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Praise for dedicated service that supports young patients with learning disabilities

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The mum of a young patient who has multiple support needs has praised the work of staff at University Hospital Southampton during their visit that coincided with Learning Disability Week.
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/AboutTheTrust/Newsandpublications/Latestnews/2019/June/Praise-for-dedicated-service-that-supports-young-patients-with-learning-disabilities.aspx

Exercises to improve your posture - patient information

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This factsheet contains some exercises to help improve your posture.
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/Media/UHS-website-2019/Patientinformation/Respiratory/Exercises-to-improve-your-posture-562-PIL.pdf

Transient ischemic attack (TIA) - patient information

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Transient ischemic attack (TIA) Information for patients You have been given this booklet because you have been referred to the TIA
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/Media/UHS-website-2019/Patientinformation/Brain-and-spine/Transient-ischemic-attack-TIA-685-PIL.pdf

Procedure for bioimpedance with Bodystat 1500

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NIHR Southampton Biomedical Research Centre The NIHR Southampton Biomedical Research Centre (BRC) has a tight quality assurance system for the writing
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/Media/Southampton-Clinical-Research/Procedures/BRCProcedures/Procedure-for-bioimpedance-with-Bodystat-1500.pdf

Standing exercises - patient information

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This factsheet contains some standing exercises for you to do at home that will help you to maintain the balance and
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/Media/UHS-website-2019/Patientinformation/Respiratory/Standing-exercises-760-PIL.pdf

UHS Green Plan 2025-2028

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Green Plan 2025 - 2028 Approved November 2025 Contents 1 Executive Summary 2 Introduction and Context 3 Organisational Vision 4 Review of
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/Media/UHS-website-2019/Docs/About-the-Trust/Sustainability-and-Green-Plan/UHS-Green-Plan-2025-2028.pdf

Procedure for growth assessment of preterm infants CHI0726

Description
NIHR Southampton Biomedical Research Centre The NIHR Southampton Biomedical Research Centre (BRC) has a tight quality assurance system for the writing, reviewing and updating of Standard Operating Procedures. As such, version-controlled and QA authorised Standard Operating Procedures are internal to the BRC. The Standard Operating Procedure from which information in this document has been extracted, is a version controlled document, managed within a Quality Management System. However, extracts that document the technical aspects can be made more widely available. Standard Operating Procedures are more than a set of detailed instructions; they also provide a necessary record of their origination, amendment and usage within the setting in which they are used. They are an important component of any Quality Assurance Framework, but in themselves are insufficient and need to be used and interpreted with care. Alongside the extracts from our Standard Operating Procedures, we have also made available here an example Standard Operating Procedure and a word version of a Standard Operating Procedure template. Using the example and the Standard Operating Procedure template, institutions can generate their own Standard Operating Procedures and customise them, in line with their own institutions. Simply offering a list of instructions to follow does not assure that the user is able to generate a value that is either accurate or precise so here in the BRC we require that Standard Operating Procedures are accompanied by face-to-face training. This is provided by someone with a qualification in the area or by someone with extensive experience in making the measurements. Training is followed by a short competency assessment and performance is monitored and maintained using annual refresher sessions. If you require any extra information, clarification or are interested in attending a training session, please contact Dr Kesta Durkin (k.l.durkin@soton.ac.uk). This document has been prepared from Version 1 of the BRC Standard Operating Procedure for growth assessment of preterm infants for RHM CHI0726. The document was written in March 2015, authorised in June 2015 and the next review date is set for June 2017. The version number only changes if any amendments are made when the document is reviewed. Page 1 of 4 NIHR Southampton Biomedical Research Centre NIHR Southampton Biomedical Research Centre Procedure for GROWTH ASSESSMENT OF PRETERM INFANTS FOR RHM CHI0726 BACKGROUND The body composition of preterm infants is known to be altered compared with those born at term. The distribution of lean and fat mass seen in preterm infants at term equivalent age suggests relative adiposity due to a failure to accrete lean mass during their stay on the neonatal intensive care unit (NICU). The aetiology for this altered body composition, together with the identification of the best way to nutritionally support these infants is an important area of research. Measurement of weight (together with head circumference and length) is the most commonly used parameter to assess growth on the NICU but as body weight may be influenced by fluid shifts and excess adiposity, current measurement options on the neonatal unit are unable to truly reflect changes in body composition. PURPOSE The purpose of this procedure is to ensure the correct and uniform measurement of mid upper arm and mid thigh circumference for study RHM CHI0726. SCOPE This procedure applies to all individuals measuring mid upper arm and mid thigh circumference on the NICU for study RHM CHI0726. RESPONSIBILITIES It is the responsibility of the measurer to use this procedure when measuring mid upper arm circumference and mid thigh circumference of preterm infants for study RHM CHI0726. It is the responsibility of the PI to ensure that staff members who are working on this study have been trained and have sufficient experience to make measurements. Page 2 of 4 NIHR Southampton Biomedical Research Centre PROCEDURE Circumferences are to be measured using standard clinical paper 1m tape measures. These should be the type with one blank unmarked side. Measurements must be taken using the blank side of the tape to avoid observer number bias, then the tape measured against a fixed metal standard rule to obtain the measurement result. Take three 1m tape measures per infant and cut each tape into four 25cm long sections using the marked side as a guide, making 12 separate sections. Using a new section of tape for each measurement made, perform three measurements of mid upper arm circumference on the left arm and three on the right arm. Follow the same procedure for thigh circumference, to make a total of 12 measurements. Once the measurements have been made and the result recorded by measuring against a fixed metal standard rule, dispose of the used tapes according to Trust local waste policies. Mid upper arm circumference: 1. Expose the baby's left shoulder and arm. 2. Judge the mid-point of the left upper arm (between the olecranon at the elbow and the acromion at the shoulder) by eye and take the measurement at this point. 3. Pass a pre-cut length of paper tape around the arm so that the upper border of the tape is at the mid-point of the upper arm. Make sure that the side of the tape with the centimetre and millimetre marks are against the baby's skin and that the blank side is facing up, so that you cannot see the measurement. 4. Measure the circumference of the arm with the arm flexed (bent) at the elbow, being careful not to compress the arm tissue. 5. Mark the blank side of the tape at the point where the end meets the tape as it wraps around the arm. 6. Repeat for 3 measurements and read off the tapes against the fixed metal standard rule. 7. Take the average of the measurements, providing there is no more than 10% difference between the measures. If there is more than a 10% discrepancy between measures, take further measurements until measurements are consistent, discarding the outlying measurements. 8. Repeat this process for the right arm. Page 3 of 4 NIHR Southampton Biomedical Research Centre Mid thigh circumference: 1. Expose the baby's left leg from the hip down. 2. Judge the mid-point of the left thigh (between the iliac crest at the hip and the middle of the knee joint) by eye and take the measurement at this point. 3. Pass a pre-cut length of paper tape around the thigh so that the upper border of the tape is at the mid-point of the thigh. Make sure that the side of the tape with the centimetre and millimetre marks are against the baby's skin and that the blank side is facing up, so that you cannot see the measurement. 4. Measure the circumference of the thigh with the leg flexed (bent) at the knee, being careful not to compress the thigh tissue. 5. Mark the blank side of the tape at the point where the end meets the tape as it wraps around the leg. 6. Repeat for 3 measurements and read off the tapes against the fixed metal rule. 7. Take the average of the measurements, providing there is no more than 10% difference between the measures. If there is more than a 10% discrepancy between measures, take further measurements until measurements are consistent, discarding the outlying measurements. 8. Repeat this process for the right leg. Page 4 of 4
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/Media/Southampton-Clinical-Research/Procedures/BRCProcedures/Procedure-for-growth-assessment-of-preterm-infants-CHI0726.pdf

