Agenda item No: 11 - North Essex Partnership University NHS

Agenda item No: 11
Name of Meeting: Meeting of the Board of Directors in Public
Date: 26 November 2014
Title of Report: Ward Staffing Levels (Full report for September and October 2014)
Presented By: Paul Keedwell, Director of Operations and Nursing.
Subject, Purpose and Recommendation:
The Board is asked to receive and discuss the safe staffing monthly update for each of
the wards operating across the Trust.
The purpose of this report is to provide the Board with:
1. A revised RAG rated report from the previous month outlining all of our wards
compliance against our current agreed establishments. These have been aggregated
up to the localities to give an indication of their overall compliance against the initial
thresholds set and assurance that we are providing safe staffing levels. (Appendices 1
& 2).
2. This report will go above and beyond that required nationally to enable the Board to
understand in more detail the issues that make a ward safe or may otherwise impact
on the quality and continuity of care. It includes not only our compliance with our
planned staffing levels but also gives an indication of the number of temporary staff
used on each ward and whether there are concerns associated with this.
3. A commentary on wards with an element of concern over staffing levels.
4. Information of additional staff available on each ward for North East and West
(Appendix 3)
5. A copy of the UNIFY table uploaded to the DoH for October (Appendix 4)
6. To approve the report for publication on the Trusts website and the NHS choices
website.
1
Finance Implications: We have reviewed the current nursing requirements across all of our
in-patient services and the increased acuity and severity of the presentation of our in-patient
population means that nursing establishments need to be increased to maintain safety and
quality. This equates to approximately £900K for this financial year. These increases to
staffing establishments are fully funded from the beginning of August 2014 and are reflected
in the current reporting framework.
Clinical Implications: This will enable ward managers to minimise the need to overspend on
ward budgets to maintain safe staff levels and ensure that an appropriate skills and grade mix
is available to meet the needs of the patients receiving treatment on our wards.
HR Implications: The need to recruit additional staff and ensure that enough staff of the right
grade is available through workforce planning to meet the needs of the service going forward.
Legal Implications: None identified other than the potential to impact upon our NHS contract
Equality Implications: As per existing Trust business.
Risks: The risks are clinical if we can’t staff at the agreed levels and may place the delivery of
quality of care at risk, financial as this places pressure on already tight Trust finances and
potentially reputational as our staffing levels will be available for public scrutiny.
2
Board Report Maintaining and ensuring Safe Staffing Levels. INTRODUCTION All NHS Trust Boards must assure themselves and reassure the public, patients and their families that ward staffing levels are properly established and reflective of the needs of the patients treated and cared for in those environments. The Trust Board and Executive Management Team must ensure that a robust system is in place to report on ward staffing levels, and that regular scrutiny and review takes place making sure that they have the right people, with the right skills, in the right place at the right time. This Bi‐monthly Board Update outlines each of the wards performance over the preceding two months (September and October 2014) against the agreed ratings threshold, and provides a narrative commentary on where the staffing levels and ratio of permanent to temporary staff (bank and Agency) of that ward raises some concern, or are experiencing some issues in maintaining the establishment set by the Executive Director of Operations and Nursing, and agreed by the Trust Board. WARD PROFILE BY LOCALITY West Essex Adults of working age – 2 wards (Chelmer and Stort 16 beds each) Psychiatric Intensive Care ‐ 1 ward (Shannon House 10 beds) Older Adults Assessment wards – 2 wards (Kitwood and Roding 16 and 14 beds respectively) Older Adult Continuing Care – 1 ward (Brian Roycroft 16 beds) Mid Essex Adults of working age – 2 wards (Finchingfield and Galleywood) Psychiatric Intensive Care ‐ 1 ward (Christopher Unit 8 beds) Older Adults Assessment wards – 2 wards (Ruby and Topaz 17 beds each) Low Secure ‐ I ward (Edward House 20 beds) North East Essex and CAMHS Adults of working age – 3 wards (Peter Bruff 18 beds. Ardleigh 18 beds and Gosfield 18 beds) Older Adults Assessment wards – 3 wards (Henneage 18 beds. Bernard 14 Beds, Tower 15 beds) Recovery Services – 2 wards (Severalls House 10 beds. 439 Ipswich Rd 11 Beds) Child and Adolescent – 2 wards (Longview 15 beds Larkwood 10 beds) ANALYSIS OF ALL WARD STAFFING LEVELS AGAINST CURRENT AGREED ESTABLISHMENTS (September and October 2014) Ardleigh SEPT 
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1 service user at CGH being nursed on Level 4 obs as required. 1 twilight HCA daily. No professional concerns identified No professional issues of concern The Staffing levels reflect the activity on the ward and have been added to, to reflect the needs of the ward. no professional issues identified. The ward is reliant on Bank staff to maintain the minimum agreed staffing levels which raises some professional nursing issues that will need to be addressed. OCT 
Band 3 twilight booked in 7 days, starting at 1600hrs until 2330 hrs Gosfield SEPT 
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No professional nursing concerns identified No professional issues of concern The minimum staffing numbers have been met using Bank as required. No professional issues identified. The ward is reliant on Bank staff to maintain the minimum agreed staffing levels which raises professional concerns. This will be reviewed in the coming weeks. 29th September: Bank nurse booked in for night shift did not turn up for work. NETSS informed. Additional HCA now being booked onto PM shift on Gosfield Ward following the recent skills mix review. 29/09/14: 3 HCAs booked onto AM shift as unable to cover with RMN bank or agency. OCT 
29th September: Bank nurse booked in for night shift did not turn up for work. Netts informed. Additional HCA now being booked onto PM shift on Gosfield Ward following the recent skills mix review. 29/09/14: 3 HCAs booked onto AM shift as unable to cover with RMN bank or agency. 
