Integrated KPI Board Report
May 2017
Page 1
Integrated KPI Board Report for
April 2017 (unless otherwise stated)
Executive Sponsors
Jane Hayward
Director of Transformation
Date of Board Meeting
1 June 2017
5. Well Led Ward Staffing Report
April 2017
May 2017
Page 26
The following highlight report (in fulfilment of the National Quality Board (NQB) expectations on trust board awareness of safe staffing) focuses on any ‘hotspot’ areas in April 2017 which the board needs to be aware of in each Division after review of the overall staffing figures, daily staffing reports and staffing incident reports. The table below represents the high level summary of the planned and actual ward staffing levels reported for April 2017. This is the information which has been uploaded and will be for public display on NHS choices from early June 2017. Detailed ward by ward information is also included as part of this KPI report. From May 2016 Care Hours Per Patient Day (CHPPD) showing average care hours per patient for SGH, PAH and CMH has been included as part of the Model Hospital dashboard and is included in this report. Costs per ward have also been included in the model hospital dashboard since December 2016. Staffing position for April 2017
April 2017 Day
Night
Care Hours Per Patient Day
(CHPPD)1
Site Name
Average fill rate - registered
nurses/ Midwives (%)
Average fill rate - care staff
(%)
Average fill rate -
registered nurses/
Midwives (%)
Average fill rate -
care staff (%)
Reg. midwives/
nurses Care Staff
Total care
hours per
patient
SOUTHAMPTON GENERAL HOSPITAL
83.2%↔ 126.1%↑ 92.4%↓ 132.7↔ 5.4↔ 3.1↑ 8.5↑
COUNTESS MOUNTBATTEN HOUSE
88.8%↑ 194.1%↑ 87.8%↓ 217.9↑ 3.5↓ 4.4↑ 7.9↑
PRINCESS ANNE HOSPITAL
96.6%↑ 68.6%↓ 96.2%↑ 90.8%↑ 6.6↑ 2.5↑ 9.1↑
NB: Arrows indicate changes against the previous month and do not represent either a positive or negative performance position.
Whilst it can be seen that we were not able to staff many clinical areas with our planned level of registered nurses due to vacancy levels, we maintained our staffing levels above minimum safety levels. This is achieved by using our nursing bank and where necessary agency and through reviewing nurse staffing on a daily basis across the Trust. ‘Hotspot’ areas for nursing/midwifery staffing in April 2017 Key metrics show that staffing and capacity challenges eased in April. Whilst acuity and dependency remained high across the trust with a corresponding demand for additional staff to support enhanced care needs, staffing requests to cover sickness and increased workload were down significantly.
1 CHPPD, split into registered nurses/midwives and health care support workers is calculated using this
formula:- Actual hours worked_
Patient count at midnight
5. Well Led Ward Staffing Report
April 2017
May 2017
Page 27
Exceptions by Division are detailed below: Division A
Cancer Care - Countess Mountbatten House remains the hotspot area with support being given from
across cancer care including the redeployment of some non-ward based nursing support.
Vacancy rates overall across the care group have reduced and high cost agency usage has also reduced
with the use of only 1 shift in April and a plan for zero in May.
Surgery – Vacancy rate for registered nurses remains high at 29% coupled with a dilute skill mix across all
wards. Staff have been moved from cancer care and NICU on a 3 month secondment to support. This high
vacancy rate is being managed with substantive staff doing bank shifts, support from band 4 staff and cross
divisional working on a day to day basis.
Critical Care – All critical care areas working together to safely staff shifts resulting in zero use of high cost
agency shifts in the month. Vacancy rate is reducing and recruitment is ongoing to support the additional
beds for SHDU and cardiac.
Division B
The overall Divisional vacancy rate increased slightly in the month to 15.6% (130 FTE).
The Divisions daily staffing challenges continued to settle in April although the volume of patients with
enhanced care needs remained consistent. Key mitigating actions and daily senior nurse focus have
supported the ward teams to maintain safe care. Golden key release for high cost agency has significantly
reduced with RMN use in ED/AMU the main reason for continued bookings.
Key recruitment activities took place in April with a targeted registered nurse open day alongside the
continual incentive offer for all externally recruited band 5 posts (outside of the acute alliance).
There is an absolute focus on retention in the Division with detailed review of reasons for each leaver. In
April there were 5 registered nurse leavers – all for relocation, retirement or moving to the community
setting.