Procedure for BIA bodystat quadscan 4000

Description
NIHR Southampton Biomedical Research Centre The NIHR Southampton Biomedical Research Centre (BRC) has a tight quality assurance system for the writing, reviewing and updating of Standard Operating Procedures. As such, version-controlled and QA authorised Standard Operating Procedures are internal to the BRC. The Standard Operating Procedure from which information in this document has been extracted, is a version controlled document, managed within a Quality Management System. However, extracts that document the technical aspects can be made more widely available. Standard Operating Procedures are more than a set of detailed instructions; they also provide a necessary record of their origination, amendment and usage within the setting in which they are used. They are an important component of any Quality Assurance Framework, but in themselves are insufficient and need to be used and interpreted with care. Alongside the extracts from our Standard Operating Procedures, we have also made available here an example Standard Operating Procedure and a word version of a Standard Operating Procedure template. Using the example and the Standard Operating Procedure template, institutions can generate their own Standard Operating Procedures and customise them, in line with their own institutions. Simply offering a list of instructions to follow does not assure that the user is able to generate a value that is either accurate or precise so here in the BRC we require that Standard Operating Procedures are accompanied by face-to-face training. This is provided by someone with a qualification in the area or by someone with extensive experience in making the measurements. Training is followed by a short competency assessment and performance is monitored and maintained using annual refresher sessions. If you require any extra information, clarification or are interested in attending a training session, please contact Dr Kesta Durkin (k.l.durkin@soton.ac.uk). This document has been prepared from Version 2 of the BRC Standard Operating Procedure for bioelectrical impedance using the Bodystat QuadScan 4000. It was last reviewed in May 2014 and the next review date is set for May 2016. The version number only changes if any amendments are made when the document is reviewed. Page 1 of 6 NIHR Southampton Biomedical Research Centre NIHR Southampton Biomedical Research Centre Procedure for using the BODYSTAT QUADSCAN 4000 BIOELECTRICAL IMPEDANCE MACHINE BACKGROUND This procedure is to be used for circumference measurements of children between the ages of 12 months and 12 years. PURPOSE To ensure correct and uniform use of the Bodystat QuadScan 4000 body composition monitoring unit when measuring hand-to-foot whole body electrical impedance. SCOPE This procedure applies to any study requiring measurements of bioelectrical impedance using the Bodystat QuadScan 4000, within the BRC. RESPONSIBILITIES It is the responsibility of the measurer to use this procedure when measuring bioelectrical impedance using the Bodystat QuadScan 4000. It is the responsibility of the principle investigator to ensure that staff members who are working on specific studies have adequate experience to do so. Page 2 of 6 NIHR Southampton Biomedical Research Centre PROCEDURE http://www.bodystat.com/products/quadscan-4000/ What information can the Bodystat QuadScan 4000 give you? ECW % and ECW Volume ICW% and ICW Volume TBW % and TBW 3rd Space Water Body Cell Mass ECW/TBW Nutrition Index Plus Normal % Levels Body Fat % and Fat Weight Body Lean Mass Dry Lean Mass Basal Metabolic Rate (BMR) BMR/Body Weight Average Daily Calorie Requirement Waist/Hip Ratio Body Mass Index - Plus Normal Range Body Fat Mass Index (BFMI) Fat Free Mass Index (FFMI) Illness MarkerTM Impedance Values at 5, 50, 100 and 200 kHz Resistance 50 kHz/Reactance 50 kHz Phase Angle 50 kHz Bodystat QuadScan 4000 Not recommended for females in the early stages of pregnancy or for participants with pacemakers. Before testing For accurate and reproducible results on repeat tests, it is important to ensure that the participant is as normally hydrated as possible. This should be based on a clinical assessment of the patient by the research nurse. They should refrain from: Eating for 4-5 hours before the test. Page 3 of 6 NIHR Southampton Biomedical Research Centre Exercise for 12 hours before the test. Caffeine (i.e. normal tea, coffee and energy drinks) and alcohol consumption 24 hours before the test. Calibration of the Bodystat QuadScan 4000 The Bodystat QuadScan 4000 should be calibrated at the beginning of each day of use. The calibrator is supplied with the Bodystat QuadScan 4000 machine. Calibration is performed following the instructions below: 1. 2. 3. 4. 5. 6. Attach one pair of red and black leads to any one terminal of the calibration unit. Attach the other pair of red and black leads to the other terminal of the calibration unit. Switch the unit on and make a note of the test number. Accept the "default" values on the display. Continue as normal to make the measurement. Scroll using the down arrow to the values of impedance. You should find that the results at 5 kHz, 50 kHz, 100 kHz and 200 kHz should reflect readings of between 496 to 503, approximately a 0.5% variance on either side of the high precision 500 ohm resistor in the Bodystat calibrator. If the results are incorrect, replace the battery with a Duracell or Procell. If this does not rectify the problem, contact Bodystat QuadScan 4000 or your local supplier. 7. Before using the Bodystat QuadScan 4000: 1. 2. 3. Explain the procedure to the participant. Clean the machine using a detergent wipe and then wash your hands. Obtain accurate measurements of the participant's height (in cm, rounded-up or -down to the nearest whole number) and weight (in kg, to the nearest 0.1 of a kg) following appropriate SOPs. Check that there is sufficient battery power in the machine prior to commencing by switching on the machine and checking the battery indicator (series of bars on the left of the display). Instruct the participant to remove their shoe and sock from their right foot, remove any watches or bracelets on the right wrist which may impede the correct placing of electrodes, Lie participant in the supine position for 5 minutes before taking the measurements. Ensure that the legs and arms are spread out so they are not in contact with any other part of the body. 4. 5. 6. 7. Page 4 of 6 NIHR Southampton Biomedical Research Centre 8. Thoroughly wipe (using alcohol wipes/sterettes) the area of the skin where the electrodes are to be attached as products such as body moisturiser, can affect the results. Using the Bodystat QuadScan 4000: 1. Place two electrodes on to the right foot (it might be helpful to draw an imaginary straight line between the protruding bones on the ankle, then place each electrode in the centre of that line). Place one just below the base of the toes and the other on the ankle between the medial and lateral malleoli (the large protruding bones on the side of the ankle) (figure 1). Figure 1. Placement of electrodes on foot Foot electrodes: Electrodes are placed sideways so that the non-stick electrode connector point is facing the researcher. One electrode is placed centrally, directly where the second and third toe meet the foot. Place the second (black) electrode at the crease of the ankle (midline to the `boney' landmarks). 2. 3. Attach two alligator clips to the electrodes (red to the electrode nearest the toes, figure 1). Place two electrodes on to the right hand (it might be helpful to draw an imaginary straight line between the protruding bones on the wrist, then place each electrode in the centre of that line). Place one behind the knuckle of the middle finger and the other on the wrist next to the ulnar head (figure 2). Page 5 of 6 NIHR Southampton Biomedical Research Centre Figure 2. Placement of electrodes on hand Hand electrodes: Electrodes are placed sideways so that the non- stick electrode connector point is facing the researcher. One electrode is placed centrally, directly below the third knuckle of the middle finger. The second (black) electrode is placed on the crease of the wrist (midline to the `boney' landmarks). 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Attach two alligator clips to the electrodes (red to the electrode nearest the fingers, figure 2). Turn on the Bodystat QuadScan 4000. `test number' appears on the screen (used to identify subjects). Make a note of the number and then press enter to continue Key in accurate data using the up and down buttons (/) (age, height, weight, and measurements of hip and waist circumference). It is not necessary to enter waist and hip measurements or to select an activity level. You can leave these as the default setting. Ensure that the participant has been in the supine position for 5 minutes. Press enter to perform the measurement. The Bodystat Quad Scan 4000 will tell you to `connect electrodes'. Press enter again to commence the measurement and `measuring' will appear on the screen. The results will appear on the screen, the top line will display the actual measured result and the bottom line displays the recommended range. Page 6 of 6
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/Media/Southampton-Clinical-Research/Procedures/BRCProcedures/Procedure-for-BIA-bodystat-quadscan-4000.pdf