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2 late shifts where staffing levels unmet and 3 weekend shifts required significant use of bank staff Additional staffing booked in for many of the shifts due to level 3 being on the ward for a number of days. Sunday morning: staff member cancelled bank shift at short notice and unable to cover. Many nights covered with agency/bank RMNs due to regular staff member having D&V Peter Bruff Unit (A) SEPT 
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Majority of shifts meet agreed staffing establishment, additional staff booked to cover activity at CGH. No professional issues noted. The agreed staffing levels are being met. Additional staff booked for ECT escort. The registered staffing numbers fall below the agreed number on a few shifts but overall there are no professional concerns. OCT 
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There are some concerns being identified with staffing the ward adequately with the revised skills mix. This is being reviewed. Whilst there remain some shifts where registered staff are not fully covered, overall there are no major issues of concern. Bernard Ward (OA) SEPT 
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No professional issues of concern here. There has been reduced registered nurse cover on the morning shifts, supplemented by additional unregistered staff and the ward manager. No significant issues of concern, Overall the minimum staffing numbers have been met, no professional issues identified There continues to be difficulties in meeting the registered staff numbers on the am shift. This will be discussed with Ward Manager. OCT 
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There are no professional issues identified Saturday am shift below establishment and Saturday pm required 1 bank and 1 agency staff The concerns regarding the low fill rate for registered nurses remains of significant concerns, these are being monitored, reviewed and carefully addressed. Staffing issues are under constant review, numbers are being supplemented with unregistered staff. Henneage Ward (OA) SEPT 
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The numbers of registered staff are below the agreed skill mix for both the am and pm shift, due to being unable to access additional staff. The numbers have been supplemented by unregistered staff during this holiday period. Overall the minimum staffing numbers have been met using Bank to cover. No professional issues identified The ward is falling below the number of registered numbers per shift and will be monitored. OCT 
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There are no professional issues identified Establishment met with only one breach Saturday am Tower Ward (OA) SEPT 
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There are pressures on this team due to vacancies and acting positions however careful management is in place to protect the staffing numbers. No professional concerns identified The number of registered staff are below the agreed staffing skill mix, but this has week been supplemented by increased use of unregistered staff. No professional issues The number of registered staff fall below the minimum staffing level and is being addressed. Ward working over established numbers due to continued high activity levels and observation levels. 2 x band 5 vacancies, 1 x band 5 acting into band 6 post and 1 x band 3 HCA sickness. No professional issues identified OCT 
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The staffing numbers are being met but not to the agreed skill mix. There are only 2 qualified staff in the Clacton area that work on Tower and they do not wish to work full time. This means that I am not always able to cover these shifts and use HCAs instead. This is being discussed with HR Establishment has been used flexibly to allow registered nurse cover for care reviews twice weekly. 9‐5 shifts are not shown in this roster summary. There continues to be 1 x band 5 vacancy 0.8 WTE. No agency use. 1 x band 6 sickness, 1 x band 5 ‐ 30 hrs vacancy (now recruited to ‐ awaiting start date) Friday late HCA shift covered with registered bank as unable to cover with HCA. The professional issues are being managed Ipswich Road (A) SEPT 
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The numbers of registered staff are below the agreed skill mix for both the am and pm shift, due to being unable to access additional staff. The numbers have been supplemented by unregistered staff during this holiday period. There are no issues of concern. No professional issues of concern No professional issues identified OCT 
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There are no professional nursing issues identified. Establishment met with use of Bank staff on 3 night and 1 late shift Longview (CYPS) SEPT 
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Overall there are no significant concerns. One shift fell below the registered nurse numbers. The establishment is being supplemented with twilight shifts that are not recorded here and the ward manager. No professional issues of concern Although the numbers appear not to meet the minimum staffing levels this is supplemented with twilight shifts when staff are most needed. No professional issues identified Concerns around the registered staffing levels remain and are being discussed as to the way forward. The numbers are being filled by unregistered staff to maintain safety. OCT 
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The registered staffing levels fall below the agreed staffing levels for some days on this rota. This will be monitored Ward Manager Shift 9‐5 Registered: 5 / 5 Twilight Shift Registered Permanent: 1 / 7 Twilight Shift Non Registered Permanent: 1 / 7 Twilight Shift Registered Bank: 0 / 7 Twilight Shift Non Registered Bank: 7 / 7 4 shifts with unmet establishment, 2 of which were weekend. No use of agency staff There are high levels of sickness and maternity leave, hence posing difficulties in staffing. The ward maintains a safe environment using staff creatively and sharing with sister ward Ongoing difficulties persist but the rota is supplemented by twilight and other therapy and teaching staff during the day. Larkwood (CYPS) SEPT 
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The number of registered staff falls below the agreed skill mix on two shifts, this will be monitored. The registered staffing levels were below the agreed skill mix, this will be reviewed regularly to ensure patient safety and risk are managed There are some concerns with fewer registered staff on the rota below the agreed staffing levels. This is being addressed locally. There are 4 registered nurses that due to mat leave or sickness are unavailable for work thus impacting on the agreed staffing levels. This is being discussed and reviewed with HR and clinical team OCT 
