SAFER STAFFING REPORT Trust Board – in public

Date: 24th September 2020 Agenda item: 2.3

Executive sponsor Jane Dickson, Chief of Nursing and Midwifery Report author(s) Tracey Tucci, Workforce and Business Manager - Corporate Nursing Report discussed previously: N/A (name of sub-committee/group and date)

Action required: Approval () Discussion ( ) Assurance ()

Purpose of report: To provide monthly Safer Staffing information and exception reports.

Summary of key issues • This report aims to provide information and assurance however should be reviewed in the context of the pandemic in that some wards were closed, some had a higher acuity of patients and some different ways of working i.e. change in specialities. • Staffing requirements were met across all clinical areas and were in line with both national and local assurance arrangements. • The percentage to actual and CHPPD date are included in this report.

Recommendation: The Board is asked to note the report.

Relationship to Trust strategic objectives and assurance framework: SO1: Safe – Deliver safe, high quality care and improving services which pursue perfection and be in the top 25% of our peers SO2: Effective – As a teaching hospital, deliver effective and improving sustainable clinical services within the local health economy SO3: Caring – Work with compassion in partnership with patients, staff, families, carers and community partners SO4: Responsive – To continue to be the secondary care provider of choice for the people of our community SO5: Well led – To be a high quality employer of choice and deliver financial and clinical sustainability around a patient centred, clinically led leadership model

Corporate impact assessment Legal and regulatory impact Yes Financial impact Yes Patient experience/engagement Yes Risk and performance Yes management NHS Constitution/equality and Yes diversity/communication

Attachments N/A

SAFER STAFFING REPORT & CARE HOURS PER PATIENT DAY

Trust Board – in public

Date: 24th September 2020

1. Introduction

To provide an update to the Board on nursing and midwifery staffing in relation to planned versus actual staffing and update regarding safer staffing monitoring and on recruitment activity.

2. Staffing Planned versus Actual – August 2020

The Trust Delivered the planned versus actual staffing profile for August 2020 at an organisational level and this month was 98.8%

In August 2020 with the exception of Copthorne Ward and Outwood ward all wards/areas had an overall compliance rate of 94.0% or above, of which 22 wards/areas had an overall compliance rate above 98%. It is also worthy to note that 16 wards/areas had a compliance rate above 99%.

Please note that gaps between planned and actual in general continue to relate more to nursing assistants than registered nurses. Overall compliance for registered nurses (day) was 101.2% and registered nurse (night) was 100.5%.

In addition please note that although compliance for nursing assistants on Copthorne Ward was low in August 47.1% (day) 62.3% (night) the ward has always achieved or exceeded a safe and appropriate skill mix of staff on duty within August when reviewing the number of actual patients. The designation of the ward has changed to a protected planned surgery pathway, the staffing requirements are adjusted in real time according to the changing and reduced needs of the service as seen in CHPPD.

3. COVID

As the hospital continued to recover and reconfigure wards to meet the needs of the pandemic, some areas required increasing numbers and this continues in part to be facilitated by other areas ceasing or dramatically reducing their staffing requirements.

During the COVID pandemic hospital have assigned ‘COVID Status’ to their wards. We have categorised all our wards (with the exception of Copthorne and Woodland) as: Risk Managed – Post COVID. The COVID status of Copthorne and Woodland is: Protected – Post COVID.

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Table 1 below shows the detailed figures

Total Ward Ward Specialty Entries RN Day RN Night NA Day NA Night Total Day Overall Night