Annual ward staffing review January 2025

Description
[5.15] Report to the Trust Board of Directors, 7th January 2025 Title: Ward Staffing Nursing Establishment Review July 2024 – October 2024 Sponsor: Gail Byrne, Chief Nursing Officer Author: Rosemary Chable, Head of Nursing for Education, Practice and Staffing Purpose (type an ‘x’ in the appropriate box(es)) (Re)Assurance Approval Ratification Information X Strategic Theme (type an ‘x’ in the appropriate box(es)) Outstanding patient Pioneering research World class people outcomes, safety and innovation and experience Integrated networks and collaboration Foundations for the future X X Executive Summary: a) The report details the methodology, findings, risk assessment and recommendations arising from the ward staffing review undertaken from July 2024 – October 2024. Recommendations in this report link to the statutory responsibilities arising from the National Quality Board (2016) expectations on ensuring safe, sustainable, and productive staffing, the NHS Improvement Developing Workforce Safeguards guidance (2018) and the Nursing Workforce Standards (RCN May 2021) assessed as part of CQC ‘safe’ and ‘well-led’ domain. The report outlines UHS progress in meeting the 38 recommendations included in the NICE guideline (2014) on safe staffing for in-patient wards and provides an update on the action – plan to achieve the recommendations in the national staffing levels guidance published by the National Quality Board in July 2016 (a key requirement of the NHSI ‘Developing workforce safeguards’ guidance (October 2018). b) To note findings of this annual ward establishment review and the Trust position in relation to adherence to the monitored metrics on nurse staffing levels, specifically: Overall, the staffing establishments remain appropriate and within recommended guidelines. There are some key exceptions where acuity and dependency levels and growing demand continue to outstrip the nursing ratios, coupled with the impact of ward reconfigurations – recommendations for uplifts in these areas will be put forward by the Divisions as part of the annual budget setting process.  UHS nursing establishments are set to achieve a range of 1:1 to 1:9 registered nurse to patient ratio in most areas during the day with the majority (43) set between 1:4 to 1:8. Differences relate to specialty and overall staffing model.  The majority of wards (32) are staffed at between 50:50 and 80:20 registered/unregistered ratio or above. Those wards with lower ratios (21 wards) are linked to the systematic and evaluated implementation of trained band 4 staff where appropriate and those with higher ratios (2) are both higher intensity care areas requiring a higher registered skill. 33 wards (down from 35 last year but remaining up significantly from 25 in 2019) are below the 60:40 ratio.  Planned total Care Hours Per Patient Day (CHPPD) range from 4.2 – 19.2 and average at 7.7  High levels of enhanced care demand, a reduced skill-mix and impact of financial controls have been highlighted as ongoing challenges for mitigation to ensure safe staffing. 1 The paper is presented for DISCUSSION. c) The report is presented in full to Trust Board as an expectation of the National Quality Board guidance on staffing which requires presentation and discussion at open board on all aspects of the staffing reviews. Contents: Paper; Appendix 1: National Quality Board (NQB Expectations for safe staffing Safe, Sustainable, and productive staffing; Appendix 2: NQB Safe Staffing Recommendations – UHS action plan; Appendix 3: NICE Guideline 1: Safe Staffing for nursing in adult inpatient wards in acute hospital - UHS action plan; Appendix 4: Ward by Ward staffing review metrics spreadsheet; Appendix 5: Specific Divisional issues emerging; Appendix 6: RCN Workforce Standards Risk(s): 1b – Due to the current challenges we fail to provide patients and families/carers with a highquality experience of care and positive patient outcomes. 3a – We are unable to meet current and planned service requirements due to the unavailability of staff to fulfil key roles. Equality Impact Consideration: NO 2 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.0 2.1 2.1.1 2.1.2 Introduction or Background The purpose of this paper is to report on the outcomes of the review of ward staffing nursing establishments undertaken from July 2024 – October 2024. This 6-monthly review forms part of the Trust approach to the systematic review of staffing resources to ensure safe staffing levels effectively meet patient care needs. This paper focuses specifically on a review of nursing levels for in-patient ward areas. Areas such as maternity, critical care, theatres and the emergency department are reviewed separately. Divisional ‘light touch’ 6 monthly staffing reviews took place in March/April 2024 for all 4 clinical divisions and were reported to their relevant divisional boards and Nursing and Midwifery Staffing Review Group. Emergent themes have been incorporated into this review. The ward staffing review this year has taken place against the backdrop of financial recovery measures, some of which came into effect in Q4 of 2023/24 after the last annual staffing review with increasing measures being introduced in 2024/25. Discussions at the staffing review meetings focussed on any impact arising from the close monitoring and management of establishment levels and any mitigations/adjustments needed to continue to assure the delivery of safe care. It should also be noted that there were some key ward reconfigurations and refurbishments, some ward moves and a new ward opening since the last annual review and these areas have now been fully included in the annual cycle. The report also includes an update on the NICE clinical guideline 1 – Safe Staffing for nursing in adult inpatient wards in acute hospitals, issued in July 2014 and details progress with the action plan for adopting this guideline within UHS. This report fulfils expectation 1 and 2 of the National Quality Board requirements for Trusts in relation to safe nurse staffing and fulfils a number of the requirements outlined in the NHS Improvement ‘Developing Workforce Safeguards’ guidance (October 2018) which sets out to support providers to deliver high quality care through safe and effective staffing. This review also meets standards outlined in the RCN Nursing Workforce Standards (May 2021). Organisations are expected to be compliant with the recommendations in these reports and are subject to review on this as part of the CQC inspection programme under both the ‘safe’ and ‘well led’ domains. Analysis and Discussion Ward staffing review methodology In 2006 UHS established a systematic, evidence based and triangulated methodological approach to reviewing ward staffing levels on an annual basis linked to budget setting and to staffing requirements arising from any developments planned in-year. This was aimed to provide safe, competent and fit for purpose staffing to deliver efficient, effective and high-quality care and has resulted in consistent year-onyear review of the nursing workforce matched by increased investment where required. Following the National Quality Board expectations in 2014 and the refresh in 2016, a full review is now undertaken annually (with a light touch review at 6 months reporting to Divisional boards to ensure ongoing quality) with annual reporting to Trust Board in October/November. 3 2.1.3 The approach utilises the following methodologies:  Shelford Safer Nursing Care Tool Acuity/Dependency staffing multiplier (A nationally validated tool reviewed in 2013 - previously AUKUH acuity tool). Now incorporated into the Healthroster Safecare system  Care Hours Per Patient Day (CHPPD)  Professional Judgement  Peer group validation  Benchmarking and review of national guidance including Model Health System data  Review of eRostering data  Review of ward quality metrics 2.2 2.2.1 2.2.2 National guidance In 2013 as part of the national response to the Francis enquiry, the National Quality Board published a guide to nursing, midwifery and care staffing capacity and capability (2013) ‘How to ensure the right people, with the right skills, are in the right place at the right time.’ This guidance was refreshed, broadened to all staff, and reissued in July 2016 to include the need to focus on safe, sustainable and productive staffing. The NQB further reviewed this document and issued an updated recommendations brief in July 2017. The expectations outlined in this guide are presented in Appendix 1. These expectations are fulfilled in part by this review and the detailed action plan (Appendix 2) has been updated with progress towards achieving compliance with the 37 recommendations that make up the 3 over-arching expectations. The latest 4 monthly review of the action plan (November 2024) shows maintenance of compliance levels despite the ongoing activity and financial challenges. UHS remaining compliant with 35 of the 37 recommendations. The following 2 outstanding areas are progressing but require further action before being signed off: Allocated time for the supervision of students and learners: Staffing establishments take account of the need to allow clinical staff the time to undertake mandatory training and continuous professional development, meet revalidation requirements, and fulfil teaching, mentorship and supervision roles, including the support of preregistration and undergraduate students. Whilst there is some allowance within the 23% headroom, requirements for supervision are growing with revised initiatives around preceptorship, staff wellbeing and student supervision. Learner numbers (students, international and apprentices, preceptees) are increasing with limited additional supervisory support available. It is also important to note that the Ward Leader Supervisory allowance was put on hold in Q4 2023/24 and reinstated slowly from Q1 2024/25 as part of the trust recovery plan. This impacted short term on some of the supervision and support available to students and learners. Equality and diversity: The organisation has clear plans to promote equality and diversity and has leadership that closely resembles the communities it serves. The research outlined in the NHS provider roadmap42 demonstrates the scale and persistence of discrimination at a time when the evidence demonstrates the links between staff satisfaction and patient outcomes. Ongoing action through Equality & Diversity Group which is reported to Board separately. 4 2.2.3 2.2.4 2.2.5 2.2.6 2.2.7 2.3 2.3.1 In July 2014 NICE published Clinical Guideline 1: Safe Staffing for nursing in adult inpatient wards in acute hospitals. This guideline is made up of 38 recommendations. A detailed action plan was developed within UHS and is reviewed 4 monthly by the Nursing and Midwifery Staffing review group. The current assessment (November 2024) shows UHS has maintained compliance in 37 of the 38 recommendations. The 1 remaining recommendation is: Escalation actions taken to address deficits on one ward should not compromise another. Management of trustwide staffing deficits and thrice daily reviews of staffing via the staffing hub, as well as an improved recruitment situation, have minimised the risk of this. The close management and maintenance of minimal staffing levels, however, does not enable assurance that wards are not compromised by staff movements in extremis. The ongoing action plan is included at Appendix 3 detailing the recommendations and the UHS compliance position and actions in progress. In October 2018 NHS Improvement published ‘Developing Workforce Safeguards’ guidance which sets out to support providers to deliver high quality care through safe and effective staffing. It includes many of the actions identified in both the NICE guidance and the National Quality Board recommendations broadened to all staff groups. In May 2021 the Royal College of Nursing published their Nursing Workforce Standards (Appendix 6), developed as part of their safe staffing campaigns. The standards summarise the expectations in other national guidance and reiterates the importance of the Chief Nurse being responsible for setting nurse staffing levels based on service demand and user needs and the requirement to report directly to the Trustboard. Self-assessment undertaken by the Nursing and Midwifery Staffing Review Group (NMSRG) show UHS remains compliant with these standards. In October 2024 the RCN launched a review of these standards which are expected to be published at the end of the year. In light of this imminent review NMSRG have refreshed the self-assessment and confirmed that UHS remains compliant with the standards. In September 2022 a key research study was published (Zaranko B, Sanford NJ, Kelly E et al. BMJ Quality and Safety Epub) which highlights the link between higher registered nurse numbers and seniority and improved patient outcomes. Additionally in August 2024 an additional follow-up article (Griffiths, P; Saville C; Ball, J JAMA Network open) identified that substitution of registered gaps with temporary staff does not necessarily significantly lower the risks for patients. In late 2023 NIHR published an evidence based Professional Judgement Framework to support the application of professional judgement in nurse staffing reviews. Rosemary Chable and Natasha Watts from UHSFT were contributors to this guidance and are acknowledged in the authorship. This framework has been used as the basis for professional judgement throughout the staffing reviews. 6 monthly Ward Staffing review July 2024 – October 2024 – Outcomes The 6 monthly review was carried out from August 2024 – October 2024 with initial review meetings taking place with each Division (attended by DHN, Matrons, Ward Leaders, Finance representatives, workforce representatives and facilitated by the Head of Nursing for Education, Practice and Staffing). The same triangulated methodology was used as in previous reviews. An update on the latest guidance and reporting requirements in relation to staffing were also included in the divisional review meetings. 5 2.3.2 2.3.3 2.3.4 2.3.5 2.3.5.1 2.3.5.2 2.3.5.3 2.3.5.4 The detailed spreadsheet with ward-by-ward findings is included at Appendix 4. This provides information on the current establishment data broken down by shift and assessing against registered/unregistered ratios; CHPPD; nurse to patient ratios by registered and total nurse staffing and acuity information from Safecare where appropriate. It should be noted that a number of wards continue to be regularly reconfigured in response to the changing capacity and service situation, including new ward build and ward moves. A number of rostering template reviews were therefore instigated as a result of the review discussions so some figures may have changed for individual wards since the review. The staffing hub which was established in April 2020 to co-ordinate and oversee the real-time nurse staffing levels across the hospital in support of the clinical site function has continued to operate and adapt. It now maintains a stronger role in the daily deployment of staff and the ongoing management of bank/agency bookings and is having a measurable impact on the reduction in high-cost agency bookings. This is particularly evident in reviewing the deployment of bank and agency support for enhanced care. The hub activity is led by a daily designated staffing matron who takes responsibility for leading the continuous review and reassignment of the nurse staffing resource throughout the day. Nurse to patient ratios by registered and total nursing The ward establishments across UHS allow for registered nurse to patient ratios during the day to range from 1:1 (Piam Brown – Children) to 1:9 (Bassett, D6, D7 G6, G8, G9, E7 and E12) depending on specialty and overall staffing model. This is a further slight increase in the number of wards with lower RN: patient ratios (up from 4 wards to 8 wards with all areas in medicine) and this will require ongoing monitoring to ensure there is not further drift. The average level is set to achieve 1:4 to 1:8 registered nurse to patient ratio in most areas during the day (43 wards, previously 47) with 42 wards set between 1:4 to 1:7 (up from 38). Exceptions are where there has previously been a planned model of trained band 4 staff to mitigate recruitment challenges and is particularly evident in Medicine and Medicine for older people. The areas on or above 1:7 (22 wards) include the medicine wards, Medicine for Older People wards, some Trauma and Orthopaedic wards, including Brooke and the Acute Stroke Unit. These areas include a higher ratio of band 2 to 4 staff creating a total nurse to patient ratio of 1:3 – 1:4. It should be noted that the ratio of patients to registered nurse can regularly increase when wards are not fully established and these wards with lower RN to patient ratios are working on their minimum safe levels. Planned staffing ratios at night require constant oversight to ensure the model is sufficient to provide the required support for patients out of hours.  