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There are 4 registered nurses that due to mat leave or sickness are unavailable for work thus impacting on the agreed staffing levels. This is being discussed and reviewed with HR and clinical team Ward Manager Shift 9‐5 Registered: 5 / 5 Twilight Shift Registered Permanent: 2 / 7 Twilight Shift Non Registered Permanent: 1 / 7 Twilight Shift Registered Bank: 1 / 7 Twilight Shift Non Registered Bank: 9 / 7 shifts with establishment not met; Friday pm and Sunday am. No agency staff used Some ongoing difficulties persist whilst waiting for new staff to join the unit. There are high levels of sickness and maternity leave, hence posing difficulties in staffing. The ward maintains a safe environment using staff creatively and sharing with sister ward
Finchingfield (A) SEPT 
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Study leave and annual leave Annual Leave and vacancies The minimum agreed staffing level has not been supplemented by bank staff so due to that, agency staff were used for RMN cover. We currently have 1 x RMN off sick, 1 RMN on compassionate leave, 1 x RMN on annual leave and 1 x RMN on mandatory training for 3 days. Extra staff were booked to cover most of the week due to high activity ‐ had 1 x level 3 observations. Interviews for Band 5s taking place on 9.10.14. Shortlisting for Band 3 is in place for this week. The minimum agreed staffing level has not been supplemented by bank staff so due to that, agency staff were used for RMN cover. We currently have 3 x RMNs off sick and 1 X HCA Off sick. Extra staff were booked to cover most of the week due to high activity ‐ had 1 x level 3 observations. Interviews for Band 5s taking place on 9.10.14. Shortlisting for Band 3 to be finalised. OCT 
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2 x RMNs sick. Bank staff utilised where possible and agency used to cover where needed. Awaiting start dates for 2 x HCAs ‐ X 1 hasn't responded to recruitment team ‐ HR chasing up and the other one we are still waiting for Occupational Health clearance and references. 2 x RMNs sick, 2 x RMNs annual leave and 1 X HCA on annual leave for part of the week. Bank staff utilised where possible and agency used to cover where needed. Awaiting start date for 1 x HCA ‐ we are still waiting for Occupational Health clearance. HCA interviews on 29.10.14 3 x RMNs on annual leave, 2 x RMNs off sick and 1 HCA on annual leave. We are still waiting clearance for one HCA and have 1 x HCA vacancy ‐ interviews for HCAs on 29.10.14. Due to high sickness levels we have covered 12 x RMN and 3 X HCA shifts with agency staff due to NETTS being unable to cover the shifts. 2 x RMNs off sick, 2 x HCAs on annual leave. Bank staff utilised where possible ‐ 7 x RMN shifts covered by agency staff and 4 x HCA shifts covered by agency staff. 2 x HCA vacancies ‐ interviews scheduled for 29.10.14. Galleywood (A) SEPT 
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Study leave and annual leave Sickness, annual leave and vacancies The minimum agreed staffing level has not been supplemented by bank staff so due to that, agency staff were used for RMN and HCA cover. We had 1 x RMN on annual leave, 1 x RMN on non‐clinical duties, 1 x RMN on paternity leave, 2 x HCAs on annual leave and 1 x HCA supernumeration as new starter on ward. Interviews for Band 5s taking place on 9.10.14. Shortlisting for Band 3 is in place for this week. The minimum agreed staffing level has not been supplemented by bank staff so due to that agency staff were used for RMN and HCA cover. We had 1 x RMN on non‐clinical duties, 1 x RMN on paternity leave and 1 x HCA sick. Interviews for Band 5s taking place on 9.10.14. Shortlisting for Band 3 to be finalised. OCT 
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1 x RMN non‐clinical duties, 2 x RMN sick, 2 x RMN annual leave, 2 x HCAs on study leave. Bank staff utilised where possible. Due to high level of activity and 5 RMNs not on the unit agency staff were block booked to cover shifts and 2 HCA shifts were covered by agency. Band 5 interviews taking We currently have 1 X RMN on induction, 1 x RMN on non‐clinical duties, 3 x RMNs off sick for part of the week, 1 X HCA off sick and 1 x HCA on annual leave. High use of agency staff 
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used to cover qualified shifts (28 shifts) due to the above and vacancies. Interviews for Band 5s took place on 9.10.14 ‐ 1 x appointed. Band 5 vacancies being readvertised. 1 x RMN remains doing non‐clinical work due to an investigation, 1 X RMN off sick, 1 x HCA on annual leave. Due to vacancies 19 x RMN shifts and 2 x HCA shifts covered by agency staff as NETTS unable to cover. 1 x RMN supernum, 2 x study days taken by RMNs, 1 x HCA off sick for 2 days and 1 x HCA on annual leave. Bank staff utilised where possible and 16 x RMN shifts covered by agency. HCA interviews taking place on 29.10.14. 1 x RMN commencing on 3.11.14. Rainbow (A) SEPT 
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Sickness and annual leave Annual leave and study days High activity due to level 3 observations. 1 x AP on annual leave, 1 x HCA & 1 x RMN ‐ supernum as new starters on Rainbow. Currently awaiting start date for 1 x HCA ‐ awaiting DBS clearance. High activity due to level 3 observations.1 x RMN, 1 x HCA & 1 x Nursery Nurse on annual leave. 1 X RMN and 1 X HCA ‐ supernum as new starters on Rainbow. Currently awaiting start date for 1 x HCA ‐ awaiting DBS clearance. OCT 
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1 x RMN on annual leave and 1 X AP on annual leave. Bank staff utilised where possible and 1 x agency used for 1 RMN shift. Awaiting DBS clearance for 1 x HCA. 2 x RMNs off sick. Banks staff utilised where possible and one agency staff used. 1 x HCA due to start on 3.11.14 2 x RMNs off sick and 1 x HCA on annual leave. 1 x HCA start date 3.11.14. Due to high sickness majority of shifts covered by bank staff and 3 x shifts covered by agency staff 1 x RMN off sick, 4 x study days taken by RMNs. Shifts covered where possible by bank staff ‐ 2 x agency RMNs used. Ruby (A) SEPT 
One member of staff supernumerary awaiting completion of medication competency framework and 2 B5 vacancies ‐ out to advert. OCT 
The ward is under established by 2 Band 5 nurses ‐ currently out for advert and vacancies being covered by bank staff. 
