NHS East London: Safer staffing levels

Many organisations, like East London NHS FT (ELFT) publish information about their staffing in terms of 'fill rates' - the difference between planned and actual staffing - and also using 'Care Hours Per Patient Day' (CHPPD). However, as can be seen by the published data, this doesn't really tell us very much about staffing capacity or capability, more whether there were more or less staff on the units than planned in the roster - and in the majority of cases in ELFT this shows that the units were 'over-filled' with staff i.e. more staff than planned were distributed to each area. So, this begs the question whether the plan was right in the first place?

If we wind our memories back to the Keogh Mortality Review, there was a recommended ambition that "nurse staffing levels and skill mix will appropriately reflect the caseload and the severity of illness of the patients they are caring for and be transparently reported by trust boards." It is hard to see how data on over- or under- filling against a roster gives transparency to the board if they do not know what was being filled in the first place, or on the acuity and dependency of the patients being cared for. 

The NQB guidance, first published in 2013, was updated in July 2016 with additional guidance to help organisations think about their workforce to include questions and inclusion of outcome measures and measures of patient safety https://www.england.nhs.uk/wp-content/uploads/2013/04/nqb-guidance.pdf  

We need to remember that the purpose of the recommended bi-annual establishment review is to ensure that the Executive Board is satisfied that nursing and midwifery staffing is set at an appropriate level to deliver safe care. This does not mean that we should not monitor our fill-rates and CHPPD monthly, but does mean that we need to be sure that our workforce plan is appropriate through understanding and comparing our levels of care both internally and with peers, looking at our outcome measures, and through thinking about the training and skills that are required now and into the future so our staff both within and outside of organisational boundaries have the skills, capability, capacity and support to deliver great, safe, person centred care whatever the setting.