In areas that are working on lower staffing ratios, managing the workload at night has again emerged as an area that still requires action in a number of ward areas.  Wards are piloting different twilight shift patterns (within existing budget) to continue to support the demands at night.  Rising acuity of patients, more therapeutic activity taking place overnight and the impact of more geographically spread clinical areas has increased the pressure on the staffing resource at night. This also highlights the importance of supernumerary bleep-holders in supporting the ward areas 6 2.3.5.5 There are now 3 in-patient ward areas with ratios of 1:11 (RN to patient) at night (the same level as the previous year). These are E3(G), Acute Surgical Assessment and F7 this is offset by a total nurse to patient ratio of 1:5 and 1:6 with the utilisation of support staff. 2.3.6 2.3.6.1 2.3.6.2 2.3.6.3 2.3.6.4 2.3.6.5 2.3.6.6 2.3.6.7 Registered to unregistered ratios UHS ward areas were reviewed against the benchmark of 60:40 registered to unregistered ratios as the level to which ward establishments should ideally not fall below unless planned as the model of care. 15 wards are now rostered at between 60:40 and 70:30. This is an increase of 1 ward on last year when there had been a reduction of 5 wards. 32 wards (an improvement on the 35 in the previous year but still remaining up significantly from 25 in 2019) are below the 60:40 ratio. These wards are utilising band 4 staff as a key contribution to the model of care and are areas where there is a wider multidisciplinary team contributing to care (e.g., MOP, T & O, Medicine, Acute Stroke). It should be noted however that this reducing trend needs to be kept under close review against other metrics to ensure safe, quality care can be provided within the establishments. As highlighted previously, recent research highlights the impact on patient outcomes in areas with reduced registered nurse cover. 8 wards (1 more than 2023) are above the 70:30 ratio reflecting the increased specialism of our regional specialties where the intensity of the patient needs requires a higher ratio of registered staff (Child Health, CV&T, Neurosciences, and Cancer Care areas). The support of band 4 roles continues to be designed in as part of a model of care in a number of areas linked to the further development of apprenticeship opportunities. This has also provided a role in which to appoint the emerging cohorts of nursing associates who have qualified and registered with the NMC from January 2019 onwards. In many areas where the acuity and intensity of patients has increased, and treatment and medication regimes are complex, further reduction in the overall skill-mix of registered to unregistered staff is not appropriate to maintain safe staffing levels and ensure adequate supervision. Additionally, in some cases a band 4 model was used to mitigate ongoing gaps in registered roles – this was particularly notable in Medicine for Older People. As recruitment for registered nurses improves these areas will be reviewing the overall required skill mix model. Focus will continue on reviewing the overall registered to unregistered ratios to ensure reductions are linked to planned model of care changes and are accompanied by appropriate quality impact assessment and evaluation. The current review of band 2/3 banding linked to national job assimilation will not have an impact on the overall registered to unregistered ratios but will have a financial impact on the establishments where uplift results. It is important to note that this will need to be managed without reducing the overall availability of unregistered nursing hours in order to maintain staffing levels. 2.3.7 Assessment against the Safer Nursing Care Tool (acuity/dependency model)  The Safer Nursing Care Tool (acuity/dependency model) has been used to model required staffing based on the national recommended nurse to patient ratios for each category of patient in all the areas. This is integrated into the health roster system as part of the safe-care tool and provides information on acuity/dependency levels and corresponding staffing levels on a real-time basis converted into recommended care hours per patient day. Where the predicted levels differ from established numbers, professional judgement has been used to 7 assure that the levels set are appropriate for the speciality and number of beds. During the review period, a Trust-wide rollout of a new version of the software took place which has seen a total refresh of the use and application of the safer nursing care tool to ensure this is being used consistently across the organisation. There is also ongoing education and support work taking place to ensure all areas are using the tool in line with the recommendations to ensure consistency. 2.3.8 Care Hours Per Patient Day 2.3.8.1 Planned total Care Hours Per Patient Day (CHPPD) range from 4.2 (G5) rising to 19.2 (Piam Brown) and average at 7.7. The average is slightly lower than the previous year and there are a higher number of wards in the lower range. This will be linked to small bed increases in ward areas that have not been accompanied by staffing increases. 2.3.8.2 Planned Registered care hours per patient day range from 1.9 (G5) rising to 14.5 (Piam Brown) and average at 4.5. This average is slightly lower this year. 2.3.8.3 Planned Unregistered care hours per patient day range from 1.3 (C6 TYA) – 8.7 (G2 Neuro) and average at 3.2. This average is slightly lower than last year. 2.3.8.4 Actual CHPPD fluctuate significantly across the year and are strongly linked to patient numbers and changes in patient acuity. For example, increased staffing for patients who require enhanced care will increase the overall CHPPD numbers attributed to a ward. An aggregated Trust-wide average, whilst useful to review month by month and annually for a trend, are less meaningful than the granular review of each ward CHPPD. 2.3.9 Allowance for additional headroom requirements and supervisory ward leader model 2.3.9.1 All areas have 23% funding allocated to allow for additional headroom requirements arising from non-direct care time. It is recognised that in a number of areas this percentage is too low to cover all of the indirect requirements in an area, particularly related to speciality and supervisory and training needs. There remains significant pressure on maintaining staffing within the allowed headroom. This is due to high training levels (resulting from the more junior workforce) and maternity/paternity levels that consistently exceed the allowance. 2.3.9.2 New national initiatives and requirements of the NHS contract such as the implementation of Professional Nurse Advocacy for all staff and Preceptorship support for all new registrants has further increased the pressure on this set level of headroom. 2.3.9.3 A discussion around management of headroom was included in each of the ward staffing reviews which took place with clear actions for the ward leaders to implement. 2.3.9.4 UHS has an established Ward Leader Supervisory model which means the Ward Leader is not included in the established numbers required to deliver safe care per shift. This enables them to focus more time on supervising and leading the ward team whilst supporting clinical care. This proved particularly important during recent years with developing the junior workforce. 2.3.9.5 In Q4 2023/24 and Q1 24/25 this model was paused as part of the financial recovery plan and Ward Leaders were rostered directly to support shifts. This impacted a range of indicators including appraisal completion, sickness reviews, roster management and learner development. In Q2 this was reinstated as part of the workforce plan for nursing and key metrics have again improved. The model is used flexibly whilst the priority is always to ensure safe staffing levels on the wards. Ward 8 Leaders clearly articulated the personal and professional impact of this pause during the discussions at the review meetings. 