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Current vacancies on Ruby Ward are: 1 x Band 6 (on secondment), 3 x Band 5, 1.4 Band 4. Band 5 posts have been recruited to and are awaiting HR/OH clearances and Band 4's will be advertised in the near future ‐ these are new posts as a result of the skill mix review. Over the past week there has been 1 x level 3 observation on the ward and no staff sickness. The ward has been functioning at a safe level and patients’ needs are being met. Two Band 5 post recruited staff awaiting clearances, two Band 5 APL 5days in total, 1 band 3 ALP, I DAY. ONE Band 3, I day off sick .one band 3 MLP. One level 3 obs for two days 20/21st Topaz (A) SEPT 
Majority of shifts covered within establishment. OCT 
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5 x Level 3 observations due to high falls risks. Observation levels being reviewed daily and management team currently looking at alternative safe ways of managing high falls risks. Current vacancies on Topaz Ward: 1 x Band 5, 1.4 Band 4, 2 x Band 3. Band 5 and 3 are out to advert and Band 4 will be going out for advert soon. Over the past week the ward have averaged 5 Level 3 observations, with 7 at its peak to cover patients transferred to Broomfield Hospital. As at 13/10/14 there are 5 x L3 on the ward. Ward staff are managing this as safely as possible, however this is an ongoing issue on Topaz. 2xBand 5, MLP. Band3 ALP 9days total (3 staff), Band 3 one day sick. 1x band 3 recruited to post awaiting clearances, 4 level 3 obs; one is currently in Broomfield Hospital. Edward House East (A) SEPT 
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OCT Annual leave, sickness and study days Bank Staff booked to cover annual leave and current vacancies. Edward House has currently the following vacancies, 1 Charge Nurse, 3 Staff Nurse, 2 Support Worker and 2, Associate Practitioner. These posts have been advertised and interviews are scheduled for w/c 6th Oct. Bank Staff and agency staff have been booked to cover current annual leave, study days and sickness. Long term sickness for one employee is being addressed with HR. One qualified staff is just started her maternity leave. Activity level has been generally consistent and there has been no additional staff booked other than the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans. 
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Edward House has currently the following vacancies, 1 Charge Nurse, 3 Staff Nurse, 2 Support Worker and 2, Associate Practitioner. These posts have been advertised and interviews are scheduled for w/c 6th Oct. Bank Staff have been booked to cover current annual leave & maternity leave and staff secondment to other Units. Activity level has been generally consistent and there has been no additional staff booked other than the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans. Edward House has currently the following vacancies: 2 Staff Nurse, 2 Support Worker and 2, Associate Practitioner. These posts have been advertised and interviews are scheduled for w/c 6th Oct. One charge nurse has been appointed due to start on 13th Oct an di Staff Nurse appointed to start once DBS & Occ Health are completed. Bank Staff have been booked to cover current annual leave & maternity leave and staff secondment to other Units. Activity level has been generally consistent and there has been no additional staff booked other than the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans, including covering the S136 Suite as required. Edward House West (A) SEPT 
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Study days, leave and sickness Bank Staff booked to cover annual leave and current vacancies. Edward House has currently the following vacancies, 1 Charge Nurse, 3 Staff Nurse, 2 Support Worker and 2, Associate Practitioner. These posts have been advertised and interviews are scheduled for w/c 6th Oct. Bank Staff and agency staff have been booked to cover current annual leave, study days and sickness. Long term sickness for one employee is being addressed with HR. One qualified staff is just started her maternity leave. Activity level has been generally consistent and there has been no additional staff booked other than the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans. OCT 
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Edward House has currently the following vacancies, 1 Charge Nurse, 3 Staff Nurse, 2 Support Worker and 2, Associate Practitioner. These posts have been advertised and interviews are scheduled for w/c 6th Oct. Bank Staff have been booked to cover current annual leave & maternity leave and staff secondment to other Units. Activity level has been generally consistent and there has been no additional staff booked other than the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans. Edward House has currently the following vacancies: 2 Staff Nurse, 2 Support Worker and 2, Associate Practitioner. These posts have been advertised and interviews are scheduled for w/c 6th Oct. One charge nurse has been appointed due to start on 13th Oct and 1 Staff Nurse appointed to start once DBS & Occ Health are completed. Bank Staff have been booked to cover current annual leave & maternity leave and staff secondment to other Units. Activity level has been generally consistent and there has been no additional staff booked other than the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans, including covering the S136 Suite as required. Shannon House (A) SEPT 
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Sickness, study days and annual leave Bank Staff booked to cover sickness, annual leave and increased in observation level 3/4. Shannon House has currently the following vacancies, 1 Charge Nurse, 1 Staff Nurse, and 2 Support Workers. We are in the process of recruiting and in the interim, Bank Staff and agency staff have been booked to cover current annual leave, study days and sickness. . Activity level has been relatively high with increased observation level 3 due to high risk and vulnerable patients. and no additional staff were booked on top of the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans OCT 