Abinger Ward 430 - GERIATRIC MEDICINE 31 100% 100% 98.92% 100% 99.54% 100% 99.71% Acute Medical Unit 300 - GENERAL MEDICINE 31 98.83% 99.60% 97.42% 97.42% 98.39% 98.76% 98.55% Birthing Centre 501 - OBSTETRICS 31 98.39% 96.77% N/A N/A 98.39% 96.77% 97.58% Ward 430 - GERIATRIC MEDICINE 31 100% 100% 98.86% 100.68% 99.52% 100.33% 99.86% Brockham Ward 502 - GYNAECOLOGY 31 100% 100% 93.20% 100% 97.68% 100% 98.61% Brook Ward 100 - GENERAL SURGERY 31 100% 100% 102.08% 96.77% 100.55% 98.94% 99.81% Buckland Ward 101 - UROLOGY 31 137.01% 101.64% 87.97% 103.23% 116.81% 102.44% 111.60% Burstow Ward 501 - OBSTETRICS 31 98.07% 95.83% 98.39% 96.43% 98.18% 96.09% 97.33% Capel Annex l Ward 300 - GENERAL MEDICINE Capel Ward 300 - GENERAL MEDICINE 31 103.10% 98.92% 96.33% 100% 100.65% 99.35% 100.16% Ward 328 - STROKE MEDICINE 8 100% 100% 92.66% 100% 96.74% 100% 98.04% Ward 301 - GASTROENTEROLOGY 31 106.25% 101.56% 83.60% 96.77% 99.27% 99.21% 99.25% Copthorne Ward 100 - GENERAL SURGERY 31 108.67% 110.17% 47.12% 62.30% 82.49% 93.85% 87.11% Coronary Care Unit 320 - CARDIOLOGY 31 100% 100% N/A 90% 100% 96.77% 98.40% Delivery Suite 501 - OBSTETRICS 31 97.48% 100% 96.77% 91.94% 97.30% 97.98% 97.64% Discharge Lounge 300 - GENERAL MEDICINE 31 100% 100% 100% 100% 100% 100% 100% Ward (Haem) 303 - CLINICAL HAEMATOLOGY 31 100% 100% 95.60% N/A 98.55% 100% 99.13% Godstone Ward (Med) 300 - GENERAL MEDICINE 31 102.29% 98.92% 88.79% 93.40% 97.16% 95.98% 96.67% Hazelwood 430 - GERIATRIC MEDICINE Holmwood Ward 320 - CARDIOLOGY 31 100% 100% 98.94% 96.77% 99.60% 99.19% 99.46% Ward 300 - GENERAL MEDICINE 8 95.54% 100% 93.55% 100% 94.51% 100% 96.42% IRU 430 - GERIATRIC MEDICINE 31 108% 100% 89.13% 89.74% 100% 94.33% 97.77%

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ITU/HDU 192 - CRITICAL CARE MEDICINE 31 98.53% 99.02% 88.87% 93.75% 97.24% 98.64% 97.91% Leigh Ward 110 - TRAUMA & ORTHOPAEDICS 31 100.71% 101.06% 97.78% 98.91% 99.28% 100% 99.57% Meadvale Ward 430 - GERIATRIC MEDICINE 31 107.54% 108.06% 100.27% 91.94% 103.81% 100% 102.56% Neonatal Unit 420 - PAEDIATRICS 31 98.59% 98.55% 97.18% 98.28% 98.12% 98.47% 98.29% Newdigate Ward 110 - TRAUMA & ORTHOPAEDICS 31 100% 102.13% 100.48% 98.92% 100.23% 100.53% 100.35% Nutfield Ward 430 - GERIATRIC MEDICINE 31 99.35% 127.78% 101.64% 109.09% 100.36% 116.96% 106.69% Outwood Ward 420 - PAEDIATRICS 31 94.09% 96.24% 90% 90.32% 93.46% 95.39% 94.34% Rusper Ward 501 - OBSTETRICS 31 93.74% 94.62% N/A N/A 93.74% 94.62% 94.07% Surgical Assessment Unit 100 - GENERAL SURGERY 31 101.08% 100% 91.67% 101.08% 97.87% 100.46% 99% Ward 430 - GERIATRIC MEDICINE Tilgate Annex 300 - GENERAL MEDICINE 31 99.35% 100% 98.19% 98.39% 98.91% 99.35% 99.08% Tilgate Ward 340 - RESPIRATORY MEDICINE 31 98.72% 101.09% 94.57% 100% 97.18% 100.78% 98.40% Woodland Ward 110 - TRAUMA & ORTHOPAEDICS 23 104.35% 95.16% 101.22% 200% 103.52% 104.41% 103.89% Total 101.16% 100.47% 93.83% 96.17% 98.61% 98.95% 98.75%

Please note that there is a variation in the data above and the data which was submitted externally. Following the submission of data, additional validation was undertaken due to the number of ward moves, which highlighted discrepancies.

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4. Care Hours per patient Day

With effect from 1 August 2019 national CHPPD guidance was updated to include a new requirement for Nursing Associates and Allied Health Professionals (AHPs) who are rostered to the in-ward establishment to be included as part of the CHPPD daily data return.

Care hours per patient day are calculated by dividing the total numbers of hours (nurses, Nurse Associates and AHP) on a ward or unit by the number of patients in beds at the midnight census. This calculation provides the average number of care hours available for each patient on the ward or unit.