2.3.10 Specific Divisional issues emerging Specific Divisional issues highlighted in the review are contained in Appendix 5. 2.4 Trust wide risks and issues considered in the review 2.4.1 Establishment monitoring and controls in line with financial recovery The staffing reviews took place against the backdrop of ongoing financial recovery. During the review period inpatient areas have been working to 97% of establishments (with identified exceptions) as a control measure and this is being monitored weekly to ensure any impact on quality indicators and staff wellbeing are flagged and responded to in a timely way to ensure safe staffing in line with NQB standards. Issues arising from these measures were openly discussed at the staffing reviews. 2.4.2 Increasing patient acuity/dependency The ongoing development of our defining services continues to result in an evidenced increase in the complexity, acuity and dependency of the patients cared for in our general ward beds, also linked to reducing length of stay. COVID-19 has had a significant impact as our patients are definitely presenting with a higher level of both acuity and dependency. Information on the acuity and dependency of our patients is available via the ‘Safe Care’ functionality in health roster and is used in real time as part of our daily staffing meetings. The information is also used at the 6 monthly reviews as part of the professional judgment assessment. 2.4.3 Increasing enhanced care needs Trust wide we have continued to see an increase in the complexity of patients particularly in relation to mental health needs including dementia and patients remaining in the acute settings for prolonged lengths of time whilst awaiting appropriate placements. We have also seen a significant rise in the episodes of violence and aggression experienced in our clinical areas which creates additional needs for staffing support. This continues to have an impact on the ability to support the additional enhanced care needs that arise for these groups of patients particularly across key specialties (MOP, Medicine, Child Health, Neurosciences, T & O and latterly Surgery). Division B retain the Trustwide overview for enhanced care, specifically mental health support, and provide an advice service, supporting clinical areas in their decision making around the need for additional support. Divisions have then developed enhanced care bays on wards and/or a local pool of staff to deploy to support enhanced care needs. Ward leaders report that this has made a major difference to the management of patients with these enhanced needs and has reduced the reliance on last minute agency to support. The numbers however remain unpredictable and are therefore managed in real-time as part of overall considerations around safe staffing. The management of additional enhanced care needs extends beyond the definition of patients requiring formal mental health support. Increased numbers of patients with 9 challenging behaviour or needing 1:1 presence brings additional pressures to ward establishments but are necessary to keep the environment safe for all patients. Through the work completed in agreeing and setting an affordable workforce level for 24/25 there was recognition and agreement to fund enhanced care based on 2023/24 M10 position, as an addition to establishments. This has had a positive impact and has resulted in a reduction in usage due to the controls in place and leadership/oversight from the matrons. During 24/25 the staffing hub has been co-ordinating the requests for additional staff with additional mental health needs specifically linked to the mental health support team. This has shown key reductions in the use of registered mental health staff and tangible financial savings but despite these efforts, demand has continued to outstrip supply. 2.4.3 Supervising and supporting the junior workforce The professional judgement discussions with all the Ward Leaders again highlighted the additional challenges posed to the staffing models of appropriately supervising and supporting the increasing range of learners having placements on the ward areas. This includes the ability to meet the supervisory standards with an increasingly junior workforce. New national guidance was issued in October 2022 and implemented within UHS during 2023 with additional requirements in relation to the provision of preceptorship for all staff new to registration. Protected time for both preceptors and preceptees is now an expectation for organisations. The robust retention and recruitment strategies across the Trust and the strong vision to ‘grow our own’ nurses for the future means that wards continue to support a range of learners including undergraduate students, trainee nursing associates, nurse degree apprentices, Return to Practice students, newly registered staff undergoing preceptorship and internationally educated nurses awaiting registration. Education teams across the trust have proved key to supporting the development and learning into the wards and particularly in continuing to train and support learners to full registration and into preceptorship. The capacity and capability within the education and support teams needs to be further reviewed for 25/26 and beyond to ensure they can continue to support the further increase in numbers which will be required for UHS to meet the challenging workforce targets set in the national plan - with nursing student placements alone set to increase by up to 230% in the southeast over the coming years. 2.4.4 Benchmarking using the Model Health System UHSFT provides data monthly to the national Model Hospital System (MHS) detailing the actual CHPPD provided (based on patient numbers) for all clinical areas including critical care. During 2024 the uploads to this system from UHS have been resubmitted following some data anomalies over the summer. It is unclear whether all of the corresponding graphs and information have been amended following this change. Direct comparison of ward areas or specialty is no longer available via the benchmarking system however an overall average of total CHPPD is available to review via peer group and this is used as part of the staffing review. Hospitals with a high volume of critical care beds (providing 1:1 care) will have a 10 higher CHPPD. Table 1 Organisation/Group Total CHPPD Registered CHPPD Unregistered CHPPD UHS excl. Critical Care 8.7 4.8 3.9 UHS with Critical Care 10.5 6.7 3.8 Shelford Group 9.8 6.7 3.2 MHS Peer Group 9.56 5.7 3.4 Region 8.9 5.6 3.3 National 8.7 5.1 3.5 All data submissions (registered and unregistered) are averaged so will not necessarily equal the total CHPPD) Data is from the MHS August 2024 (latest figure) and includes nursing and midwifery and ward AHP staffing. and the UHS excluding critical care is UHS reporting Sept 2024 figure from People Report just for nursing. 2.4.5 Review of quality metrics and staffing incidents The NICE guidance outlines some key quality metrics that should be considered as part of the staffing reviews. The safety metrics defined are patient falls, pressure ulcers and medicine administration errors. These metrics, along with a range of other UHS defined quality indicators are already monitored through our internal clinical quality dashboard and are discussed ward by ward as part of the professional judgement methodology in the reviews. In addition, there is ongoing review of red flags raised as part of the adverse event reporting system and on ‘safecare’. 3.0 Conclusion 3.1 A robust ward staffing establishment review was undertaken using a mixed methodology of approaches and in line with recommendations from the National Quality Board, NICE guidance, and the RCN Nursing Workforce Standards 3.2 Overall the staffing establishments remain appropriate and within recommended guidelines. There are some key exceptions where acuity and dependency levels and growing demand continue to outstrip the nursing ratios, coupled with the impact of ward reconfigurations – recommendations for uplifts in these areas will be put forward by the Divisions as part of the annual budget setting process. 4.0 Recommendations 4.1 To discuss the report at Trust Executive Committee and Trust Board as an ongoing requirement of the National Quality Board and developing workforce safeguards guidance around safe staffing assurance. 