Shannon House has currently the following vacancies, 1 Charge Nurse, 1 Staff Nurse, and 2 Support Workers. We are in the process of recruiting and in the interim, Bank Staff have been booked to cover current annual leave, study days and sickness. . Activity level has been relatively high with increased observation level 3 due to high risk and vulnerable patients. and no additional staff were booked on top of the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans. Staff also support the ECT clinic as rostered & to cover S136 Suite. Christopher Unit (A) SEPT 
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Sickness, annual leave and study day Bank & Agency staff have been booked to cover; annual leave, sickness, current vacancies and increased in Observation Level.3/4. Christopher Unit has currently the following vacancies, 1 Charge Nurse , 1 Staff Nurse , These posts have been advertised and interviews are scheduled for w/c 6th Oct. Bank Staff and agency staff have been booked to cover current annual leave, study days and sickness. Long term sickness for one employee is being addressed with HR. Activity level has been 
relatively high with increased observation level 3 due to high risk and vulnerable patients. Additional staff were booked on top of the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans. Christopher Unit has currently the following vacancies, 1 Charge Nurse , 1 Staff Nurse , These posts have been advertised and interviews are scheduled for w/c 6th Oct. Bank Staff and agency staff have been booked to cover current annual leave, study days and sickness. Long term sickness for one employee is being addressed with HR. Activity level has been relatively high with increased observation level 3 due to high risk and vulnerable patients. Additional staff were booked on top of the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans. There have been a few shifts where the Unit has been unable to find cover and been running on minimum staffing level and supported by other wards if needed, for instance, covering the S136 Suite. OCT 
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Christopher Unit has currently the following vacancies, 1 Charge Nurse , 1 Staff Nurse , These posts have been advertised and interviews are scheduled for w/c 6th Oct. Bank Staff and agency staff have been booked to cover current annual leave, study days and sickness. Long term sickness for one employee is being addressed with HR. Activity level has been relatively high with increased observation level 3 due to high risk and vulnerable patients. Additional staff were booked on top of the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans. Running on minimum staffing level and supported by other wards if needed, for instance, covering the S136 Suite. There has been additional staff booked over the weekend due to increased observation to reduce risk of harm to self and others. Christopher Unit has currently the following vacancy 1 Staff Nurse, These posts have been advertised and interviews are scheduled for w/c 6th Oct. One charge nurse has been appointed and will start on 13th Oct. No Band 5 was appointed and this is to be re‐
advertised. There is currently one Band 5 on secondment to CMHT. Bank Staff and agency staff have been booked to cover current annual leave, study days and sickness. Long term sickness for one employee is being addressed with HR. Activity level has been relatively high with increased observation level 3 due to high risk and vulnerable patients. Additional staff were booked on top of the daily requirement for the establishment. The Unit has been managed safely and professionally at all times and patients' needs are being met as per their care plans, including covering the S136 Suite as required. Brian Roycroft (OA) SEPT 
There is a high level of observations within the ward as this unit caters for people with dementia who have challenging behaviours. Currently there are 4 users on level 4 observations. Additionally, the unit is carrying some vacancies which we have not been able 
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to recruit to. Further advertising will occur in line with the recent skill mix review. We are hopeful that these issues will be addressed by the end of this year. There is a high level of observations within the ward as this unit caters for people with dementia who have challenging behaviours. Currently there are 3 users on level 4 observations. Additionally, the unit is carrying some vacancies which we have not been able to recruit to. Further advertising will occur in line with the recent skill mix review. We are hopeful that these issues will be addressed by the end of this year. Bank and agency staffed use to meet clinical need. Bank and agency staff used to meet clinical need and establishment. Area chief nurse and matron to review recruitment strategy for the three older adult wards. OCT 
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Bank and agency used to meet clinical need. Bank and agency used to meet clinical need (over agreed establishment). Vacancies at registered and unregistered level. Current vacancies for Non Reg is 1.07. Registered staff is 5.40. High level of observation and majority of services users’ dependent on full nursing care. Currently advertising for registered and unregistered. Redeployment of staff from other units currently being explored. High staffing is due to increase in levels of observations and patient safety. High level of vacancies, these out to advert. Chelmer (A) SEPT 
