Update re Safe Staffing September 2016 Agenda item 4(iv): Appendix A Update re Safe Staffing September 2016

Recent Publications Lord Carter Of Coles (Feb 2016) Operational productivity and performance in English NHS acute hospitals: Unwarranted variations July 2016- Model Hospital Nursing Dashboard Good Practice Guide: Rostering (June 2016) NQB (July2016) Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time. Safe sustainable and productive staffing Focus on Nursing & Midwifery …….other professions to follow…..

Lord Carter of Coles Report Care Hours per Patient Day (CHPPD) This has been reported to NHS Choices since June and is to become the principle measure of nursing and care deployment. Derived from planned and actual staffing E- Rostering Hospitals required to have a firmer grip on e-rostering Enhanced Care Review systems and processes going to develop a Good Practice Guide. We have Levels of Safe Supervision flowchart and Care Plan for Level D The Model Hospital Metrics dashboard, national publication. Actual and comparative data by Ward. Nurse staffing metrics include; CHPPD Sickness and absence rates, average shift fill rates, training variance from budget, % harm free care. (April 2017) NHS Improvement, also tracking cost of care. This report covers a wide range of recommendations to improve efficiency across all areas in Hospitals but the areas specifically for Nursing and Midwifery staffing are.

Good Practice Guide: Rostering This identifies e-rostering needs to be used to its full potential and Trusts need to have a robust policy with KPI’s Headroom and usage of annual leave 6 week roster approval rates Lost contracted hours not used per month Additional shifts and reason for booking Working restrictions – flexible working 6 monthly review Auto roster percentage enabled Number of Bank requests to the total bank hours worked Number of Bank requests on weekend and night duties. Monitoring…… Appropriate headroom 18.5 – 28% across Carter reviewed Trust ours is 20% Flexible working includes staff who cant work a particular day or shift do we follow flexible working policy for all? Annual leave distributed evenly throughout the year, should fit in headroom our uplift allows 14 % leave Policy to include rules eg shift patterns, swapping shifts etc Roster policy checklist performed to identify gaps

NQB Expectations Right staff - Annual review using; evidence based tools, Professional body guidance, workforce tools, Professional Judgement, benchmarking taking into account adequate ‘uplift’. Right Skills - Sufficient ‘uplift’ for mandatory training/ training, competency based assessments, training needs analysis. Good leadership with Sisters Supervisory time. New roles, skill mix , multidisciplinary team working. Recruitment and retention strategies mindful of generational differences. Right Place and Time – lean working, optimise patient flow, monitoring of staffing ‘real time’ throughout the day, reduce Agency usage, work with Commissioners and Health Education England re workforce plans

What the Trust is doing to meet these expectations Business Case re electronic rostering system Review of Rostering policy Providing information to NHS Improvement who are developing Model Hospital Dashboard Access for Trust staff to data Levels of Safe Supervision Care Plan and Directorate assurance sheet Propose annual review of staffing all areas