of Shifts both over Price Cap & 21 20 25 28 21 Wage Cap No. of Shifts off Fram ew ork only 0 0 0 0 0

Total no. of Shifts over Cap 28 27 34 37 30

Total no. of Shifts 144 137 137 147 141

% of Shifts over Cap 19% 20% 25% 25% 21%

Com m entary

General Nursing requests are all w ithin w age & rate cap. Nursing cap overrides being charged at April fringe rates at present for specialist & critical areas; A&E, Theatres, Oncology, Radiology and Paeds. Critical/specialist rates have been negotiated through the East of England collabrative hub to reduce this rate to Novem ber by July. This therefore w ill help decrease our ependiture. Agency cascade has been m oitored and days out for requests have been reduced for night shifts to encourage day cover.

Figure 8 - variance of NHSi agency wage and price cap breaches, May 2017 During May there was a decrease in agency rule breaches for agency rate caps. The percentage has fallen from 31% to 22% of all agency shifts for registered staff. This decrease partly relates to the review of maternity shifts agency price rates and one agency’s re-designation of wage rates. Use of the cascade process ensures that complaint agencies are approached prior to any that are non-compliant. Temporary Staff Recruitment Nursing recruitment update for May;  6 internal RNs joined the bank; most of these were existing staff.  2 external RNs completed induction and have started taking shifts.  A RN external advert on NHS Jobs closed with 5 applicants, all of which were shortlisted and invited to interview 17th May. One attended and was successful. Often newly qualified nurses apply for multiple posts. CSW recruitment update for May;  5 internal CSWs joined the Bank; most of these were existing staff.  The recent CSW advert on NHS Jobs closed and 27 were shortlisted and invited to interview on the 24th & 26th May. 24 candidates were offered posts.

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4  Induction for these staff will take place for 8 in June, 3 in July and 13 in August 2017. These induction dates are at the personal preference of the candidates owing to prior commitments.

5. Datix events for Short staffing

During May 2017 23 Datix forms were submitted. Four of these were related to either medical staff or outpatient departments. This is slightly higher reporting rate than in recent months. The top three impacts were delays in documentation, administering medication and answering call bells. Of the 19 remaining incidents, 18 were all classified as ‘no harm’. One was classified as low harm; this incident on the acute assessment unit requires investigation to be completed. Three no harm incidents require completion of investigation, two of these relate to maternity and provisionally have three red flag events associated between them. The remaining incidents relate to short notice changes to staffing levels, partly by sickness or unfilled temporary staff requests. Lessons learned have been noted on several of the incidents that require reprioritisation of work load for that time. The themes from datix will discussed at divisional quality meetings.

Figure 9 – Location of Datix incidents relating to staff shortages in April 2017

S i c Total Bank k Post Vacancies Units & Agency n Parenting % Additional Duties WTE Use % e s s % 4 . 1 0 AA Unit 33.80% 13.1 % 4.90% 0 . 0 0 Orchard Gynae 33.70% 1.1 % 5.70% 4 . 6 0 Russell Ward 25.70% 7.1 % 2.50% Shuttleworth/SAU 25.10% 6.7 2 8.70% . 0fb24fc10ff48d5821092e59a01c0039.docx

5 4 0 % 2 . 2 0 Shand 23.50% 6.5 % 3.30%

Figure 10 - Wards with highest temporary staffing use for May 2017 (data source roster perform 24/04/2017 to 21/05/2017)

The wards in Figure 10 are those identified with the highest rate of temporary staff usage. Unavailability for these wards for this period was high. The earlier notes on AAU recruitment initiative indicate actions being aimed to resolve this high rate use. Enhanced Patient Observation (EPO). Figure 11 illustrates a decreasing demand for enhanced patient observation during May. A review of EPO is being conducted within the STP workforce working group. EPO requirements are reviewed daily with a process of approval in place. Audit of these patients is taking place every two weeks to determine if compliance with policy and process has been achieved, this information will be reported upon next month. To mitigate any risk associated with unfilled shifts, there is a daily review of all wards with such shifts. Identified patients are reviewed and a risk assessment is undertaken regarding their care needs. Staff are reallocated, to ensure higher acuity wards are supported in care for these patients.

Figure 11 – Enhanced Patient Observation (Specials) Trends over the last year

Figure 12– Enhanced Patient Observation Total Hours required trends over the nine months

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6 6. Roster Approval Compliance by wards (% of rosters)

The latest roster commencing on 17/07/2017 was completed on time by 91% of wards. All with the exception of two rosters had been fully approved by the deadline date of 05/06/2017. All the rosters were approved within 8 days of the deadline (status at 21/06/2017). Divisional lead nurses will ensure that ward managers and matrons achieve 95 % compliance for the next roster period.

A & E AA Unit Arnold Whitchurch Ward CAU/ Ambulatory Care CCU Crit Care Comp Elizabeth Godber Harpur Howard Ward Stroke Unit Maternity Meadowbank Orchard Gynae Pilgrim Reginald Hart W Richard Wells OWH Riverbank Russell Ward Shand Shuttleworth/SAU Tavistock Whitbread Medical

On time Delayed

Figure 13 - Roster approval compliance by ward (17/07/2017 roster)

Figure 14 –Roster approval trend 7. Safer Staffing Work

7.1 Nursing Work streams – Work continues with all divisions reviewing nursing and midwifery efficiencies and potential cost improvement plans. Divisional progress is reported to the TfE N&M meeting. 7.2 Clinical Time – supervisory shifts - Ward Sister/Charge Nurses are expected to work in a supervisory capacity. In the roster commencing 24/04/2017, 51% of Supervisory

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7 shifts were worked. There is some local variation. This Divisional compliance is reviewed monthly at the roster review meetings with divisional lead nurses. 7.3 Care Hours Per Patient Day (CHPPD) - CHPPD continues to be included in the monthly staffing returns via the UNIFY portal. The Trust awaits national guidance from NHSI on its implementation and interpretation at Trust level. This is accessible via the Model Hospital dashboard portal. 7.4 Establishment Review – Safer Staff report. The next full establishment review of all in- patient areas will be conducted in June and July 2017. The methodology has being established and agreed with senior nursing staff. 7.5 Enhanced Observations. Work within the STP continues and at present a pilot reviewing two components of the process are being reviewed using PDSA process. The trust policy and implementation are under review, to align outcomes of STP review and following Carter best practice guidance. 7.6 Roster review and restructure. The paediatric unit is in the process of restructuring the roster to reflect a separate Children’s assessment unit roster from Children’s ward. Further work has been completed to transfer other non-ward based staff to other roster. He changes will take place as of 11/09/2017 roster and the responsiveness of eRoster reporting will be more dependable for these areas. The Maternity unit are reviewing a number of structural issues within their roster in particular the net hours recording. 8. Recommendations To feedback this report at Workforce, Education and Wellbeing Board meeting on 04/07/2017.

Tracey Brigstock Director of Nursing and Patient Services.

Adam Brown Associate Director of nursing (Workforce)

29th June 2017

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