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Ward manager works 9‐5 and supports to cover the ward. We have one Band 5 on Secondment to CMHT, one Band 3 on Redeployment in Admin to help facilitate return to work. We had one staff who had to take urgent leave as her daughter was unwell. One staff also went off sick. All vacant shifts were given to NETSS 2 weeks in advance but they were unable to cover some of the shifts. Substantive staff who work bank shifts helped cover the ward. We still have high level of activity on Chelmer with 20 to 22 patients on our board. Ward manager covered Monday to Thursday 9 to 5 this week. We have one staff on Secondment, 1 band 3 vacancy. One staff was on 1 week unpaid leave. 1 staff was off sick. And bank shifts were covered with bank staff. On some shifts we had only 1 qualified staff with 3 HCA. Our bed numbers remains high and staff were booked to cover ECT (2 inpatients and 1 community patient). Ward Manager covers Monday to Friday 9‐5. We have one Band 3 Vacancy, 1 Band 6 on Secondment. 2 Band 5's off sick, 5 Staff went on C&R refresher (there had been cancellations for this training hence the number who had to attend), 1 Band 5 was on COSHH training. 1 Band 3 on Manual Handling training. Some staff were on annual leave. All shifts were sent to NETSS. They were unable to cover some of the shifts. High level of activity getting to the end of the week. Bank staff used to meet establishment and clinical need. Support from Stort ward provided when needed. OCT 
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5 Staff went on C&R refresher (there had been cancellations for this training hence the number who had to attend), All shifts were sent to NETSS. They were unable to cover some of the shifts. Ward establishment for Band 5 is over. 9.51 instead of 5.61. 1 Band 6 vacancy and 1 Band 4 vacancy. All shifts were booked to cover high clinical activity (ECT Recovery nurse) Ward establishment for B5 is over we have 9.51 instead of 5.61. All shifts booked to cover high clinical activity. We have 1 Band 6 vacancy and 1 band 4 vacancy. 2 Bleep Holder nights was covered with bank. (30 & 31st). Stort (A) SEPT 
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Ward manager helps Mon ‐ Fri 8‐4 where possible. A majority of bank staff are substantive staff working bank or regular bank staff who know the ward and patients. Low level of activity and low patient numbers the ward has been assessed as being safe. Both wards support each other with staffing when the need arises. We have vacancies, annual leave and training. We have 3 vacancies, Paul Littlechild has been appointed as a band 5 and due to start as soon as his clearances have come through and he has attended trust induction. Asiatu has been appointed into a 6 month fixed term post to complete her preceptorship (This is covering a 6 month career break). This leaves us with 1 substantive band 5 nurse post which will need to go back out to advert, Tracey Haley seconded from the trust is due to complete the nurse training end of September 2014. Ward manager helps Mon ‐ Fri 8‐4 where possible. A majority of bank staff are substantive staff working bank or regular bank staff who know the ward and patients. Low level of activity and low patient numbers the ward has been assessed as being safe. Both wards support each other with staffing when the need arises. OCT 
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Bank Staff used to cover gaps in rota. Staff recently recruited, yet to take up post (awaiting clearances), band 6 secondments out. Current vacancy 1 band 4. Band 6 secondment currently being advertised. Ward manager helps Mon ‐ Fri 8‐4 where possible. A majority of bank staff are substantive staff working bank or regular bank staff who know the ward and patients. Low level of activity and low patient numbers the ward has been assessed as being safe. Both wards support each other with staffing when the need arises. Kitwood (OA) SEPT 

Kitwood ward is carrying many vacancies of qualified staff currently which we are having difficulty recruiting to. Staffing levels have been unsafe and this has been rectified by reducing the bed numbers to 14 instead of 16. Arrangements have been made to transfer 1 x Band 6 from Roding Ward on the week commencing 29 September 2014 (allowing for annual leave) and further advertisements will be going out shortly in line with the recent skill mix review for Band 5, 4 & 3 staff. One Band 5 preceptorship nurse has recently started. We are hoping to have this situation well on the way to being resolved by the end of the year. Bank and agency staff used to meet clinical need. The e ward continues to carry two band 6 vacancies. To date recruitment into these posts have been unsuccessful. Band 6 moved from Roding to assist in strengthening the clinical leadership on the ward until till these posts are filled. OCT 



Bank Staff and agency staff used to meet establishment and clinical need Bank and agency used to meet establishment (vacancies) and clinical need (high level of observation). Bank and agency used to cover gaps in establishment and meet clinical need. Currently vacancies; band 6 x 2, band 4 x 1.6 , band 3 X 4 . Band 5x 2 Total 9.6 Area Matron in the process of advertising the vacant posts, with the exception of the band 6. Recruitment into these post has proved difficult to be revisited by Matron & Area Chief Nurse with view to acting up & re‐advertising Bank and agency used to meet clinical need. High level of vacancies. Vacancies currently advertised. Roding (OA) SEPT 
