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Delivering Care: Nurse Staffing in Northern Ireland WSCNTL 2014, Kings Hall Leading Care, Leading Teams - Innovating and Supporting Person-Centred Care Siobhan McIntyre Regional Lead Nurse Consultant PHA Chair of Delivering Care Regional Working Group Slide 2 Community Nursing Four key principles: Effectiveness: Timely access Integration: Collaborative multi-disciplinary working Efficiency: right person, right place, right time, right service, right outcome Expertise: Appropriately skilled Slide 3 Mapping the Change in Service Direction Reduction in inappropriate referral to hospital and NIAS Reduction in unscheduled care admissions Increased acute care delivery at home Consider the needs of the over 65yrs and patient groups for community acute care teams/triage and see and treat protocols. Have an agreed directory of service Expansion of 24 hour provision in primary care nursing Developing the right interfaces / secondary + primary care inc diagnostics Choice of preferred place of care for palliative patients Nurse led clinics across primary and secondary services Disease prevention and early intervention Increased technological interventions Slide 4 The Need to Transform Safe, effective, person centred care; Increased demand for efficiency and effectiveness; Changing population demographics; Working closely with GPs; Changing patterns of disease eHealth / Telehealth; Changing lifestyle; Changing public expectations; Inequalities in health; Reconciliation in demand, need & access. Slide 5 Commissioning Framework An integrated vision and framework will be developed and led by the PHA which outlines how district nursing services will be modelled across each HSCT; The framework will seek out evidenced based and good practice examples for district nursing services to support the targeting of resources at local and regional level. This will take cognisance of population needs and enhance delivery closer to home and improve health and social care outcomes and productivity; The framework will seek to capture the importance of technology and to promote more effective mobile working practices to support care delivery; The framework will be based on the principles for core district nurse services aligned to Gps 24 hour provision and the management of acutely ill patients in primary care. Slide 6 The planning, provision and evaluation of appropriate programmes of nursing care, particularly for people discharged from hospital and patients with complex needs; long-term conditions, those who have a disability, are frail or at the end of their life. (RCN, 2013) District nurses will be the key professionals involved in planning and providing this care within the following three care domains Acute care at home Complex care at home End of life care at home Slide 7 Slide 8 Workforce Planning in Nursing & Midwifery- whats happening in Northern Ireland 1.Policy/Strategy recommendations 2.DHSSPS Workforce Review 2014 3.Delivering care Regional Project for Normative Staffing 4.Caseload analysis for Community Nursing & Health Visiting 5.Clinical Nurse Specialist Job Plans 6.Community Information Systems 7.92% female, 44% part time 8.773.67 WTE district nursing staff across N.I. 9.Caseloads > 29,000 patients as at Dec 2013 10.Largest professional workforce in HSC 11.Responsible for continuous care provision 12. Delegate care to unregulated care workforce 13.Learning and development requirements > post registration qualifications > uptake on courses to meet TYC requirements 14.Professional and regulatory requirements Slide 9 Regional Policy and Strategy Transforming Your Care Quality 20:20 The Peoples Priorities A Partnership for Care Community indicators /caseload analysis Commissioning directions Integrated Care Partnerships. Evidence Base Related to Staffing Levels and Patient Outcomes Link to patient outcomes http://www.rn4cast.eu/en/index.phphttp://www.rn4cast.eu/en/index.php Evidence from Public Inquiries Francis Hine Inquiry Health Committee House of Commons Strategic Drivers Slide 10 Context High Quality care in community Improving and extending services Complexity of patients D/N qualification 20 % of the overall contacts Limited No of nurses Slide 11 To promote a shared understanding between professional, management, finance and human resources colleagues of the essential components to set and review nurse staffing establishments and when commissioning new services to provide safe, effective, person centred care. To support general and professional managers in presenting clearly the need for investment in nurse staffing, within changing service profiles, particularly in response to incremental service growth and TYC. As a reference document for the nurse staffing levels component within investment proposals. Why? Slide 12 Ref page 4, 2.10 It is anticipated that on occasion nurse staffing may be outside the normal range. In such cases the Executive Director of Nursing must provide assurances about the quality of nursing care to these patients, and the efficient use of resources through internal and external professional and other assurance frameworks. Why Define a Range? Reasonable starting point for conversation. Not as prescriptive as a ratio and for district nursing, it will be