4.2 To note findings of this annual ward establishment review and the Trust position in relation to adherence to the monitored metrics on nurse staffing levels. 4.3 To note the ongoing progress in UHS compliance with the guidance from the National Quality Board on safe, sustainable, and productive staffing. 4.4 To note the ongoing progress in UHS compliance with the NICE guideline on safe staffing for nursing in adult inpatient wards. 4.5 To note and acknowledge the ongoing risks and challenges of matching actual staffing to established staffing levels and to agree the continuous monitoring of this with the introduction of any additional financial recovery measures. 11 4.6 To support the continued Trust wide commitment and momentum on actions to fill clinical nursing vacancies and further reduce the reliance on high-cost agency against the backdrop of rising acuity and emergency and elective recovery. 4.7 Systematic ward staffing reviews to be reported to board annually, with 6 monthly light touch reviews reported through Divisional Boards. Next full staffing review to be presented to Trust Board in November 2025. 5.0 Appendices Appendix 1: National Quality Board (NQB Expectations for safe staffing Safe, Sustainable, and productive staffing Appendix 2: NQB Safe Staffing Recommendations – UHS action plan Appendix 3: NICE Guideline 1: Safe Staffing for nursing in adult inpatient wards in acute hospital - UHS action plan Appendix 4: Ward by Ward staffing review metrics spreadsheet Appendix 5: Specific Divisional issues emerging Appendix 6: RCN Workforce Standards 12 Appendix 1 National Quality Board Expectations for safe staffing - Safe, Sustainable, and productive staffing (July 2016) Expectation 1: Right staff  Boards should ensure there is sufficient and sustainable staffing capacity and capability to provide safe and effective care to patients at all times, across all care settings in NHS provider organisations.  Boards should ensure there is an annual strategic staffing review, with evidence that this is developed using a triangulated approach (i.e., the use of evidence-based tools, professional judgement, and comparison with peers), which takes account of all healthcare professional groups and is in line with financial plans.  This should be followed with a comprehensive staffing report to the board after six months to ensure workforce plans are still appropriate.  There should also be a review following any service change or where quality or workforce concerns are identified.  Safe staffing is a fundamental part of good quality care, and CQC will therefore always include a focus on staffing in the inspection frameworks for NHS provider organisations.  Commissioners should actively seek to assure themselves that providers have sufficient care staffing capacity and capability, and to monitor outcomes and quality standards, using information that providers supply under the NHS Standard Contract. Expectation 2: Right skills  Boards should ensure clinical leaders and managers are appropriately developed and supported to deliver high quality, efficient services, and there is a staffing resource that reflects a multi professional team approach.  Decisions about staffing should be based on delivering safe, sustainable, and productive services.  Clinical leaders should use the competencies of the existing workforce to the full, further developing and introducing new roles as appropriate to their skills and expertise, where there is an identified need or skills gap. Expectation 3: Right place and time  Boards should ensure staff are deployed in ways that ensure patients receive the right care, first time, in the right setting. This will include effective management and rostering of staff with clear escalation policies, from local service delivery to reporting at board, if concerns arise.  Directors of nursing, medical directors, directors of finance and directors of workforce should take a collective leadership role in ensuring clinical workforce planning forecasts reflect the organisation’s service vision and plan, while supporting the development of a flexible workforce able to respond effectively to future patient care needs and expectations. 13 Appendix 2 Expectation 1: Right staff NATIONAL QUALITY BOARD - JULY 2016 Supporting NHS Providers to deliver the right staff with the right skills, in the right place at the right time - safe sustainable and productive staffing - NURSING & MIDWIFERY Assessed UHS rating Descriptor No. Recommendation Current measures in place (November 2024) C = compliant Boards should ensure there is sufficient A = Actions required and sustainable staffing capacity and 1.1 Evidence-based workforce planning capability to provide safe and effective Triangulated approach to care to patients at all times, across all care settings in NHS provider organisations. Boards should ensure there is an annual 1.1.1 strategic staffing review, with evidence that this is developed using a triangulated approach (i.e. the use of evidence-based The organisation uses evidence-based guidance such as that produced by NICE, Royal Colleges and other national bodies to inform workforce planning, within the wider triangulated approach in this NQB resource (see Appendix 4 for list of evidence-based guidance for nursing and midwifery care staffing). staffing establishments well embedded. Shelford SNCT used and embedded in 'safecare' as part of eRostering. NICE guidance systematically reviewed 3 x per year. C tools, professional judgement and comparison with peers), which takes The organisation uses workforce tools in accordance with their account of all healthcare professional groups and is in line with financial plans. 1.1.2 guidance and does not permit local modifications, to maintain the All tools used as reliability and validity of the tool and allow benchmarking with recommended. C This should be followed with a peers. comprehensive staffing report to the board after six months to ensure Workforce plans contain sufficient provision for planned and 23% included in all direct care in-patient areas. workforce plans are still appropriate. 1.1.3 unplanned leave, e.g. sickness, parental leave, annual leave, Compliance monitored as C There should also be a review following training and supervision requirements. part of healthroster reporting any service change or where quality or suite workforce concerns are identified. Safe staffing is a fundamental part of 1.2 Professional judgement good quality care, and CQC will therefore always include a focus on staffing in the inspection frameworks for NHS provider organisations. Commissioners should actively seek to assure themselves that providers have sufficient care staffing capacity and 1.2.1 Clinical and managerial professional judgement and scrutiny are a crucial element of workforce planning and are used to interpret the results from evidence-based tools, taking account of the local context and patient needs. This element of a triangulated approach is key to bringing together the outcomes from evidencebased tools alongside comparisons with peers in a meaningful way. 6 monthly staffing reviews include face to face meetings with Corporate Nursing Team/DHN/Matron/ward leaders as well as workforce systems and finance. Professional judgement key part of the reviews. C capability, and to monitor outcomes and quality standards, using information that providers supply under the NHS Standard Contract. 