Roding ward is also carrying vacancies but in the main have been in a position to supply qualified staff to help cover Kitwood & Brian Roycroft, leaving themselves depleted. Additionally, Roding has agreed to supply one Band 6 to Kitwood Ward and act up one of their Band 5's into the vacant position ‐ this will occur the w/c 29 September 2014. Tuesday & Thursday are particularly difficult to cover due to the level of staff required for ECT, for which Roding holds the budget currently ‐ this is being reviewed by our Area Chief Nurse. Adverts will be going out shortly as with the other wards and in line with the recent skill mix review. 
Bank used to meet establishment and clinical need. Band 6 move to Kitwood to strengthen the leadership. OCT 



Bank and agency used to meet clinical need. Bank and agency use to meet daily establishment and clinical need. Vacancies at registered and unregistered level. Bank and agency used to cover gaps in establishment and meet clinical need. Currently vacancies; Band 5 X1, Band 4 X 1.6 , Band 3 X 4 Total 6.6. Area Matron in the process of advertising the vacant posts. In addition to the vacancies, 1 bank 6 is currently on suspension and 1 band and 5 is long term sick. Bank and agency used to meet clinical need and establishment. High number of vacancies. Current advertising CONCLUSION We are fully compliant with the required national standards of reporting and will be able to upload our Board Report both to the Centre via the UNIFY data collection system, the NHS Choices website and publish our staffing levels on our own website following the presentation of this Report at each of our Board meetings throughout the year. The Report indicates that all of our wards have some staffing issues for a number of reasons, including short notice sickness, Human Resource activity and some difficulty in recruiting in some wards. These issues of concern are routine in nature and are apparent across the Organisation, and each Area Clinical Board, supported by the HR Directorate, is addressing those relevant to each ward. The September and October comparators show an overall improvement in staffing compliance against the planned numbers with the following exceptions; Ruby Ward and Brian Roycroft ‐ both are struggling to maintain the agreed registered nursing numbers and as indicated in the narrative, these issues are being addressed. BOARD ASSURANCE In summary, the Trust is operating its wards to its agreed establishment on the majority of shifts, and is compliant with its ratio of qualified to unregistered members of staff, apart from those indicated on the individual ward data sheets. It is the Executive Director of Operations and Nursing’s opinion that safe staffing levels are a top priority for the area management teams and the Trust as a whole, and levels have been maintained to a safe level, except where indicated, and appropriate remedial action has been taken to mitigate the risks where staffing levels have been difficult to achieve. It is important to differentiate between individual shifts not being covered for legitimate reasons and those where there are material concerns impacting on a wards ability to provide safe staffing. This is a very dynamic process with changes to shifts happening on a daily basis. Tower Peter Bruff Henneage Bernard Ipswich Road Gosfield Ardleigh Larkwood Longview East ‐ Additional staff to those listed on rota Ward Manager 9‐5 Monday to Friday OTA Monday – Friday 9‐5 Care Review Nurse 9‐5 x 2 a week Ward Manager 9‐5 Monday to Friday Band 6 O/T 30 hours Band 6 O/T 30 hours Band 5 RMN Therapy Team 30 hours HCA Band 3 Therapy Team 30hours Band 6 Psychotherapist 15 hours Ward Manager 9‐5 Monday to Friday OTA 4 days per week (included on rota 9‐5) Music Therapist 1 session (1 hour) per week. Psychologist attends clinical meetings 1 hour per week. Ward Manager 9‐5 Monday to Friday One full time OTA working Monday – Friday on Bernard ward. 2 x 9‐5 shifts each week allocated to the 2 charge nurses who cover review Ward Manager 9‐5 Monday to Friday Band 6 OT who works 3 days/22.5 hrs per week (mon, tues, weds) One 9‐5 to cover reviews One 9‐5 to cover tribunals (as required), and a recurring once a month outpatient appt that one of our service users has in Southend. Ward Manager 9‐5 Monday to Friday One psychologist shared between both wards and home treatment team. Two OTA and X1 OT shared between both wards. OT runs 3 groups daily (Monday to Friday) and complete ADL for both wards. OT and psychologist will attend reviews, clinical meeting and professional meetings when they can. Ward Manager 9‐5 Monday to Friday One psychologist shared between both wards and home treatment team, Two OTA and X1 OT shared between both wards. OT runs 3 groups daily (Monday to Friday) and complete ADL for both wards. OT and psychologist will attend reviews, clinical meeting and professional meetings when they can. Ward Manager 9‐5 Monday to Friday Two psychologists , one will spend around 2 hours each day carrying out individual work with YP. Teaching staff run 1 group on the ward for 2 hours a week. MDT leads, i.e. psychotherapist, CAT therapist, who spend an hour a day on the ward carrying out individual work with YP, although this would vary depending on how many YP they are MDT lead for. Groups that are run off the ward by education and OT too? Ward Manager 9‐5 Monday to Friday Two psychologists , one will spend around 2 hours each day carrying out individual work with YP. Teaching staff run 1 group on the ward for 2 hours a week. MDT leads, i.e. psychotherapist, CAT therapist, who spend an hour a day on the ward carrying out individual work with YP, although this would vary depending on how many YP they are MDT lead for. Groups that are run off the ward by education and OT too? West ‐ Additional staffing – Oct 2014 BRU Kitwood Roding Stort & Chelmer 1 hour every weekday by geriatrician from SEPT. Consultant reviews once a month. Ward Manager available Monday –Friday 9am‐ 5pm. No OT input at present – ( being reviewed) Training area for student nurses Daily access to Junior DRs and weekly Consultant ward rounds Psychology input by referral. OT currently provided the following groups Tuesday: 8‐9am Breakfast group Pm group 1. 