Integrated KPI Board Report
October 2017
Page 1
Integrated KPI Board Report for
September 2017 (unless otherwise stated)
Executive Sponsors
Jane Hayward
Director of Transformation
Date of Board Meeting
26 October 2017
5. Well Led Ward Staffing Report
August 2017
October 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 September 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 September 2017. This is the information which has been uploaded and will be for public display via NHS
choices from early November 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 September 2017
September 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 77.5% ↓ 116.3% ↓ 87.9%↓ 124.4%↑ 5.2↓ 3.2↑ 8.4↔
COUNTESS MOUNTBATTEN HOUSE 86.1%↓ 167.6%↑ 84.5%↑ 163.4%↓ 3.3↓ 3.6↓ 6.9↓
PRINCESS ANNE HOSPITAL 86.0%↓ 68.1%↓ 105.8%↓ 86.1%↑ 6.1↓ 2.2↓ 8.3↓
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 current vacancy levels, we maintained our staffing levels at or above minimum safety levels.
This was achieved by using our nursing bank and agency, through reviewing nurse staffing on a daily basis
across the Trust and deploying non-ward based staff to support.
‘Hotspot’ areas for nursing/midwifery staffing in September 2017 Key metrics show that staffing and capacity challenges remained consistent in September. Acuity and
dependency remained high across the trust, with a number of complex patients with mental health needs
requiring enhanced care.
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
August 2017
October 2017
Page 27
Exceptions by Division are detailed below: Division A Surgery – The surgical wards continue to be challenged by significant registered nurse vacancies with a
vacancy rate of 30% however there are 30 new recruits due over coming months following intensive
recruitment actions.
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.
F11 have a particular difficulty with recruiting for specialty currently and this is being supported by
movements within the care group
Cancer Care –Registered nursing vacancies at CMH are an emerging challenge and this is being supported
by movements within the care group and the support of bank/agency.
Critical Care – All critical care areas are working together to safely staff shifts despite fluctuating levels of
acuity and occupancy. RN vacancy rate is stable at 10.7% across the 4 units. SHDU is now fully staffed and
has now opened one of the two new beds.
Division B
The Divisional overall vacancy position remains significant at 11% (101 FTE) with an improved Registered
Nurse vacancy of 19% (91 FTE) compared to 23.7% in August (114.2 FTE) due to the NQN induction of 35
FTE.
The division’s daily staffing challenges have remained consistent in September, with some shifts remaining
at ‘critical’ levels. Key mitigating actions and daily senior nurse focus have supported the ward teams to
keep patients safe; golden key release is monitored carefully in order to ensure that high cost agency is
only used for true ‘break glass’ eventualities.
On a number of occasions in the month wards have run below their planned staffing levels and difficult
decisions have been made to amend the skill-mix and run on 2 registered nurses with band 4 support when
no other support trust wide or high cost agency has been available.
ED and AMU - The vacancy position within the Emergency Department is 2.8% for RN’s; HCA vacancies are
15.8% with dates for new cohort of starters including RMNs.
Emergency medicine wards & Medicine for Older People – Registered nurse vacancies fell again slightly in
the month and are at 26.9% (68 FTE). Medicine continues to have a low unregistered vacancy rate which
really supports the risk associated with the RN vacancy rate.
Division C
Child Health - RN vacancies across child health reduced to 12.1% with the appointment of the new
qualified children’s nurses. A number of children with complex mental health needs have required
enhanced care support during the month which has been supported by the use of additional agency staff.
Maternity – Activity across the service remained normal for this time of year; however acuity continued to
be high with an increasing number of high care clients. Safe staffing was maintained throughout the month
by sharing staffing resources during periods of high activity.
Division D The overall Divisional registered nurse vacancy position fell to 19.2% (89 FTE) with a pipeline of 16
registered nurses to start in the next few months.
5. Well Led Ward Staffing Report
August 2017
October 2017
Page 28
T&O and Neurosciences remain areas of focus with trained nurse vacancies of 30.7% (39 FTE) and 26.1%
(37 FTE) respectively. High vacancies are being managed with staff doing bank shifts, over recruitment of
band 3 and 4’s and deploying staff across wards.
The vacancy position is also supported by the closure of 14 beds on F1 ward to enable refurbishment works
to be undertaken.
------------------------ 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 September there were 135 staffing incident reports in total covering 11 different staff groups. This is a
further rise on the 116 reported in August and is at the same level as reported this time last year. These
incidents have been rated from near miss to moderate (8) impact.
Of these incidents, 102 were related to nurse staffing, a further rise on the 86 in the previous month and
back to the level last seen in March 2016. There were 5 Midwifery incidents reported for the month.
Hotspot areas identified through the reporting are being closely reviewed by the divisions.
In addition to the existing system, in August we introduced the capability to report red flag incidents in
real-time on the safecare acuity/dependency system in healthroster. These red flags will then be reviewed
at the daily staffing meetings.
------------------------ The overall vacancy level for ward staffing (registered, unregistered and other support roles) reduced in
September as predicted as the newly qualified staff started to join the organisation. The overall vacancy
level now stands at 419 FTE (13.3%). This is made up of 357 FTE (17.1%) registered vacancies and 56 FTE
(6.5%) unregistered vacancies.
A further centralised recruitment event for unregistered nurses took place in September with offers made
to 37 candidates who have the potential, if they meet the required entry criteria, to progress to
apprenticeship training expected to come on line in Autumn 2018. These candidates will commence
employment in October/November. Work is underway with HR to increase the frequency of these
intensive recruitment days to ensure a regular pipeline of good HCA recruits is maintained.
It should also be noted that 32 registered overseas nurses are 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 completed with 85 newly qualified
nurses (adult/child) commencing employment in September. The remaining 39 will commence in October.
They are now undergoing a period of induction and supernumerary practice. The cycle for recruitment in
2018/19 has now commenced with attendance at a variety of university employment events.
5. Well Led Ward Staffing Report
August 2017
October 2017
Page 29
Graph 1 below details the breakdown of temporary staffing cover across the last year.
Overall use decreased in the month. The use of high cost agency continued to be limited through effective
utilisation of our nursing resource (7.7 FTE - 123 shifts in the month which is 2.2% of the total temporary
staffing usage) but were still used to maintain safe staffing and particularly to support enhanced care for
some complex mental health patients in the month. Detailed service by service plans remain in place 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.
Graph 1
5. Well Led Ward Staffing Report
August 2017
October 2017
Page 30
Graph 2 – Ward Staffing - Predicted vacancies
