Background Despite the NHS having safe staffing reporting requirements in place since 2014 (NHS England. How to ensure the right people, with the right skills, are in the right place at the right time: a guide to nursing, midwifery and care staffing capacity and capability [Internet] 2013; Francis. The Mid Staffordshire NHS Foundation Trust Public Inquiry [Internet] 2013), this has not been applied to hospices. There are also no specific staffing standards for hospice inpatient units.
Aims To provide quality assurance on staffing levels within the hospice inpatient unit. To obtain intelligence on bed occupancy, demand, and capacity, and our ability to support the wider health and care system in relation to specialist palliative and end-of-life care.
Method A retrospective audit was performed over 6 months (Nov. 2022 to Mar. 2023) collecting actual nursing and health care assistant staffing numbers against planned staffing levels. This was reviewed against numbers of patients and the standard calculation for Care Hours Per Patient Day (CHPPD) was applied.
Results We were safely staffed within our budgeted staffing establishment for registered and unregistered workforce, and expectations on hours filled. Nights were better staffed than days due to more set patterns of working for that group of staff. There was an average of 16 CHPPD received by patients and their families. Lower staffing levels aligned with lower bed occupancy, suggesting we flexed our staffing to meet clinical need and demand on services. There was no impact on our ability to achieve other deliverables, including time from referral to admission.
Staffing levels demonstrate that we could have potentially taken more admissions on occasions, had the demand for inpatient beds been present showing we can support the systems in which we operate.
Discussion We recognise that safe staffing is only a tool, and for it to be fully effective (Royal College of Nursing. Impact of staffing levels on safe and effective patient care: literature review [Internet] 2023), it needs to be reviewed alongside additional information such as adapted dependency tools (NHS England. Safer nursing care tool [Internet] (no date)) and capacity and demand information. We have committed to continuing to review this information, including an annual report, and will adapt other national tools for our use as they become available.
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