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Nursing within Lord Carter’s report:
‘Operational productivity and performance in
English NHS acute hospitals: Unwarranted
variations’
Lyn McIntyre MBE
Senior Nurse Advisor – Workforce Efficiency
2 Unwarranted Variations: final report summary, February 2016
Introduction
1. Background
2. Overview of the report
3. Nursing recommendations
4. Next steps
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Interim report – June 2015
• £5bn opportunity – tighter grip of resources
• Workforce is the biggest cost = biggest opportunity for
improving productivity
• Variances between trusts – the NHS can be up with the
world’s best but inconsistency and a need for relentless
attention to costs
• Greater savings to be had in improving workflow within
and in and out of hospitals
• Advocated ATI now termed Adjusted Treatment Cost
(ATC). This metric could be applied to any combination
of inputs to enable both comparison between trusts and
to create baselines for future improvement
• Detailed analysis with 22 trusts
• Advocated a model hospital to allow trusts to compare
themselves against best practice
• Final report by the end of the calendar year
Interim report
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Overview of the final report
15 recommendations across:
• Optimising clinical resources,
including nursing
• Optimising non-clinical
resources
• Quality and efficiency across
the patient pathway
• Implementation and
engagement with trusts
Unwarranted Variations: final report summary, February 2016
6 Unwarranted Variations: final report summary, February 2016
Background
• Deep dives with 32 and wider engagement across 104 non-specialist acute
trusts (136 trusts in total)
This chart shows the pay and non-pay split of spend for the 136 non specialist acute trusts, with a breakdown of pay
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Optimising nursing resources
To increase nurse and healthcare support worker productivity by:
• implementing robust e-rostering systems,
• taking a collaborative improvement approach,
• developing enhanced care guides, and
• setting appropriate benchmarks against which trusts should plan
staffing resources to ensure safe and productive levels of staffing
through Care Hours per Patient Day (CHPPD)
• so that the right teams are in the right place at the right time,
collaborating to deliver high quality, efficient patient care by the
end of 2016.
Unwarranted Variations: final report summary, February 2016
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RosteringTrusts should use an e-rostering system and implement the follow practices:
• An effective approval process by publishing rosters six weeks in advance and
review them against trust key performance indicators such as proportion of
staff on leave, training and appropriate use of contracted hours;
• A formal process to tackle areas that require improvement, with escalation
paths, action plans and improvement tracking; and,
• Cultural change and communication plans to resolve any underlying policy or
process issues.
Unwarranted Variations: final report summary, February 2016
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Collaborative improvement approach
• Developed by the Institute of Healthcare Improvement
• We invited 26 directors of nursing, along with their trust
colleagues, regulatory bodies and Royal College of Nursing
representatives to form a nursing workforce efficiency
improvement collaborative
• This collaborative approach proved very effective as a means
of mobilising the range depth of experience and expertise
across the NHS
• Highlighted an overreliance on external consultancies.
Unwarranted Variations: final report summary, February 2016
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Workforce Efficiency Improvement
Collaborative
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Examples of projects
• Reduction of sickness by 0.5% on each ward
area – 500k
• Improved roster grip – avoidance of
overstaffing – 300k
• Decrease in specialling by implementing Safety
Support Worker role – 330k
• Underused hours – 350k
• Rosters moved to 13 week approval
• Specialling pool, uplift, generic worker
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Specialling (Enhanced Care)
• 9 Trusts chose Specialling as their improvement goal
• Review of policies, risk assessment, working with carers and
patients
• TDA also ran a 90 day rapid improvement collaborative
• Reviewing learning from both with the aim of setting up a
national programme - tackling variation in specialling across
the service.
• Good Practice Guidance – including replacing the term
specialling with ‘enhanced care’ to better reflect this
management practice and patient intervention.
• Acute trusts implement the enhanced care guide by 1st
October 2016.
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Care Hours per Patient Day (CHPPD)
• CHPPD is a simple
calculation by dividing the
number of nursing hours
available by the numbers of
patients
• CHPPD looks at the number
of registered nurses and the
number of healthcare
support workers (HSWs)
over the total number of
inpatients
• It provides a measurement
that enables units of a
similar size and patient
group to be benchmarked
• The CHPPD metric will form
one part of the Model
Hospital Nursing Dashboard,
that will allow comparison
with quality, financial and
staffing metrics.
Unwarranted Variations: final report summary, February 2016
14 Unwarranted Variations: final report summary, February 2016
15 Unwarranted Variations: final report summary, February 2016
The design and metrics for inclusion on the Nursing dashboard of the model hospital are under review. These
metrics are for illustration purposes only.
• Single approach to
reporting
• Data validation
• Performance
comparisons
• What good looks
like in comparable
organisations
• Currently under
development by a
Steering Group
• Being tested in
acute Trusts in
March 2016
• Evaluated and
reviewed April
2016.
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Next steps
• Continued engagement with trusts
• Working closely with our partners
• Moving towards NHS Improvement
• Getting the model hospital nursing dashboard and right
• Mental Health and community trust involvement
• Allied Health Professionals and Clinicians
Unwarranted Variations: final report summary, February 2016
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Lyn McIntyre MBE
Senior Nurse Advisor – Workforce EfficiencyProductivity and Efficiency Division
Department of Health
Email: [email protected]: @McIntyreLyn
Unwarranted Variations: final report summary, February 2016
