We will have zero nursing agency hours on October 31st€¦ · Standard number of Bank shifts per...
Transcript of We will have zero nursing agency hours on October 31st€¦ · Standard number of Bank shifts per...
People: at the heart of healthcare Allocate User Group Conference BIRMINGHAM 2015
We will have zero nursing agency hours on October 31st
Cambridge University Hospitals NHS Foundation Trust Julie Chapman (Head of Resourcing)
presented by Sarah Raper
Zero hours by October 31st
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5/20
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08/0
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05/0
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03/0
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10/0
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28/0
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02/1
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Axis
Titl
e
Agency Filled Shifts Since 01 May
Early
Late
Long Day
Night
Twilight
Total
Zero hours by October 31st (daily data pulled from BankStaff)
800 general inpatient beds +/- 30 GP clinic in the A&E In 2 years we have decreased inpatient bed numbers and increased <23 hours stays. Also have Maternity Hospital & neonatal ICU Regional trauma centre and research centre Last year equivalent of 9 out of 10 people in Cambridge came through the doors We use Healthroster, BankStaff and EOL
Cambridge University Hospitals
2973 RNs (1084 also have Bank registration) 1331 HCSWs (270 also have Bank registration) 170 Bank only RNs and 517 bank only HCSWs
Nurse numbers
We have not done anything exceptional! Yet we have maintained and built on any improvements in Nursing Agency usage We have a well publicised financial position which has meant we had no option !! We are not in an ideal position, and will have to work hard, creatively and rationally to have enough nurses/ODP’s to maintain our current status Currently – we have closed 2 ICU Use every report we can out of Healthroster and Bankstaff We look at the detail of everything
What we have done
During autumn 2014 agency use increased as we implemented EPIC which had a major effect on the Trust as substantive staff were pulled to support areas as super users and Bank shifts increased to 7000 a week.
Other factors
E-hospital launch effect
Our Recruitment services and Staff Bank services teams combined to manage all recruitment for both Bank and Substantive staff. An experienced Roster Support team provide back up and work with these teams and all Healthroster users.
Other factors
For most of 2013/14 our clinical agency use was very limited. Staffing issues were raised in early 2014 which saw the Trust start to use agency workers again as Bank shifts increased to unprecedented levels. We set up a Taskforce with senior nurses of the Trust which continues to meet weekly.
RN Agency usage
Standard number of Bank shifts per week varies between 2800-3000 clinical shifts currently Agency requests sits only with the Bank services team and on-call Head of Nursing, so all requests are made to Bank, then there is a corporate discussion and decision to go to Agency. So we went back to the start and looked at all Bank requests and put the monitoring and controls in
Bank Usage
We quickly set up EU and overseas campaigns to ensure as we headed towards winter we would have staff available. Campaigns were organised to the Philippines, Spain, Italy, Romania, Portugal, Ireland and more latterly to Greece. It is important to understand that it is unlikely that those recruited will be able to start sooner than 4 months post interview due to pre-employment checks and NMC registration.
A number of nurses are from the Philippines who needed to undertake an overseas nurse programme which we quickly established.
Additional Recruitment actions
We have recruited an additional 340 nurses in the last 15 months which is 10% more than the year before in terms of establishment. We have had month on month increase in headcount since April 2015
Substantive RN increase
We implemented a process for all nurses to have registration on to the Bank immediately - automatic Bank registration (at Band 5 or 2) on substantive employment, unless opt out All shifts requested to Bank are standard either B2 or B5, only in exceptional circumstances (eg take charge cover) is Band 6 offered. Divisions cross cover to provide senior cover in absence where ever possible.
Bank registration
Utilising online self booking via EOL we went live with this in June
All Band 2 and Band 5 staff paid at current point (or years in service) We offered additional enhancements for specific Bank staff during early 2015 for both nursing and HCSWs.
Bank enhancements
Early – 25% Late – 50% Night and
weekends 20% As the fill rate went down the enhancement increased to a maximum of 100%
(eg 60% Sunday and 40% extra on standard hours). Applied for 3 shifts - reassessed and amended.
