The Trust was faced with a significant recurrent financial deficit in part due to their PFI and contracted service and the inflexible nature of such deals, but also to the changing nature of healthcare funding and contracting for care.
Payment by results ensures a high quality and value for money service for the tax payer, but makes no allowances for the extra costs that Peterborough Hospital face and so placing them in a difficult position, making it necessary to pursue a cost improvement agenda over and above the QIPP savings already timetabled for the Trust.
Without such pressures it would already be part of the responsibility of senior management to ensure a safe and high quality service for the patients of Peterborough and Stamford / Rutland, but within the cost envelope of what can be afforded against what standard of service must be provided. It was necessary therefore to review major elements of service, particularly those which require considerable financial investment and staffing is of course the single most expensive resource for any organisation. A systematic review of current provision and therefore cost against Benchmark organisations and by systematic analysis of patient needs, national and local standards of best practice and safe care was the starting position for this project.
We were commissioned to conduct a review of nursing staff (from Band 2 to Band 7) in the majority of patient care areas within the Trust.
Terms of Reference
The terms of reference were as follows:
- To undertake an initial benchmarking exercise of the Trust's Nursing establishments in each of the areas within the scope of this review
- To review the outcomes of the benchmarking exercise with the project sponsor and where required, to; Undertake more in-depth analysis of staffing levels in each ward/department to include rosters, skill-mix, hours/patient, etc. And, to identify alternate staffing models that provide the Trust with greater value for money
- For all of the above, stages of the review to be supported by robust evidence from other NHS Trusts and to provide an analysis using a recognised Nursing Tool, as per Monitor requirements.
Throughout the review process, our Team sought to work in an open, consultative and interactive manner to ensure that key stakeholders were fully involved and had ownership in the diagnosis of the issues and in redesigning the services.
Our Transformation Team worked closely with the project sponsor and a Steering Group, which met several times during the course of the review to ensure that the project achieved its reporting targets and to resolve any issues that arose during the course of the review.
We used a number of different tools/models to analyse the nurse staffing establishment at the Trust. The Models used for calculating the number of nursing staff required were as follows;
Hurst calculations - based on the number of patient beds, the speciality and if the beds are single rooms or non-single room beds.
- Professional Judgement results - based on the mandatory shift patterns within the E-rostering system.
- GK calculations - based on professional experience in developing duty rosters and a review of all available models.
- Alternative GK calculations factored differing shift patterns from the E –rostering template e.g. increase in long days shift pattern and, where needed, an increase in the skill mix.
- Benchmarking calculations based on like-for-like comparisons with other NHS Trusts.
The review adopted a number of different approaches because there is no one single methodology that is accepted by everyone. Each has their merits and detractors. The Hurst and Professional Judgement methodologies were used, in part because this was requested by the Trust as part of the terms of reference and in part as they are the most recognised staffing calculation methodologies adopted within the NHS.
Our calculations provided another methodology, which we have found offers a more realistic outcome from previous experience. The benchmarking calculations are somewhat different and provided a picture of how the Trust compared to its peers in terms of relative staffing levels. The benchmarking analysis was therefore a comparison of actuals, whereas the other three methodologies calculate staffing requirements based upon activity and workload.
By adopting this range of approaches, it was anticipated that where an area was shown to be consistently over or under resourced against each of the methodologies, it provided the Trust with a much stronger indication of the actual position than if any one methodology were adopted in isolation.