1.2.2 Professional judgement and knowledge are used to inform the skill mix of staff. They are also used at all levels to inform real-time decisions about staffing taken to reflect changes in case mix, acuity/dependency and activity. As above. Professional judgement also used as part of the daily staffing review meetings through site control. C Identified actions required and notes on compliance Timescale Continue with current approach and strengthen with the use of CHPPD and safecare complete Need to ensure there is corporate rigour on adapting SNCT while rolling out 'safecare'. Monitor the impact on the inclusion of 'enhanced care' scoring. Participate in the national NIHR research Ongoing compliance monitored as part of healthroster reporting suite. Increased headroom requirement due to COVID-19 complete complete Continue with current approach and strengthen with the use of CHPPD and safecare complete Continue with current approach. Professional judgement remains the ultimate measure of safe staffing. Key part of the staffing hub set-up during COVID-19 complete 1.3 Compare staffing with peers Lead Head of Nursing staffing/DMT Head of Nursing staffing/DMT DoF/Chief Nurse Head of Nursing staffing/DMT Head of Nursing staffing/DMT/site team 1.3.1 Previous ad hoc The organisation compares local staffing with staffing provided by peers, where appropriate peer groups exist, taking account of any underlying differences. benchmarking included through AUKUH network and targeted at specific services under development. Need to strengthen and formalise C Build on the current benchmarking capabilities included in the Model Hospital and N&M Dashboard. Continue to utlise the 'civil eyes' data for child health. Work with eRoster provider to introduce reporting that includes benchmarking data complete Head of Nursing staffing/workforce systems team 1.3.2 1.3.3 The organisation reviews comparative data on actual staffing alongside data that provides context for differences in staffing requirements, such as case mix (e.g. length of stay, occupancy rates, caseload), patient movement (admissions, discharges and transfers), ward design, and patient acuity and dependency. The organisation has an agreed local quality dashboard that triangulates comparative data on staffing and skill mix with other efficiency and quality metrics: e.g. for acute inpatients, the model hospital dashboard will include CHPPD. All considered as part of the systematic staffing reviews Clinical Quality Dashboard (CQD) includes all staffing and quality metrics. Used as part of the systematic clinical accreditation scheme reviews Model hospital benchmarking now C being used routinely. All services benchmark with other areas where complete Head of Nursing staffing/DMT appropriate C Build the model hospital work into the CQD complete Head of Quality and Clinical Assurance Appendix 2 Boards should ensure clinical leaders and managers are appropriately developed 2.1 Mandatory training, development and education and supported to deliver high quality, efficient services, and there is a staffing resource that reflects a multiprofessional 2.1.1 Frontline clinical leaders and managers are empowered and have the necessary skills to make judgements about staffing and assess their impact, using the triangulated approach outlined in team approach. Decisions about staffing this document. should be based on delivering safe, sustainable and productive services. Clinical leaders should use the competencies of the existing workforce to the full, further developing and introducing new roles as appropriate to their skills and expertise, where there is an identified need or skills gap. All frontline leaders skilled to manage staffing agenda. Included in competencies for ward leaders 2.1.2 Staffing establishments take account of the need to allow clinical staff the time to undertake mandatory training and continuous professional development, meet revalidation requirements, and fulfil teaching, mentorship and supervision roles, including the support of preregistration and undergraduate students. 23% headroom allowance and provision of supervisory ward leader role covers most aspects of time identified but not fully assured around adequate time for supervision of all learners. Backfill provided for some roles in development degree apprenticeships but does not cover release for all staff C Continue to maintain competence, skills and knowledge through master classes and staffing review meetings complete Head of Nursing staffing/DMT 23% headroom is included in all nursing establishments as well as an allowance in all areas for the Ward Leader to be supervisory. A number of additional requirements e.g. increased student numbers and supervision, increased numbers of junior staff needing more supernumerary training time and A professional nurse advocacy have led Unable to to the 23% allocation falling short of identify an the needs in a number of areas. expected date This is particarly notable in critical for compliance. care and ED where the training needs Mitigations in outstrip the provision in the 23% place Head of Nursing staffing/DHN's/Divisional Education Leads/Education Quality Lead headroom. Important to note that the Ward Leader Supervisory allowance was put on hold in Q4 2023/24 and reinstated slowly from Q1 2024/25 as part of the trust recovery plan. This impacted short term on some of the non-direct activities and KPI's eg appraisal rates/progression/HR actions 2.1.3 Those with line management responsibilities ensure that staff are All expectations clearly managed effectively, with clear objectives, constructive appraisals, included in JD and annual and support to revalidate and maintain professional registration. objectives for line managers C Monitored as part of ongoing HR key performance metrics complete Associate Director of People/DMT 2.1.4 The organisation analyses training needs and uses this analysis to Annual training needs help identify, build and maximise the skills of staff. This forms part analysis process well of the organisation’s training and development strategy, which embedded within the annual also aligns with Health Education England’s quality framework. cycle for the trust C Continue with current approach with review in 2020 to further streamline priorities to staffing needs and match to changed CPD arrangements . complete Divisional Education Leads/Education Quality Lead/DMT 2.1.5 The organisation develops its staff’s skills, underpinned by Comprehensive training knowledge and understanding of public health and prevention, and programmes in place to supports behavioural change work with patients, including self- equip staff with required care, wellbeing and an ethos of patients as partners in their care. skills C Monitored through ongoing evaluation complete Director of TD&W/Divisional Education Leads//DMT 2.1.6 2.1.7 The workforce has the right competencies to support new models of care. Staff receive appropriate education and training to enable them to work more effectively in different care settings and in different ways. The organisation makes realistic assessments of the time commitment required to undertake the necessary education and training to support changes in models of care. Comprehensive training programmes in place to equip staff with required skills The organisation recognises that delivery of high quality care depends upon strong and clear clinical leadership and well-led and motivated staff. The organisation allocates significant time for team leaders, professional leads and lead sisters/charge nurses/ward managers to discharge their supervisory responsibilities and have sufficient time to coordinate activity in the care environment, manage and support staff, and ensure 100% Supervisory ward leader time provided in all inpatient direct care areas. Clinical leaders programme in place standards are maintained. C Monitored through ongoing evaluation complete Director of TD&W/Divisional Education Leads//DMT Continue to review % of time Head of Nursing - C achieved as supervisory linked to complete staffing/DMT/workforce ongoing vacancy position systems 2.2 Working as a multiprofessional team 2.2.1 The organisation demonstrates a commitment to investing in new roles and skill mix that will enable nursing and midwifery staff to spend more time using their specialist training to focus on clinical duties and decisions about patient care. The organisation recognises the unique contribution of nurses, Range of new roles developed and evaluated within the organisation. Extended scope policies in place to support. Further strengthen the trustwide Director of C approach to service by service complete TD&W/Divisional workforce development Education Leads//DMT midwives and all care professionals in the wider workforce. Multiprofessional approach to 2.2.2 Professio
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Advice and exercises for before and after your total hip replacement - patient information

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This leaflet contains advice and exercises for before and after your total hip replacement.
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