The Trust has 9 Registered Nurse Associates who have registered and obtained their PIN. In line with national CHPPD guidance we are finalising our templates to capture the detail of Registered Nurse Associates who are rostered to the in-ward establishments.

The report for August is shown.

This tool links with planned versus actual reporting and other data such as incident reporting, sickness rates, vacancy rates and professional judgement to determine the appropriate staffing levels for a ward or unit.

Care hours per patient day should differ depending on the acuity of the ward; this can be seen most obviously in ITU and care of the elderly wards.

In August due to a number of ward moves and template changes the CHPPD data is difficult to interpret. Further narrative will be provided in report for November 2020 Safer Staffing Report.

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Table 2: Care hours per patient day (CHPPD)

August 2020 Average Fill Average Fill CHPPD Rate - Day Rate - Night Night Night Night Day RN Day RN Day CS Day CS Night CS Day RNA Day RNA RN RN CS Night RNA Night RNA Ward Specialty1 Planned Actual Planne Actual Planned Inpatients RN CS Overall RN CS RN CS Planned Actual Planne Actual Actual Planned Actual Hours Hours d Hours Hours Hours d Hours Hours Hours Abinger Ward 430 - GERIATRIC MEDICINE 1426 1426 1069.5 1058 0 0 713 713 713 713 0 0 627 3.4 2.8 6.2 100% 99% 100% 100% Acute Medical Unit 300 - GENERAL MEDICINE 3921.5 3875.5 1782.5 1736.5 0 0 2852 2840.5 1782.5 1736.5 0 0 1010 6.6 3.4 10.1 99% 97% 100% 97% Birthing Centre 501 - OBSTETRICS 713 701.5 0 0 0 0 713 690 0 0 0 0 46 30.3 - 30.3 98% 97% Bletchingley Ward 430 - GERIATRIC MEDICINE 2806 2806 2016 1993 0 0 1828.5 1828.5 1690.5 1702 0 0 581 8.0 6.4 14.3 100% 99% 100% 101% Brockham Ward 502 - GYNAECOLOGY 1421.5 1421.5 735.5 685.5 0 0 1046.5 1046.5 402.5 402.5 0 0 541 4.6 2.0 6.6 100% 93% 100% 100% Brook Ward 100 - GENERAL SURGERY 939 939 337 344 0 0 724.5 724.5 356.5 345 0 0 333 5.0 2.1 7.1 100% 102% 100% 97% Buckland Ward 101 - UROLOGY 1460.5 2001 1022.5 899.5 0 0 701.5 713 713 736 0 0 617 4.4 2.7 7.0 137% 88% 102% 103% Burstow Ward 501 - OBSTETRICS 1426 1398.5 713 701.5 0 0 828 793.5 644 621 0 0 612 3.6 2.2 5.7 98% 98% 96% 96% Capel Ward 300 - GENERAL MEDICINE 1855 1912.5 1049 1010.5 0 0 1069.5 1058 713 713 0 0 594 5.0 2.9 7.9 103% 96% 99% 100% Chaldon Ward 328 - STROKE MEDICINE 460 460 368 341 0 0 276 276 276 276 0 0 838 0.9 0.7 1.6 100% 93% 100% 100% Charlwood Ward 301 - GASTROENTEROLOGY 1472 1564 655.5 548 0 0 736 747.5 713 690 0 0 606 3.8 2.0 5.9 106% 84% 102% 97% Copthorne Ward 100 - GENERAL SURGERY 1725 1874.5 1276.5 601.5 0 0 1357 1495 701.5 437 0 0 158 21.3 6.6 27.9 109% 47% 110% 62% Coronary Care Unit 320 - CARDIOLOGY 1081 1081 0 0 0 0 724.5 724.5 345 310.5 0 0 241 7.5 1.3 8.8 100% 100% 90% Delivery Suite 501 - OBSTETRICS 2139 2085 713 690 0 0 2139 2139 713 655.5 0 0 159 26.6 8.5 35.0 97% 97% 100% 92% Discharge Lounge 300 - GENERAL MEDICINE 759 759 713 713 0 0 414 414 356.5 356.5 0 0 266 4.4 4.0 8.4 100% 100% 100% 100% Godstone Ward (Haem) 303 - CLINICAL HAEMATOLOGY 713 713 352.5 337 0 0 713 713 0 0 0 0 179 8.0 1.9 9.8 100% 96% 100% Godstone Ward (Med) 300 - GENERAL MEDICINE 2012.5 2058.5 1230.5 1092.5 0 0 1069.5 1058 1219 