Staff BenchmarkingStaff Benchmarking

Does this add value and should we Does this add value and should we pursue this more widely?pursue this more widely?

Francis Thompson Francis Thompson West London Mental Health TrustWest London Mental Health Trust

National contextNational context

NHS Constitution, NHS Act and one of the six essential NHS Constitution, NHS Act and one of the six essential CQC standards place a duty on Trusts to ensure that CQC standards place a duty on Trusts to ensure that staffing levels are adequate;staffing levels are adequate;

Francis (no not me);Francis (no not me); Prime Minister’s commission;Prime Minister’s commission; The Centre for Social Justice (2011) argue that all acute The Centre for Social Justice (2011) argue that all acute

inpatient wards should be seen as specialist areas and inpatient wards should be seen as specialist areas and staffed accordingly;staffed accordingly;

Increasing acuity (HTT); Increasing acuity (HTT); The Royal College of Nursing (2007) survey RMN’s The Royal College of Nursing (2007) survey RMN’s

showed that two thirds deemed inpatient staffing to be too showed that two thirds deemed inpatient staffing to be too low and 42% felt that staffing levels compromised patient low and 42% felt that staffing levels compromised patient care at least once per week. care at least once per week.

Local ContextLocal Context

- Lack of easily identifiable information at a Trust - Lack of easily identifiable information at a Trust level and concerns re acute unit staffing;level and concerns re acute unit staffing;

- Concerns re differences in staffing between units;- Concerns re differences in staffing between units;

- CQC concerns;- CQC concerns;

- Lack of clarity regarding safe staffing levels and - Lack of clarity regarding safe staffing levels and lack of a recognised way to measure staffing lack of a recognised way to measure staffing needs;needs;

- Context of financial savings.- Context of financial savings.

What we did and some caveatsWhat we did and some caveats

“Oh, people can come up with statistics to prove anything. 14% of people know that.”

Trust dataTrust dataTeam Average patient to

staff ratio Range RMN:HCA ratio

High Secure Wards (Ex PICU) 1.4 1.02-2.36 1:0.82

PICU 0.60 NA 1:0.73 Forensic services

Male admissions/HDU

3.6 3.5-3.8 1:0.89

Male rehab/long term

4.67 4.5-5.2 1:0.80

Male Average 4.26 1.85-4.70 1:0.83 Female 2.63 1.8-4.05 1:0.95

Local services Admission 4.55 3.72-5.0 1:0.78 Recovery 5.21 4.65-5.69 1:0.67

OPS 3.16 2.9-4.1 NA PICU 2.0 NA NA

Staffing data admission and Staffing data admission and recovery wardsrecovery wards

Recovery wards

Average patients per staff member (RMN+HCA)

Admission wards

Average patients per staff member (RMN+HCA)

Day Night Average Day Night Average Ealing (2 wards)

4 5.33 4.65 1 ward 4 6 5

RMN:HCA ratio

1:1 1:0.5 1:0.75 1:1 1:0.33

H and F (2 wards)

4.2 6.33 5.26 1 ward 4.4 5.5 4.95

RMN:HCA ratio

1:0.5 1:0.5 1:0.5 1:0.66 1:1

Hounslow (2 wards)

4.88 6.5 5.69 2 wards 3.3 4.13 3.72

RMN:HCA ratio

1:1 1:0.5 1:0.75 1:0.66 1:1

Overall average

Day Night Grand average

Day Night Grand Average

4.36 6.05 5.21 3.9 5.21 4.55 RMN/HCA 1:0.83 1:0.5 1:0.67 1:0.77 1:0.78 1:0.78

Local comparisons recovery Local comparisons recovery wards

Average Number of Patients to Staff Members (RMN and HCA) WLMHT Trust 1 Trust 2 Trust 3 Day shifts

4.36 4.58 4.1 4.46

Night Shifts

6.05 6.07 5.6 6.43

Total 5.21 5.35 4.85 5.44 Skill mix RMN:HCA

Days 1:0.83 1:0.95 1:0.73 1:0.63 Nights 1:0.5 1:0.5 1:0.62 1:0.5 Average 1:0.67 1:0.73 1:0.68 1:0.56

Points to notePoints to note

Disparities noted between wards inside Trusts in Disparities noted between wards inside Trusts in both the areas I have carried out this work;both the areas I have carried out this work;

Particular differences noted in availability of 9-5 Particular differences noted in availability of 9-5 staff;staff;

Need to include other available resources for a Need to include other available resources for a robust comparison e.g. OT resource etc and this is robust comparison e.g. OT resource etc and this is not easy to gather;not easy to gather;

It did enable a high level discussion on staffing It did enable a high level discussion on staffing and noted some other local interesting points…..and noted some other local interesting points…..

Potential benefitsPotential benefits

- Provides some assurance regarding staffing levels Provides some assurance regarding staffing levels locally and compared to other Trusts;locally and compared to other Trusts;

- Good intelligence to support workforce planning;Good intelligence to support workforce planning;- Lever to raise quality issues and argue for budget Lever to raise quality issues and argue for budget

protection/enhancement;protection/enhancement;- May improve patient care/experience if numbers May improve patient care/experience if numbers

felt to be below par;felt to be below par;- Raises unit staffing to board level;Raises unit staffing to board level;- Opportune time given national drivers.Opportune time given national drivers.

RisksRisks Biggest risk - no benchmark to measure against – what if we Biggest risk - no benchmark to measure against – what if we

are all too high or low??;are all too high or low??; May be inadvertently be used as quality measure;May be inadvertently be used as quality measure; Crude - difficult to compare units in different contexts and areas;Crude - difficult to compare units in different contexts and areas; If not done carefully may isolate nursing numbers from other If not done carefully may isolate nursing numbers from other

MDT input;MDT input; Complexity of data collection and peripherals such as bleep Complexity of data collection and peripherals such as bleep

holders;holders; Data may be felt to be sensitive by Trusts;Data may be felt to be sensitive by Trusts; Financial implications of having comparatively lower staffing;Financial implications of having comparatively lower staffing; Can the numbers influence change?Can the numbers influence change? Constant flux and change – this will only ever be a snapshot.Constant flux and change – this will only ever be a snapshot.

Points for discussionPoints for discussion

Given the risk, benefits and complexity is Given the risk, benefits and complexity is this worth pursuing?this worth pursuing?

If so is this better done locally or more If so is this better done locally or more broadly?broadly?

What could be done with the outcomes? What could be done with the outcomes? Would this lead to rigidity?Would this lead to rigidity?

If this is pursued it would only be a snapshot If this is pursued it would only be a snapshot and timeframes and shared data tool would and timeframes and shared data tool would need to be developed.need to be developed.

Any more thoughts, comments or Any more thoughts, comments or questions?questions?

Any more?Any more?