1. Safe Staffing NQB Report - October 2014 Presentation for Trust Board December 2014 Fiona Hyett Deputy Director of Nursing

2. Monthly Comparisons – Actual Staffing Levels Registered NursesNursing AssistantsCombined Planned Skill Mix Actual Skill Mix PA%PA%PA% 55279.555873.61013409435411.5103.989373.591285.110270306832

3. Overview of Nurse Staffing Hours – October 2014 The percentage hours are based on actual versus planned and are measured on a shift by shift basis. RNNA Total Planned hours (day shift)3380922298 Total Actual hours (day shift)34222.923024.8 Percentage101.2%103.3% Total Planned hours (night shift)21470.511796 Total Actual hours (night shift)21650.712386.7 Percentage100.8%105%

4. Nursing Hours by Day Shifts RN hours requiredRN hours filled% RN hours filledCA hours requiredCA hours filled% CA hours filled Medicine13695.813837.31101.0%10193.2511051.26108.4% Durrington1195.251227.25102.7%869.51159.5133.4% Emergency Department356.5 100.0%356.5 100.0% Farley Ward1919.71846.4596.2%14901777.5119.3% Hospice941942100.1%657.5685.75104.3% Pembroke Ward816819.5100.4%44644599.8% Pitton Ward1424.11369.3596.2%11311088.2696.2% Redlynch Ward1573.5145992.7%11651235106.0% Tisbury Ward2099.45198694.6%707.75598.7584.6% Whiteparish Ward1695.81931113.9%108898290.3% Winterslow Suite1674.51900.26113.5%22822723119.3% Surgery6651.56242.8593.9%2745.52416.7588.0% Britford Ward21852286104.6%11631086.593.4% Downton Ward1402.51430.35102.0%1180.51020.2586.4% Radnor30642526.582.5%40231077.1% Clinical Support3914.54414.25112.8%1966.5157580.1% Maternity22312409108.0%1299.51106.2585.1% NICU7131019.25143.0%356.5170.2547.8% Sarum Ward970.5986101.6%310.5298.596.1% Musculo-Skeletal9547.319728.5101.9%7392.827981.84108.0% Amesbury Suite1841.751748.594.9%15871517.6195.6% Avon Ward1430.611327.8592.8%1501.621832.11122.0% Burns Unit14812207.25149.0%543505.893.1% Chilmark Suite1540.751505.2997.7%1127.251516.07134.5% Laverstock Ward1864.25179496.2%1096.599490.7% Tamar Ward1388.951145.6182.5%1537.451616.25105.1% Grand Total33809.1134222.91101.2%22298.0723024.85103.3%

5. Nursing Hours by Night Shifts RN hours requiredRN hours filled% RN hours filledCA hours requiredCA hours filled% CA hours filled Medicine9339.5916698.1%5475.56380116.5% Durrington655.5701.5107.0%713655.591.9% Emergency Department356.5 100.0%356.5 100.0% Farley Ward1069.51081101.1%713703.598.7% Hospice484.5532109.8%48544992.6% Pembroke Ward713 100.0%043#DIV/0! Pitton Ward1069.587381.6%713931.5130.6% Redlynch Ward1069.5103596.8%356.5470131.8% Tisbury Ward1426140398.4%356.5333.593.5% Whiteparish Ward14261413.599.1%713 100.0% Winterslow Suite1069.51057.598.9%10691724.5161.3% Surgery4390.53976.590.6%850942.5110.9% Britford Ward930940101.1%540570105.6% Downton Ward62061098.4%310372.5120.2% Radnor2840.52426.585.4%00#DIV/0! Clinical Support40024077101.9%17481185.2567.8% Maternity2495.52225.589.2%1069.5881.7582.4% NICU713885.5124.2%356.518451.6% Sarum Ward793.5966121.7%322119.537.1% Musculo-Skeletal3738.54431.21118.5%3722.53879104.2% Amesbury Suite58957497.5%883.5 100.0% Avon Ward550729.25132.6%90081090.0% Burns Unit620.51168.33188.3%310 100.0% Chilmark Suite589598.13101.6%589861146.2% Laverstock Ward770740.596.2%430405.594.3% Tamar Ward620621100.2%61060999.8% Grand Total21470.521650.71100.8%1179612386.75105.0%

6. Overview of Areas with Red/Amber FlagWard%RNNAShiftMitigation RedRadnor77.1√DaySmall number of NAs used RedNICU47.8√DaySmall number of NAs used (over on RNs) RedNICU51.6√NightSmall number of NAs used RedSarum37.1 √ NightSmall number of NAs used (over on RNs) AmberDownton86.4√DayHigh threshold for use of agency AmberTisbury84.6√DayHigh threshold for use of agency AmberMaternity85.1√DaySmall numbers of MAs used AmberRadnor82.5√DayLower numbers of patients (all staffing appropriate) AmberTamar82.5√DayAdditional RN shifts not always filled (NAs 105%) AmberPitton81.6√Night 3 rd RN replaced by NA if unable to fill with RN (NAs 130%) AmberRadnor85.4√NightLower numbers of patients (all staffing appropriate) AmberMaternity89.2√NightEscalation of staffing to cover gaps AmberMaternity82.4√NightLow numbers of MAs used NB: Flags based on green 90% and above, amber 80-90%, red below 80% - no ratings yet agreed by NHS England

7. Mitigation of Risk There are several wards this month flagging amber/red against our internal measures. Vacancies remain high in medicine and MSK– newly qualified nurses commenced end of September, and overseas recruitment being planned. All shifts are assessed daily by Directorate Senior Nurses to ensure they are safe. Maternity has had high sickness levels, internal escalation process used NA usage has remained lower reflected in the continued lower spend on specials this month. Agency fill rates have been challenging but all shifts are assessed daily by Directorate Senior Nurses to ensure they are safe. Wards often use staff on long days to cover 2 shifts – ward has the required level of staff but uses less hours resulting in shortfall in actual hours. DSNs monitoring to ensure appropriate numbers on shift.

8. Actions taken to mitigate risk Patient acuity assessed for staffing levels by individual wards by nurse in charge Trust wide staffing levels assessed against patient acuity and staff moved across wards by Directorate Senior Nurses and Clinical Site Team as required Staffing levels reduced when beds empty/ procedure lists reduced whilst maintaining appropriate staffing ratios Staff on training days brought back to work clinically as required Sisters on management days work clinically Additional NAs rostered to support unfilled RN shifts CCOT team support wards where acuity of patients high