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Safer Staffing The Right Staff, with the Right Skills, in the Right Place at the Right Time Sara Courtney – Head of Professions SEISD Wider Policy Context Francis Recommendations Evidence to the inquiry suggested that the Trust did not have reliable nursing establishment figures 23 – 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 mix 195 – Nurse ward managers should operate in supervisory capacity, visible to patients and staff, role model and mentor 205 – Seek and record the advice of Nursing Director on quality and safety on major change 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 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 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’. National Quality Board Guidance Available at: http://www.england.nhs.uk/wpcontent/uploads/2013/11/nqb-how-toguid.pdf Good Practice Guidance 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 Accountability and Responsibility 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 2. Processes are in place to enable staffing establishments to be met on a shift-to-shift basis Full Trust Board Accountability SitRep Pilot in SEISD in April 2014 – purpose emergency planning Roll Out to whole Trust 30th May 2014 – with adapted staffing metrics to meet daily safer staffing requirements Eroster in use but not fully utilised NHSP Bank and Agency Evidence-Based Decision Making 3. Evidence-based tools are used to inform nursing, midwifery and care staffing capacity and capability. AUKUH adaptation 1st Measures commence in May 2014 for Adult Inpatient Services Working with Professor Keith Hurst – advisor to NHS England – to develop ICT Tool NICE publication due 2015 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 Trust Policies in place Leadership development being rolled out Duty of Candour, open culture being developed Positive mdt engagement in some teams Critical time balance between frontline clinical, managerial and governance 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. 1st Board Paper to go to Trust Board in June 2014 Monthly SitRep report will be available from June 2014 – and published on Trust website and NHS Choices Divisional escalation SOPs in draft form March 31st Safer Staffing Census highlighted 26/146 teams with high ‘planned v actual’ gaps – being investigated by HoP Staffing levels are being displayed as calendar crosses for all inpatient units Planning for Future Workforce Requirements 9. Providers of NHS services take an active role in securing staff in line with their workforce requirements Trust recruitment and retention plans Some recruitment and retention challenges in certain specialities ICT model developing well in some areas, with redesign of roles and Professional Boundaries The Role of Commissioning ole 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. Safer Staffing is part of 14/15 Quality Contracts for all Divisions CQC, Monitor and the TDA, as well as Commissioners (local and specialist), have agreed to the National Quality Board approach to Safer Staffing requirements Challenges Trust Lead Project Management time Administrative Support (Project Board meetings, agendas, minutes, etc) Tight Publication timescales – SHFT ‘starting from scratch’ Dedicated representative at the Project Board meetings – Divisional and Support Services required