essential to consider cover and hours of service for the future model of service for an agreed population range. Slide 13 Steering Group Working Group Additional expertise as required Project Structure Slide 14 Who are the Partners? Project Aim PHA HSC Trusts DHSSPS HSCB HR Reps Staff side PCC To support the provision of quality care which is safe and effective in hospital and community settings through the development of a tool to determine staffing ranges for the nursing and midwifery workforce in a range of major specialities. Slide 15 Phase 1 Acute Hospital Settings Phase 2 Emergency Depts Phase 3 District Nursing Phase 4 Health Visiting Phases Slide 16 Slide 17 Underpinned by: Communiqus Literature reviews/searches Interviews with HSC Trust Assistant Directors responsible for nursing workforce Data gathering of current workforce and caseloads Gathering of international and national intelligence around workforce planning in nursing Development and production of Part 2 of a framework External Critical Review Engagement with stakeholders Process Slide 18 Slide 19 Slide 20 Assumptions of the Framework Staffing Ranges Delivering Care, Part 1 Slide 21 Assumptions of the Framework Key Performance IndicatorsPUAASkill MixManagement of RecruitmentInfluencing Factors Slide 22 Planned and Unplanned Absence Allowance What is it? Periods of absence from work, which can be described as anticipated and, therefore, must be factored into the workforce planning process. Comprises: Annual leave Sickness absence Study leave Evidence base: Telford (1979) Other professions: Consultant Contract Framework (2003), BASW, UK Supervision Policy (2011) Auditor General Scotland (2002) Slide 23 Planned and Unplanned Absence Allowance What has changed since 2002? Annual leave: Overall net increase of 16% following Agenda for Change Study Leave 56% full time, 44% part time Increased intensity and complexity of patient care practice and competence training needs significantly increased Statutory/mandatory training Professional/regulatory updates and training in relation to pre- registration nursing and midwifery mentorship Professional supervision Slide 24 Planned and Unplanned Absence Allowance YearAnnual Leave: Sick Leave:Study Leave: Total Allowance 201215%5%4%24% So.......? YearAnnual Leave: Sick Leave:Study Leave: Total Allowance 200213.5%5.5%3%22% Slide 25 Workforce Activity Environment and Support Professional Regulatory Activity Influencing Factors Competence skill set to work flexibly Management of absenteeism Constitution of district nursing teams Caseload activity Referral rates Visiting patterns 24 hour services Throughput Acuity/Dependency Seasonal Variations Geographical areas Location of care Population sizes GP attachment Skill mix Compliance with professional regulatory standards Supervision / Training Accountability and governance requirements Slide 26 Key Issues Need to understand how the district nursing service has developed Review the integration of multi-disciplinary working Need to review the alignment of core district nurses to GP practices Requirement to enhance practice knowledge and specialist skills Develop workforce planning methods Slide 27 Progress Population and caseload management Consistent Data/activity collection Support and care for patients who are unwell, recovering at home End of life/palliative care 24 hour provision Acute care at home Support and care for independence Promotion of technology and LTC Peer Review / Expert Reference Groups Users views of the service Communication and Dissemination Slide 28 Measuring Impact and Enhancing the Patient Experience District nurses : contributing to population health needs leading care and contributing to healthy communities working in partnership with social care enhancing the quality of care. contributing to enhancing the patient experience Slide 29 Key Performance Indicators Phase 1 Organisational: absence rates within nursing and midwifery teams; normative staffing ranges - including vacancy rates. Safe and Effective Care: incidence of pressure ulcers falls omitted or delayed medications Patient Experience: consistent delivery of nursing/midwifery care against identified need involvement of the person receiving care in decisions made about their nursing/midwifery care time spent by nurses and midwives with the patient Should quality indicators begin to fall below the accepted level of achievement, staffing levels should be reviewed as one of the lines of enquiry of attributable causes. Slide 30 Process for Phase 3 To conduct an academic literature review on district nursing workforce models; To build on the work already collated with HSCTs from Ecats; To build on the commissioning framework developed for district nursing in Northern Ireland; To liaise with key partners re critical success factors for training and development; To agree a regional workforce and caseload range for district nursing in Northern Ireland; To agree the influencing factors as they relate to district nursing practice; To agree service definitions; To agree KPIs as they will relate to the workforce planning framework for District Nursing; To set up user feedback forums for the project. Slide 31 Slide 32 Slide 33 Thank you Siobhan.mcintyre@hscni.net Telephone ; 02871860086 Mobile; 07818556161