AH ANNUAL REPORT 2018

Recommendations

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In November 2017, the National Quality Board (NQB) published improvement tools specifically for the care of children and neonates: Safe, Sustainable and Productive Staffing: An improvement resource for children and young people’s in-patient wards in acute hospitals / neonatal care. The improvement resources are based on the 2013 NQB guide to nursing, midwifery and care staffing capacity and capability that sets out the need for safe, effective, caring, responsive and well led care, on a sustainable basis, that ensures the right staff with the right skills are in place the right place at the right time. The Trust is undertaking a review of all ward establishments in line with this new guidance which will be reported to the Trust Board. In line with Department of Health Hard Truths Commitments (2013), all trusts are mandated to provide nurse staffing information on a monthly return via the National Reporting and Learning System and publish this data at ward level and make the information available to the public. The Trust is compliant with submitting data to the public through NHS Choices, on the Alder Hey website, and at ward level. A monthly ward fill rate of 90% and over is considered acceptable nationally. Fill rates for 2017 demonstrated that the overall staffing level was consistently higher than 93% throughout the year. The staffing levels reported are the head count on each shift which does not analyse skill mix or the impact of temporary staff on a shift. The Trust has continued to successfully recruit to vacancies through collaborative working with our education providers, national recruitment days and bespoke recruitment in specialty areas. Additionally there has been a key focus on reducing the use of agency staff, which in addition to reducing expenditure, also provides safer nursing care with staff employed directly by the Trust. Use of nurse agency staff has continued to be low in 2017 with virtually no agency used in summer months, with 0.2 WTE used in August 2017 which is the lowest ever rate. In 2017, the Trust took the decision to take non-complaint agencies off our framework and only use agencies that are compliant with the rate cap. We have been able to do this due to the increased numbers of registered practitioners recruited, with 114.68 WTE registered staff recruited in 2017. Safe Staffing Levels and Compliance with RCN Guidelines To continue to monitor and improve staffing levels, an audit against the RCN standards has been repeated in February 2018 involving the Ward Managers, Matrons and Associate Chief Nurses for all in patient and day case wards. A previous audit of compliance against the core standards conducted in February 2017 demonstrated Trust compliance with 12 standards, partial compliance with 3 standards and no compliance with one standard as shown in the thermometer below: The February 2018 audit has demonstrated an improvement against the standards compared to February 2017 with core standard 14 moving from a rating of Red (no compliance) to Amber (partial compliance) following the appointment of Matrons, and core standard 3 moving from Amber (partial compliance) to Green (full compliance) following a comprehensive review of resuscitation training incorporating identified service need for Advanced Paediatric Life Support trained nurses on each shift. This is demonstrated in the 2018 thermometer below: The areas for improvement rated Amber above relate to: Core standard 1: All clinical areas are required to have a supernumerary shift supervisor: Not all wards have an establishment funded for a supernumerary shift supervisor however there have been significant improvements in 2017 with increased funded establishment on three wards resulting in supernumerary shift coordinators. Six wards are fully compliant with this standard. Partially compliant wards allocate a nurse to take charge and coordinate the shift. All wards have a Ward Manager who is supernumerary and benefit from presence of a supernumerary Matron. Core standard 5: There should be a 25% increase in nursing establishment to cover annual leave, sickness and study leave: Alder Hey provision is capped at 23% from 2013/14. The impact of this will continue to be monitored and evaluated between nursing and finance staff particularly the impact of the proposed Clinical Educator role in 2018. Core standard 14: There should be access to a senior (Band 8a) children’s nurse for advice at all times. This standard has moved from Red to Amber following the establishment and appointment of a Matron structure. An experienced Band 6 or 7 provides support to the nursing team out of hours through the Patient Flow, Night Matron and Senior Nurse bleep holder. In further progressing the work towards the aims of having zero nurse vacancies, sustaining the Nurse Pool, recruiting proactively, and ensuring the provision of a nursing workforce who have the right skills and receive the right training for the job, the Trust has made the following improvements: Alder Hey Children’s NHS Foundation Trust 142 Annual Report & Accounts 2017/18
Improvements Recruitment: • 114.68 WTE front line nursing staff recruited in the last 12 months. • The development of a responsive recruitment culture with evidence of strong partnership between senior nurses and human resource staff, notably working together on two successful national recruitment days and a comprehensive induction programme for new nursing staff. • Nurse Pool sustained to cover maternity leave, sickness and vacancies. • Development of nurse recruitment working group. • Review and revamp of the nurse national recruitment day. • Revamp of the Nurse Induction Programme. Safe Staffing Levels • Significant reduction month on month in the closure of beds to admissions due to nurse staffing levels. • Reduction in cancelled operations due to “staffing unavailable”. • 11 additional beds opened and staffed sustainably to support bed availability due to projected winter pressures. • Increased funding of the Nurse Pool from 20 WTE to 40 WTE. • Increased ward based funded establishment for registered and unregistered nurses on four wards • Increased PICU funded establishment to support safe and effective provision of ECMO. • Comprehensive review of nurse staffing on Tier 4 CAMHS ward. • Increased fill rates via NHSP for both registered and unregistered staff. • Reduction in use of “agency rate” payment leading to significant savings. Strong and Effective Leadership Structure • Introduction and recruitment to a Matron structure across the three clinical Divisions. • Introduction and recruitment of a specific HDU Ward manager to provide dedicated leadership. • Internal promotion and