Emergency medicine wards, ED, and AMU - Emergency Care Registered Nurse vacancies in April are again
slightly higher at 28.3% (98 FTE) however HCAs remain actively over-recruited at -4.5% (-7 FTE).
Medicine for Older People – Registered nurse vacancies rose in the month and are now at 37.7% (41 FTE)
whilst over-recruitment to HCA vacancies has continued.
Division C Child Health - There was a slight increase in the number of RN vacancies across child health which are now
at 45 FTE. There is a focus to fill the vacant senior ward leader posts to support the leadership within the
care group. Recruitment seems to be improving with a particular focus on increased social media
presence. A drive to fill the HCA vacancies continues with pipeline recruits for all the vacancies.
Neonates – April has been less pressured for capacity for neonates and has resulted in a reduction in the
use of high cost agency to maintain safe staffing. A plan to link and share staff with PICU is in place, the
interface between rostering and NHSP has been activated for neonates and agency requests are reviewed
daily. Work also continues to identify and appoint alternative agency suppliers specifically for neonates.
Maternity – The service has gone out to early advertisement to attract newly qualified midwives (NQM) in the absence of an autumn output of NQM this year from Southampton. The plan will be to over recruit to maintain a healthier reduced vacancy level and to maintain a lower use of agency.
5. Well Led Ward Staffing Report
April 2017
May 2017
Page 28
Division D The overall Divisional registered nurse vacancy position has fallen slightly to 17.1% (79 FTE) as predicted
with further recruitment in the pipeline for May and June. However both neuro and T&O remain areas of focus with trained nurse vacancies of 25.3% (32.26 wte) and 24.3% (32.26) respectively. High vacancies are being managed with staff doing bank shifts, over recruitment of band 3 and 4’s, deploying staff across wards, and a range of recruitment and retention initiatives continuing. Requests for high cost agency have reduced with only 1 shift required in April to support increased acuity
------------------------ Staff continue to reference the ‘red flags’ identified in the NICE guidance on safe staffing when completing adverse event reports (AER) linked to staffing. These red flags highlight when patient care has potentially been impacted due to staffing shortfalls. These AERS are reviewed, actioned and mitigated in real-time to reduce the risks. They are also themed monthly and identified actions taken forward linked to the reporting on safe staffing and the trust risk register. Care group and divisional reports are also available to enable focus on trends in incidents being reported from each clinical area. In April there were 59 staffing incident reports in total covering 7 different staff groups. This is a fall on the 80 reported in March and brings reporting back to the normal level of incidents and range of staff groups. These incidents have been rated from near miss to moderate (4) impact. Of these incidents, 37 were related to nurse staffing, a fall on the previous month at 54 and brings reporting back to normal levels. Midwifery incidents accounted for 1 report. Hotspot areas identified through the reporting are being closely reviewed by the divisions.
------------------------ The overall vacancy level for ward staffing (registered and unregistered) in April was 411 FTE (13.3%) compared to 396 FTE (12.9%) in March. There was a further rise in the level of registered nursing vacancies to 409 FTE (19.2%). There was a further reduction in the level of unregistered vacancies with over-recruitment to -6.5 FTE (-0.8%). This is a result of the centralised recruitment focus as many services over-recruit to unregistered vacancies to offset vacancy levels and to support the growing enhanced care and dependency needs. It should also be noted that 31 registered overseas nurses currently working as unregistered nurses as they await the results of their English language testing (IELTS) requirements and competency requirements stipulated for NMC (Nursing and Midwifery Council) registration. The annual cycle for the recruitment of the newly qualified registrants (adult/child) continues with 167 applications received (119 adult and 48 child). In total 130 qualifying students were interviewed resulting in 129 offers being made (97 adult and 32 child). A further advert has now been opened to capture those applicants who may not yet have secured their first post. Social media has been used to further spread the impact of the recruitment. https://twitter.com/UHS_Jobs/status/831411766999523329 Graph 1 below details the breakdown of temporary staffing cover across the last 2 years. Requests and fill for temporary staff fell in the month. The use of high cost agency continued to be limited (remaining at 7 FTE in the month) through effective utilisation of our nursing resource but were still used if required for safe staffing. Detailed service by service plans are gradually being implemented to further limit and eradicate the use of high cost agency where safe to do so. Daily escalation processes continue to support the most effective deployment of staff in real-time with the use of ‘safecare’ acuity/dependency data embedded as part of the daily staffing reviews.
5. Well Led Ward Staffing Report
April 2017
May 2017
Page 29
Graph 1
