How to ensure the right people, with the right skills, are in the right place at the right time

1. How to ensure the right people, with the right skills, are in the right place at the right time Hazel Richards Deputy Chief Nurse NHS England North

3. Action Area 5: ‘ensuring we have the right staff, with the right skills in the right place’

4. Wider Policy Context

5. Francis Recommendations Evidence to the inquiry suggested that the Trust did not have reliable nursing establishment figures23 – NICE to develop evidence-based tools for establishing what each service is likely to require as a minimum in terms of staff numbers and skill mix195 – Nurse ward managers should operate in supervisory capacity, visible to patients and staff, role model and mentor205 – Seek and record the advice of Nursing Director on quality and safety on major change

6. The Keogh Review Issues related to nurse staffing in some organisations identified by reviewers: • dissonance between nursing establishments, staff in post and staff available on each shift • inadequate staffing levels on night shifts and weekends • poor skill mix • links to Compassion in Practice Action Area Five Workstream

7. Berwick Recommendations Government, Health Education England and NHS England should ensure that sufficient staff are available to meet the NHS’s needs now and in the future. Healthcare organisations should ensure that staff are present in appropriate numbers to provide safe care at all times and are well-supported’. ‘Boards and leaders of provider organisations should take responsibility for ensuring that clinical areas are adequately staffed in ways that take account of varying levels of patient acuity and dependency, and that are in accord with scientific evidence about adequate staffing’. Reference to NICE work and to staffing ratios

8. Hard Truths Department of Health response to the Francis Inquiry Hard Truths. The Journey to Putting Patients First; includes the requirement for that: ‘from April 2014, and by June 2014 at the latest, NHS Trusts will publish ward level information on whether they are meeting their staffing requirements. Actual versus planned nursing and midwifery staffing will be published every month; and every six months Trust boards will be required to undertake a detailed review of staffing using evidence based tools’.

9. Key Objectives of Action Area Five • Directors of Nursing to agree appropriate staffing levels through the application of evidence based tools • All nursing and midwifery staffing levels and quality experience metrics should be discussed at a public board meeting • Boards to sign off and publish evidence based staffing levels at least every six months, providing assurance regarding the impact on quality of care and patient experience • Monitoring of compliance (CQC, NTDA, Monitor, Contracts) • Work with NICE to establish adequate and appropriate staffing levels for all care settings

10. Key Objectives of Action Area Five • Develop Good Practice Guidance with National Quality Board • Undertake an assessment of ward or community nurse / midwifery leaders having a supervisory role • Directors of Nursing to undertake a review of options for each patient being allocated a named key nurse responsible for co-ordinating care • HEE leading the on values / HCSW workstreams (linked to Cavendish Review)

11. National Quality Board Guidance • Available at: • http://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf

12. Good Practice Guidance National Quality Board guidance published on 19/11/13 Includes ten expectations and twenty case studies Six themes – • Accountability and responsibility • Evidence-based decision making • Supporting and fostering a professional environment • Openness and transparency • Planning for future workforce requirements • Role of commissioning Work in progress with CQC regarding the monitoring of implementation of the expectations

13. Accountability and Responsibility • 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. • Processes are in place to enable staffing establishments to be met on a shift-to-shift basis.

14. Evidence-Based Decision Making 3. Evidence-based tools are used to inform nursing, midwifery and care staffing capacity and capability.

15. Supporting and Fostering a Professional Environment 4. Clinical and managerial leaders foster a culture of professionalism and responsiveness, where staff feel able to raise concerns. 5. A multi-professional approach is taken when setting nursing, midwifery and care staffing establishments. 6. Nurses, midwives and care staff have sufficient time to fulfil responsibilities that are additional to their direct caring duties.

16. Openness and Transparency 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. 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.

17. Planning for Future Workforce Requirements 9. Providers of NHS services take an active role in securing staff in line with their workforce requirements.

18. The Role of Commissioning 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.

19. Workforce Planning Tools Tools for Acute Care: Safer Nursing Care Tool guidance and multipliers updated in July 2013. Available at: http://shelfordgroup.org/resource/chief-nurses/safety-nursing-care-tool Work in progress to develop Safer Nursing Care Tool for AMUs / A&E / Children’s In-Patients / Older People’s care IPAD-APP in development to record SNCT acuity and dependency scores at the bedside and generate local reports – proof of concept stage

20. Workforce Planning Tools Tools for Maternity: Birthrate Plus - RCM published updated guidance in autumn 2013. Tools for Community: QNI have undertaken a review of existing tools(publication pending) Work being taken forward with NHS England Community Nursing Strategy Programme

21. Workforce Planning Tools Tools for Mental Health Two workshop sessions held Pilots of Dr Keith Hurst and NHSScotland tools Literature review commissioned Tools for Learning Disabilities Initial literature review undertaken Working with MH group on tools for in-patient settings (pilot as above) Focus on tools for LD care in community settings (nursing and social care workforce)

22. the tools in practice