Seize the Opportunity

1. Seize the Opportunity NQB Safer Staffing Event – 25th March 2014 Mike Wright - Executive Director of Nursing & Patient Experience

2. Content National Context: Key RCN documents Reviewing 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

3. Context

4. 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’

6. Context

12. Requirements of NHS Trust Boards Ten ‘Expectations’ 9 for trusts; 1 for commissioners A significant opportunity for nursing and midwifery to get this right

13. 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’ !

14. 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

15. 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!

16. The ‘Mark-up’ conundrum

17. 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]

18. Evidence-Based Decision Making Expectation 3: Evidence-based tools are used to inform nursing, midwifery and care staffing capacity and capability [where they exist] Supporting & Fostering a Professional Environment Expectation 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]

19. 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]

20. 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]

21. 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]

22. Preliminary results

23. Other factors to be resolved Current 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

24. 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!