external recruitment to Band 6 and Band 7 posts. • Introduction and recruitment of a Play Manager to enhance and improve the play and recreation provision for children and young people. Educational Developments • Increased number of places to train Advanced Nurse Practitioners secured and recruited to enhance nursing practice and assist in the reduction of Junior Doctors. • Partnership working with HEI to run a new training programme for individuals educated to Masters level to undertake a shortened course to become a registered Children’s nurse. Cohort due to complete course in April 2018. Quality Metrics • Reviewed and enhanced monthly Safety Thermometer point of care survey designed to measure commonly occurring harms and support improvements in patient care and experience. • Reviewed and enhanced Ward Accreditation scheme, a quality initiative where wards across the Trust are regularly inspected by an independent senior team of nurses and patient experience leads assessed against a range of measures based on the Care Quality Commission’s Key Lines of Enquiry (KLOE’s). Future Plans • Continue proactive recruitment of student nurses • Development of nurse apprenticeship and nurse associate programmes. • Ensure that the nursing workforce strategy is a continuing integral part of the overarching Trust strategy. • Review and revamp the Preceptorship programme • Work with the Communication Team to develop a recruitment offer including a brochure and handouts for the recruitment days. • Explore developing an offer of nursing rotational posts • Continue monitoring vacancies, turnover rates and daily staffing levels with work feeding in to Workforce sustainability group. • Review the potential to implement an E Roster system to support staff management of shifts. • Review provision and resourcing of nurse education requirements in line with new Nursing & Midwifery Council (NMC) standards for nurse training due May 2018 and ongoing specialist training needs. Alder Hey Children’s NHS Foundation Trust 143 Annual Report & Accounts 2017/18
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A E H E LD Y R ANNUAL REPORT & ACCO
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©2018 Alder Hey Children’s NHS F
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A MESSAGE FROM OUR CHAIR AND CHIEF
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PERFORMANCE REPORT OVERVIEW The fol
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Teenage Cancer Trust Honorary Patro
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OUR CQC RATINGS The Trust’s curre
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• Applied clinical research perfo
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The Trust’s performance against n
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‘Alder Play’ A new approach to
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KEY RISKS TO DELIVERY IN 2017/18 Th
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Regulatory Ratings NHS Improvement
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Expenditure Operating expenses tota
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ALDER HEY USES MRI/ CT DATA TO CREA
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Louise Shepherd CBE - Chief Executi
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Mags Barnaby - Interim Chief Operat
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NHS IMPROVEMENT’S WELL LED FRAMEW
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Clinical Educators The Trust has ag
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All complainants are offered the op
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have resulted in Memoranda of Under
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The Community Cluster Developed wit
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Alder Hey’s collaborative campaig
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accordance with Non-Executive remun
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(R) Indicates that the individual i
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SALARY AND PENSION ENTITLEMENTS OF
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STAFF REPORT Analysis of Trust staf
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approach to internal materials and
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EXIT PACKAGES 2016/17 Exit Package
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As in 2016, we surveyed all staff i
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NHS FOUNDATION TRUST CODE OF GOVERN
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Governor Constituency Class Term of
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Throughout our membership activitie
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Attendance at Board of Directors an
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External Audit In April 2017 new re
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Segmentation Alder Hey has been pla
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STATEMENT OF THE CHIEF EXECUTIVE’
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During the year the Trust sustained
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The Divisions report against CQC Fu
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organisation’s ability to continu
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Nursing, Deputy Director of Nursing
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THE YOUNG PEOPLE’S CANCER UNIT RE
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PART 2: PRIORITIES FOR IMPROVEMENT
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2.1.2 Quality Improvements in 2017/
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National Confidential Enquiries Par
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2.2.4 Actions arising from Local Cl
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Local Audit Retrospective Audit of
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Page 134 and 135: 3.3.8 Peri-operative Care The focus
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32.5 Maturity of Financial Liabilit
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34. RELATED PARTIES (CONT’D) In a
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KEY AUDIT MATTERS Key audit matters
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AN OVERVIEW OF THE SCOPE OF OUR AUD
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“A matter is significant if, in t
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Alder Hey received visits from both
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AH ANNUAL REPORT 2018

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