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From April 2014 it became a national requirement for all
hospitals to publish information about staffing levels on wards, providing the
percentage of shifts meeting safe staffing guidelines. This initiative is part of the NHS response
to the Francis Report which called for greater openness and transparency in the
health service. Information about staffing levels for our community hospital is
published monthly and full details are discussed at our Board Meetings.
Staffing Levels - Safer Staffing - one element of our work in ensuring we provide
safe care is that we routinely and systematically review our staffing levels.
This takes place in all of our services but is formalised within our Community
Hospitals as part of national reporting on hospital staffing levels following
the learning from the Mid Staffordshire failures.
Safer staffing relates to many
different components that includes good recruitment and retention processes,
accessible and relevant training in addition to robust appraisals, performance
assessment and feedback. For the purposes of ensuring that hospital wards have
the right people with the right skills in the right place and time, all
hospitals are required to publish their nursing ‘fill-rate’.
Planned Staff - in order to determine the number of staff required for each shift,
ACE uses a validated tool that considers patient age, condition and need i.e.
their dependency, combined with the number of beds on each ward. The
calculation of staff required is then reviewed to take into consideration local
knowledge i.e. seasonal variances to demand for beds or community in-reach
services. The outcome of this provides the ward manager with the numbers of
staff they need to rota each day in order to care for their patients – this is their planned staff numbers.
The process of using the validated
tool occurs every 6 months in order to secure stability of staffing numbers,
however, the ward manager carefully considers the needs of the patients
throughout every day and will increase; or on occasion, decrease the staff
numbers if required. This enables both flexibility of staffing and best use of
Actual Staff - the staff on duty each shift is
recorded and monitored for any gaps. Any duty unfilled for example be staff
calling in sick at short notice will be filled by bank or agency staff if the
ward manager feels that the patient needs cannot be met by those staff already
At the end of every day the actual
staff on duty is compared with the staff planned to be on duty which gives us
A nationally mandated tool is used to
calculate the average fill-rate for the month. The ‘fill-rate’ tells us
in percentage terms not only our actual compared with planned staffing for day
and night shifts, but is broken down further by registered and unregistered
staff. This is important because we can see what the skills are available for
each shift too.
All health care organisations are
using validated tools and reviewing staffing levels as described above but
there is no national benchmark data yet with regards to the tolerance level
above or below 100% for fill rate.
There may be legitimate occasions
when the fill rate will be above or below 100% without compromising patient
safety or poor use of resources e.g. intense nursing needs over and above those
that are planned i.e. this will take the fill rate above 100% or unfilled beds
which may take the fill rate below 100%.
ACE Safer Staffing – August 2016 Fill Rates
Grant Rehabilitation Unit (22 beds and 10 beds commissioned for stroke) is
provided to meet individual needs of patients recovering from stroke,
orthopedic surgery and related mobility conditions.
St Osyth Priory Ward has 15 beds and
provides admission avoidance inpatient short stay.
Trinity ward has 21 beds for the
provision of rehabilitation.