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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Axis

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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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Jan 2015

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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.

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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!