NURSING COST SCRUTINY AND SKILL MIX REVIEW

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NURSING COST SCRUTINY AND SKILL MIX REVIEW

• TRICIA HART
• DIRECTOR OF NURSING
• January 2006

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NURSING WORKFORCE

• The capacity of the nursing workforce to provide
  good quality care does not depend solely on
  numbers of staff in post

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The following considerations are of fundamental
importance

• Systems of professional education, practice and
  accountability must respond to public
  expectations of safe, good quality nursing care
• The nursing needs of patients and their carers
  must be assessed systematically by nurses
  themselves
• Organisational culture should promote a whole
  systems approach to patient and staff safety
• Local decisions about nursing skill mix should be
  based upon agreement between the profession and
  employers about different nursing roles and
  levels of practice
• Clinical leaders must acquire the skills to plan
  and manage the nursing workforce effectively in
  the interests of good quality care and high staff
  morale

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PROGRAMME MANAGEMENT STRUCTURE
REVIEW ROLES AND RESPONSIBILITIES OF CLINICAL
MATRONS Chair Alison Smith
REVIEW OF THEATRES NURSING ESTABLISHMENTS Chair
Kath Martin
INPATIENT WARD NURSING ESTABLISHMENTS Chair
Anne Sutcliffe
NURSING COST SCRUTINY AND SKILL MIX
REVIEW NURSING AND MIDWIFERY GOVERNANCE
COMMITTEE (Programme Board)
REVIEW OF ACCIDENT AND EMERGENCY NURSING
ESTABLISHMENT Chair Janice Partlett
OUTPATIENTS NURSING ESTABLISHMENTS Chair Gill
Tarry
REVIEW SPECIALIST NURSES ROLES AND
RESPONSIBILITIES Chair Tricia Hart
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OUTPATIENTS REVIEW

• The aim was to ascertain the establishment
  and skill mix of nursing teams within outpatient
  departments across the Trust
• Main Findings
• Significant differences in terms of the make up
  of nursing teams in out patient departments
  throughout the Trust
• Differing organisational structures within
  departments resulted in credible internal
  benchmarking impossible
• The lack of a recognised model for estimating
  size and mix of nursing teams
• Main Recommendations
• Agree a model whereby non registered staff are
  the default with an escalation to registered
  staff depending on clinical need

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SPECIALIST NURSES REVIEW

• No central database
• Lack of equity in title, responsibilities,
  academic achievement, workload and remuneration
• Differences within the organisation in respect of
  position in organisational structures
• Lack of assurance for reporting arrangements,
  appraisal and professional development
• Recommend generic title, core person
  specification and ensure the four common
  components of specialist nurse role included in
  all job descriptions

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SPECIALIST NURSES REVIEW

• Establish current database - each DLN to inform
  the deputy chair of specialist nurses in
  respective divisions by end November 2005
• Director of Nursing to be informed of any future
  specialist nurse appointments
• Further work to be completed on KSF post outline
  to enable staff development review process
• Further consideration to be given to remaining
  nursing titles for some post-holders
• Project group to complete all objectives by March
  2006

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AE REVIEW

• Total attendances in 2002 was 60000 increasing to
  85000 in 2004 with no increase in nursing numbers
• All objective measures confirm significant
  shortfall in nursing staff against national
  benchmarks
• Constant pressure of Department of Health driven
  AE performance targets (984 hour)
• Quality indicators from Audit Commission show
  failure to reach national standards
• Case mix changes due to Tees Valley Trauma Centre
  status and impact of air ambulance

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THEATRES REVIEW

• Inconsistencies in establishment calculation
  both within Trust and externally
• Theatre efficiency to be recognised within Trust
  as central to performance
• Link efficiency with service redesign e.g.
  Theatre session time flexible to allow for
  complexity of case mix
• Post op recovery risk at peak times             
• Recommend annual realignment of ALL
  theatre staffing to achieve optimum utilisation
• Development of workforce plan in progress to
  reflect additional capacity requirements
• Case complexity/high turnover list
•      

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CLINICAL MATRONS ROLE REVIEW

• 24 Matrons across the organisation
• Roles and responsibilities currently vary
  enormously throughout the organisation- staff
  responsibilities, pay, areas of responsibilities
  and main focus of roles vary according to
  Divisional / Directorate need unworkable
• Proposed clinical model focusing clearly on
  outcomes in line with the DOH 10 key
  responsibilities (NHS Plan)
• 10 Key roles
• Making sure patients get quality care
• Ensuring staffing is appropriate to patient needs
• Empowering nurses to take on a wide range of
  clinical tasks
• Leading by example
• Improving hospital cleanliness
• Ensuring patients nutritional needs are met
• Improving wards for patients
• Making sure that patients are treated with
  respect
• Preventing hospital acquired infection
• Resolving problems for patients and their
  relatives by building closer relationships

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CLINICAL MATRONS ROLE REVIEW

• Proposed generic job description and KSF now
  developed pending final approval
• Proposed training programme for Clinical Matrons
  across the organisation now developed pending
  final approval
• Proposed induction and training programme for new
  Matrons now developed pending final approval
• Further discussion needs to take place about the
  number of Matrons needed across the organisation
• Future work Trust wide evaluation of the impact
  of the Clinical Matron across the organisation

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INPATIENT REVIEW

• Keith Hurst model June 2004
• Re run August 05 using June 05 budget reports
  for staff in post
• Keith Hurst model updated 2005
• Recommended skill mix 7030 in many areas
• Keith Hurst model used for all inpatient areas
  (excluding critical care)
• Reports prepared by ward detailing recommended
  staffing levels and skill mix and in-post
  levels and skill mix
• Potential savings or additional costs
  identified by ward and division
• Oct/Nov 05 Director of Nursing met will all
  divisions proposed 6040 skill mix based on total
  numbers recommended in Keith Hurst model

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NEXT STEPS

• All project groups will continue to feedback
  their ongoing work to the NMGC on a monthly
  basis
• New projects have started which include
• Training and development of non registered staff
• Development of clinical supervision
• Development of rotational posts
• Workforce model will be led by Director of
  Nursing with support from Director of HR
• Clinical Matron model in place by 1 April 06
• Outpatient model and work completed by April 06