1138.5 0 0 796 3.9 2.8 6.7 102% 89% 99% 93% Holmwood Ward 320 - CARDIOLOGY 1782.5 1782.5 1080.5 1069 0 0 1058 1058 356.5 345 0 0 833 3.4 1.7 5.1 100% 99% 100% 97% Horley Ward 300 - GENERAL MEDICINE 336 321 356.5 333.5 0 0 184 184 184 184 0 0 203 2.5 2.5 5.0 96% 94% 100% 100% IRU 430 - GERIATRIC MEDICINE 1437.5 1552.5 1058 943 0 0 724.5 724.5 897 805 0 0 621 3.7 2.8 6.5 108% 89% 100% 90% ITU/HDU 192 - CRITICAL CARE MEDICINE 4692 4623 723.5 643 0 0 4692 4646 368 345 0 0 381 24.3 2.6 26.9 99% 89% 99% 94% Leigh Ward 110 - TRAUMA & ORTHOPAEDICS 1630 1641.5 1556.5 1522 0 0 1081 1092.5 1058 1046.5 0 0 811 3.4 3.2 6.5 101% 98% 101% 99% Meadvale Ward 430 - GERIATRIC MEDICINE 1419.5 1526.5 1493.5 1497.5 0 0 713 770.5 713 655.5 0 0 639 3.6 3.4 7.0 108% 100% 108% 92% Neonatal Unit 420 - PAEDIATRICS 1633 1610 816.5 793.5 0 0 1587 1564 667 655.5 0 0 417 7.6 3.5 11.1 99% 97% 99% 98% Newdigate Ward 110 - TRAUMA & ORTHOPAEDICS 1630.5 1630.5 1455 1462 0 0 1081 1104 1069.5 1058 0 0 774 3.5 3.3 6.8 100% 100% 102% 99% Nutfield Ward 430 - GERIATRIC MEDICINE 1782.5 1771 1406 1429 0 0 828 1058 1138.5 1242 0 0 852 3.3 3.1 6.5 99% 102% 128% 109% Outwood Ward 420 - PAEDIATRICS 2498 2372 460 414 0 0 2139 2058.5 356.5 322 0 0 349 12.7 2.1 14.8 95% 90% 96% 90% Rusper Ward 501 - OBSTETRICS 1782.5 1671 0 0 0 0 1069.5 1012 0 0 0 0 110 24.4 - 24.4 94% 95% Surgical Assessment Unit 100 - GENERAL SURGERY 2139 2162 1104 1012 0 0 1426 1426 1069.5 1081 0 0 26 138.0 80.5 218.5 101% 92% 100% 101% Tilgate Annex 300 - GENERAL MEDICINE 1766.5 1755 1075.5 1056 0 0 1069.5 1069.5 713 701.5 0 0 618 4.6 2.8 7.4 99% 98% 100% 98% Tilgate Ward 340 - RESPIRATORY MEDICINE 1794 1771 1058 1000.5 0 0 1058 1069.5 414 414 0 0 736 3.9 1.9 5.8 99% 95% 101% 100% Woodland Ward 110 - TRAUMA & ORTHOPAEDICS 793.5 828 287.5 291 0 0 713 678.5 69 138 0 0 239 6.3 1.8 8.1 104% 101% 95% 200% 53447 54094 27965 26217.5 0 0 37329 37490 20412.5 19826 0 0 15813 5.8 2.9 8.7 101% 94% 100% 97%

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5. Recruitment and Retention

Although there has been an increase the registered nursing and midwifery vacancy rate remained low at 3.3%.

Nursing Recruitment – We continue to assess our recruitment trajectories in line with projection of future demands in particular the current pandemic and winter planning.

On 15 August 2020 we held a volume recruitment event which focused on nursing assistants - the event was very successful and we made 61 substantive offers to candidates.

We have 14 International Nurses scheduled to join us on 28 September 2020 with a further cohort planned for November 2020.

In addition we are commencing a local recruitment campaign for registered nurses to support the changes to the Medicine Division Model.

Retention - We are continuing to work with key stakeholders to ensure career development and progression is available to all our nursing workforce. It has been agreed as part of our ‘Retention Strategy’ to advertise all nursing roles internally in the first instance to support the career progression of our current nursing workforce.

6. Recommendation

The Board is asked to note the report.

Author: Tracey Tucci Workforce and Business Manager – Corporate Nursing September 2020

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