Pool Enhancement increases
Daily bed meetings Cross division review There was an escalation process for Divisional Heads of Nursing to use at bed meetings (now superceded) We have a pool of nurses on each shift for allocation each shift (this is staffed from the Bank)
Daily reviews
Escalation process
Reporting out of the system we have became essential Most reports we dump out data and pivot We report anything from daily to 6 month reviews Clinical nursing is the emphasis, but starting to look at all staff groups
Daily reporting
Actual assigned
12th Oct 13th Oct 14th Oct 15th Oct 16th Oct 17th Oct 18th Oct Weekly shift %
Registered E 377 386 379 377 373 329 319 2540
% filled 93.8% 96.0% 94.3% 93.8% 92.8% 94.0% 96.4% 94.4%
L 344 360 356 355 343 298 303 2359
% filled 93.0% 97.3% 96.2% 95.9% 92.7% 92.3% 96.5% 94.9%
N 239 243 241 239 237 245 228 1672
% filled 89.8% 91.4% 90.6% 89.8% 90.8% 94.2% 89.1% 90.8%
Unregistered E 184 187 185 183 192 149 144 1224
% filled 96.8% 98.4% 97.4% 96.3% 101.1% 103.5% 102.1% 99.1%
L 149 156 155 160 163 135 136 1054
% filled 97.4% 102.0% 101.3% 104.6% 106.5% 104.7% 107.1% 103.2%
N 99 100 98 99 97 98 91 682
% filled 101.0% 102.0% 100.0% 101.0% 101.0% 103.2% 96.8% 100.7%
Overall% filled
E 94.8% 96.8% 95.3% 94.6% 95.4% 96.8% 98.1%
L 94.3% 98.7% 97.7% 98.5% 96.7% 95.8% 99.5%
N 92.9% 94.2% 93.1% 92.9% 93.6% 96.6% 91.1%
Daily status 94.1% 96.8% 95.6% 95.5% 95.4% 96.4% 96.7%
Daily headcount report
This year we have undertaken a careful review of all Bank requests. We do not have second level approval, but we do feedback and challenge at divisional meetings Every additional shift sent to Bank (excepting specialling requests) goes to high level review and are approved or declined
Bank requests
Weekly RN Bank and Agency Requests and Filled Shifts
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500
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3000
Sep 2014
Oct 2014
Nov 2014
Dec 2014
Jan 2015
Feb 2015
Mar 2015
Apr 2015
May 2015
Jun 2015
Jul 2015
Aug 2015
Total Requests
Total filled
Bank Filled
Agency Filled
We started to look at projections and retention rates in much more detail to look at our needs going forward
Actions
We increased our assessment/recruitment days for HCSWs which has seen a decrease in our vacancy rates – our pipeline reporting shows actual and planned substantive and Bank starters
Actions
In the pipeline HCA starters Oct-Dec 2015 Actual HCA Starters
Div A 22 Month Overall Permanent Bank
Div B 8 January 29 15 14
Div C 29 February 30 20 10
Div D 40 March 53 24 29
Div E 2 April 34 21 13
Total Permanent 101 May 33 20 13
Total Bank 25 June 26 12 14
July 36 12 24
August 39 15 24
September 28 20 8
Pipeline reporting
Full establishment review ESR, finance, Healthroster all match !! Reporting and challenge sessions by division
add duties, Bank request reasons, unused hours, cancelling unrequired demand, publishing on schedule Whilst I feel like we have been doing this stuff for a while now it is sticking!
Using the Allocate Insight report to highlight the issues we need to work on
General actions
Insight report – how we compare to Trusts who use Additional duties
Unfilled Duty Hours % Issues highlighted in Insight report
Generally units are below the average and performing well
Small number of outliers skewing average figures.
0.0%
1.0%
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8.0%
April 6th May 4th June 1st June 29th July 27th Aug 24th
Average
Average
Unused hours for clinical rosters
Approval lead time
Just to prove it is not going elsewhere
And that we are leaving our rosters unfilled
We are in a difficult but not necessarily unusual position We may have to make hard decisions on whether close beds or reconfigure services Report and challenge culture becoming the normal We continue to have a robust calendar of EU campaigns for 2015/2016 so we don’t take our eye off the ball.
Ongoing work and plans
Next time we have our report we should have disappeared off the chart!