1:1 sessions Pm group 2 sensory sessions Wednesday: 3‐4 PM 1:1 sessions Thursday: Memory café group 2‐3pm Friday : 1.30‐3pm mixed activities OT also provide specialist assessments including home visits Ward Manager available Monday – Friday 9‐ 5pm Training area for student nurses Daily access to Junior DRs and weekly Consultant ward rounds Psychology input by referral OT currently provided the following groups Thursday: AM Feel Good group 1 hour PM Activity group 1 hour OT also provide specialist assessments including home visits Ward Manager available Monday – Friday 9‐ 5pm Training area for student nurses Daily access to Junior DRs and weekly Consultant ward rounds OT Tech – 3 times a week – closed groups OT Band 5 – ad hoc – attends ward rounds, facilitates assessments Dietician‐ weekly Chaplain‐ Monday and Friday Psychology – Case reviews assessment & ward rounds Facilities group on a Monday Staff support every fortnight Student nurse training area Ward manager available Monday to Friday 9‐5 Mid ‐ Additional staff to those listed on rota Galleywood Ward Manager 9 ‐ 5 Monday to Friday Occ Therapist B6 Arts/Music Therapist Band 7 Finchingfield Ward Manager 9 ‐ 5 Monday to Friday Occ Therapist B5 Arts/Music Therapist Band 7 Rainbow Ward Manager 9 ‐ 5 Monday to Friday Occ Therapist B5 ‐ 4 days per week Ruby Ward Manager 9 ‐ 5 Monday to Friday Topaz Ward Manager 9 ‐ 5 Monday to Friday Occ Therapist B5 Edward House Ward Manager 9 ‐ 5 Monday to Friday East Occ Therapist B6 Technical Instructor B4 Psychologist B5 (at advert for Psychologist and Psychology Assistant) AP X 2 B4 out to advert Shared resource as below with EH West Edward House Ward Manager 9 ‐ 5 Monday to Friday West Shared resource as above with EH East Christopher Ward Manager 9 ‐ 5 Monday to Friday Unit Occ Therapist B5 ‐ 3 days per week AP B4 – Monday ‐ Friday Psychologist B8a ‐ 2 sessions per week Shannon Ward Manager 9 ‐ 5 Monday to Friday House Occ Therapist B6 ‐ 0.5 hrs Technical Instructor B4 ‐ 27 hrs per week Day
Specialty 2
Ward name
Specialty 1
Site code *The Site code is
automatically populated
when a Site name is selected
Registered midwives /
nurses
Main 2 Specialties on each ward
Hospital Site name
Hospital Site Details
Night
Care Staff
Registered midwives /
nurses
Day
Night
Care Staff
Total
Total
Total
Total
Total
Total
Total
Total
monthly
monthly
monthly
monthly
monthly
monthly
monthly
monthly
actual
planned
actual
planned
actual
planned
actual
planned
staff
staff hours staff hours staff hours staff hours staff hours staff hours staff hours
hours
Average fill
rate registered
nurses/midwi
ves (%)
Average fill
rate - care
staff (%)
Average fill
rate registered
nurses/midwi
ves (%)
Average fill
rate - care
staff (%)
RRDA1
COLCHESTER - THE BRAMBLES
Ipswich Road
710 - ADULT MENTAL ILLNESS
465
480
930
930
233
233
233
233
103.2%
100.0%
100.0%
100.0%
RRDD7
COLCHESTER - KING'S WOOD CENTRE
Bernard Ward
715 - OLD AGE PSYCHIATRY
233
428
233
240
465
270
465
593
100.0%
715 - OLD AGE PSYCHIATRY
1200
1335
100.0%
Henneage Ward
930
930
129.0%
COLCHESTER - KING'S WOOD CENTRE
675
938
72.6%
RRDD7
930
930
100.8%
143.5%
56.1%
219.4%
RRDE0
COLCHESTER - BIRCHWOOD
RRDE1
COLCHESTER - THE LAKES
Ardleigh Ward
710 - ADULT MENTAL ILLNESS
Peter Bruff Unit
710 - ADULT MENTAL ILLNESS
112.9%
Tower Ward
715 - OLD AGE PSYCHIATRY
263
338
263
488
104.7%
CLACTON - MENTAL HEALTH SERVICES - CLACTON HOSPITAL
270
323
233
465
124.0%
CLACTON - MENTAL HEALTH SERVICES - CLACTON HOSPITAL
473
465
458
240
114.5%
RRDE2
428
375
465
233
112.1%
RRDE2
998
1065
885
1418
97.2%
710 - ADULT MENTAL ILLNESS
930
930
930
930
110.5%
Gosfield Ward
1005
1043
975
690
107.3%
COLCHESTER - THE LAKES
930
930
930
930
108.1%
RRDE1
RRD16
THE CRYSTAL CENTRE
Ruby Ward
715 - OLD AGE PSYCHIATRY
RRD16
THE CRYSTAL CENTRE
Topaz Ward
715 - OLD AGE PSYCHIATRY
RRDAH
CHELMSFORD - THE LINDEN CENTRE
Christopher Unit
710 - ADULT MENTAL ILLNESS
RRDAH
CHELMSFORD - THE LINDEN CENTRE
Edward House
710 - ADULT MENTAL ILLNESS
RRDAH
CHELMSFORD - THE LINDEN CENTRE
Finchingfield Ward
710 - ADULT MENTAL ILLNESS
RRDAH
CHELMSFORD - THE LINDEN CENTRE
Galleywood Ward
710 - ADULT MENTAL ILLNESS
RRDAH
CHELMSFORD - THE LINDEN CENTRE
Rainbow Unit
710 - ADULT MENTAL ILLNESS
RRDPA
HARLOW - DERWENT CENTRE
Shannon House
710 - ADULT MENTAL ILLNESS
930
930
930
1860
1163
1163
465
930
690
705
863
1643
1358
1238
555
878
930
930
930
1860
930
930
1395
930
1028
2535
1185
1853
1395
1058
1463
1200
428
698
435
667
465
465
233
465
195
233
293
688
458
473
240
443
270
233
233
1333
233
233
465
465
495
870
690
1279
270
233
563
488
RRDPA
HARLOW - DERWENT CENTRE
Chelmer Ward
710 - ADULT MENTAL ILLNESS
RRDPA
HARLOW - DERWENT CENTRE
Stort Ward
710 - ADULT MENTAL ILLNESS
RRDHD
EPPING - ST MARGARETS HOSPITAL
Kitwood Ward
715 - OLD AGE PSYCHIATRY
RRDHD
EPPING - ST MARGARETS HOSPITAL
Roding Ward
715 - OLD AGE PSYCHIATRY
RRDHF
HARLOW - SYDENHAM HOUSE
Brian Roycroft
715 - OLD AGE PSYCHIATRY
930
930
930
930
930
1050
915
990
885
668
930
930
930
930
1163
863
968
1628
1290
2093
465
465
465
233
465
465
420
240
240
315
233
233
233
465
233
233
278
750
638
885
RRDE0
COLCHESTER - BIRCHWOOD
Longview
711- CHILD and ADOLESCENT PSYCHIATRY
RRDE0
COLCHESTER - BIRCHWOOD
Larkwood
711- CHILD and ADOLESCENT PSYCHIATRY
930
930
788
810
1163
1395
1200
1523
233
233
278
233
465
698
510
533
104.8%
95.2%
98.4%
74.2%
152.4%
103.2%
104.8%
74.2%
110.5%
45.6%
183.3%
75.8%
272.6%
33.3%
374.2%
92.7%
127.4%
67.2%
296.8%
88.3%
99.6%
103.2%
96.0%
116.8%
150.0%
98.4%
116.1%
106.5%
113.7%
101.6%
100.0%
119.4%
104.8%
103.2%
121.0%
94.4%
129.0%
95.2%
104.8%
112.9%
92.7%
100.0%
100.0%
98.4%
104.0%
90.3%
119.4%
106.5%
175.0%
51.6%
322.6%
95.2%
138.7%
103.2%
137.1%
71.8%
180.0%
67.7%
380.6%
84.7%
103.2%
119.4%
109.7%
87.1%
109.1%
100.0%
76.3%