Staff Benchmarking Does this add value and should we pursue this more widely? Francis Thompson West London Mental Health Trust

National context  NHS Constitution, NHS Act and one of the six essential CQC standards place a duty on Trusts to ensure that staffing levels are adequate;  Francis (no not me);  Prime Minister’s commission;  The Centre for Social Justice (2011) argue that all acute inpatient wards should be seen as specialist areas and staffed accordingly;  Increasing acuity (HTT);  The Royal College of Nursing (2007) survey RMN’s showed that two thirds deemed inpatient staffing to be too low and 42% felt that staffing levels compromised patient care at least once per week.

Local Context - Lack of easily identifiable information at a Trust level and concerns re acute unit staffing; - Concerns re differences in staffing between units; - Concerns re differences in staffing between units; - CQC concerns; - CQC concerns; - Lack of clarity regarding safe staffing levels and lack of a recognised way to measure staffing needs; - Lack of clarity regarding safe staffing levels and lack of a recognised way to measure staffing needs; - Context of financial savings. - Context of financial savings.

What we did and some caveats “Oh, people can come up with statistics to prove anything. 14% of people know that.”14%

Trust data

Staffing data admission and recovery wards

Local comparisons recovery wards wards

Points to note  Disparities noted between wards inside Trusts in both the areas I have carried out this work;  Particular differences noted in availability of 9-5 staff;  Need to include other available resources for a robust comparison e.g. OT resource etc and this is not easy to gather;  It did enable a high level discussion on staffing and noted some other local interesting points…..

Potential benefits -Provides some assurance regarding staffing levels locally and compared to other Trusts; -Good intelligence to support workforce planning; -Lever to raise quality issues and argue for budget protection/enhancement; -May improve patient care/experience if numbers felt to be below par; -Raises unit staffing to board level; -Opportune time given national drivers.

Risks  Biggest risk - no benchmark to measure against – what if we are all too high or low??;  May be inadvertently be used as quality measure;  Crude - difficult to compare units in different contexts and areas;  If not done carefully may isolate nursing numbers from other MDT input;  Complexity of data collection and peripherals such as bleep holders;  Data may be felt to be sensitive by Trusts;  Financial implications of having comparatively lower staffing;  Can the numbers influence change?  Constant flux and change – this will only ever be a snapshot.

Points for discussion  Given the risk, benefits and complexity is this worth pursuing?  If so is this better done locally or more broadly?  What could be done with the outcomes? Would this lead to rigidity?  If this is pursued it would only be a snapshot and timeframes and shared data tool would need to be developed.

 Any more thoughts, comments or questions?  Any more?