NHS – The Operational Challenges of Safe Staffing

NHS Safe StaffingAs an election year looms, the pressure on the NHS continues to build. The future of the service continues to be a heavily debated topic and a clear battle ground for the main parties. The issue of privatisation remains prominent with many public thinkers expressing doubts over whether the service will soon cease to be free. Whilst others suggest taking the pressure off hospitals and GP clinics by spreading patient treatment across pharmacies instead.

Undoubtedly, the biggest concern for all must be the quality of patient care. The NHS care watchdog recently warned of a risk to patient care due to a shortage of doctors and nurses. Then its annual report assessing NHS and social care services, the Care Quality Commission (CQC) said recently that while much care is excellent, “the variation in the quality and safety of care in England is too wide and is unacceptable”.

Against this backdrop, organisations are continuing to offer their guidance to NHS leaders in order to improve patient care. For example, recently the National Institute for Health and Care Excellence (NICE) endorsed a decision support toolkit to be used alongside its guideline on safe staffing for nursing in acute hospitals.

It’s clear that as the service continues to face financial challenges, technology will play a key part in supporting staff in their roles.

Kronos recently hosted a series of NHS workshops following the initial guidelines published by NICE. These were attended by a broad spectrum of healthcare professionals from NHS trusts across the UK. The aim of these workshops was to help NHS trust managers meet safe staffing obligations, control labours costs and improve patient care. Through the discussions at these workshops, a number of consistent challenges were highlighted.

One of these issues were the Unify reports. These report templates are a government requirement for trusts to report their staffing levels. But there appears to be inconsistencies and a disparity in the way trusts are reporting safe staffing. These inconsistencies arise from Trusts recording the supernumerary/supervisory status of nurses as clinical hours or not. In addition, there are some discrepancies with how the wards are recording the hours in terms of long or short days.

The unify report simply asks for hours on day and hours on night shifts. With enough detail lacking in these logs, it could negatively impact some trusts, especially if they are logging reports differently. The hope is that soon enough, there will be thorough guidance provided on reporting expectations.

But, how is the staffing data impacting upon patients right now?

The consensus here seems to be that patients are not using the data or they cannot understand the data. Staffing numbers are not currently being quoted in complaints, for example. Trusts believe that patients are either not interested in the numbers, or are not aware of the relevance. This will change though, and it will be interesting to measure the impact upon service requirements for those having patient choice for surgery, etc. There was a clear consensus from our panels that whilst data is not used during normal clinical visits, it could be used in future complaints or legal cases. Therefore, in the future it is imperative that trusts will need to have access to accurate records. And those that fail to manage this process will find themselves under immense scrutiny from public sector leaders and the public.

Keep an eye out for our next blog, where we’ll discuss the operational challenges facing trusts today.


10 Common Challenges for Workforce Management in the NHS

nhsLast week Kronos hosted its annual conference for the EMEA region – Kronos Live EMEA. The event is naturally one of the highlights of Kronos’ year. Spending time with customers and prospects talking about their workforce management challenges and requirements is invaluable and vital to ensuring that, as a business, we continue to meet the needs of our users.

Ahead of the main conference I also had the pleasure of hosting an intimate dinner for workforce management professionals within the healthcare sector. The discussion was led by LSE professor Dr. Tony Hockley, who recently authored the report – NHS Staffing: Not Just a Number.

It’s clear that NHS Trusts across the UK are all at different stages of technology implementation and – to some extent – their experiences and user demands are unique. However, there are also many commonalities which exist, regardless of a Trusts location, size or the type of care it offers to patients.

Here are my 10 observations – in no particular order – which the NHS faces when approaching workforce management.

  1. Nurses and administrative staff should be proud to be workforce management trailblazers. Some might feel that nurses have been ‘picked on’, as they comprise the majority of health professionals who are currently utilising workforce management or eRostering technology. I think the opposite. Nurses and admin staff are leading the way and inevitably other health professionals (medical and other services, etc.) will follow.
  2. Transparency through technology is essential. The NHS relies on the good nature and professionalism of its employees. But too often this can then be open to mismanagement or abuse. Technology can help to remove guess work and provide evidence around hours worked, shift patterns and workforce anomalies.
  3. Accuracy, accuracy, accuracy! Transparency is only of value if the data is precise and – crucially – provided in real time.
  4. Ratios of staff to patients are important, and collectively we have to get it right and respond positively to proposed government targets. But patient care will never be an exact science. Across all forms of care there are anomalies, inconsistencies and exceptions.
  5. We all want a simpler life… I am always astounded to hear stories from across the NHS about how many shift patterns exist across a Trust. Whilst it’s vital to offer employees the flexibility to fit work around other commitments, greater standardisation and simplicity of shift options means greater efficiency. In one instance a Trust consolidated an unwieldy 68 shift options to just six.
  6. Workforce management solutions are still in their infancy in the NHS. We can certainly learn from private sector industries, such as retail and manufacturing, which are now well established and in their third or fourth iterations of technology deployment. But it is wrong to try and compare like for like. The NHS is different from the private, sector and we have to recognise that.
  7. We all need help to become better managers. One consistent challenge which does exist across private and public sector is that continuous development and training is essential. Nurses shouldn’t be expected to become team managers without investment in management training and learning. The best technology in the world can’t help if managers aren’t confident, empowered and up-skilled to make managerial decisions based on the insight IT solutions provide.
  8. Build a justification case for implementation. In tough economic times, all tech decision makers are under pressure to show the value of their investments and ROI. As technology vendors, it’s our responsibility to help our customers do this.
  9. Change management is the key to success. The NHS is driven by people and behavior. No tech implementation or change to processes and practices will succeed without the buy-in of staff.
  10. Finally, it’s all about the patients. In a climate driven by cost saving, efficiency and cuts, we must never lose sight of the fact that we are all here to serve the best needs of the patient.


Reliable systems will help the NHS fight fraud

NHS Fraud

The NHS has suffered a great deal of scrutiny recently – as the service tries to battle with public sector cuts and increasing demand from patients, it must now respond to the latest blow: the cost of fraud in the NHS. A BBC Panorama programme which aired last month revealed that NHS fraud and error is ‘costing the UK £7 billion a year’. The last thing the service needs is to lose money to fraud and error when the pressure to save and cut costs has never been higher.

Given that the biggest areas of fraud are found to be payroll and procurement budgets, we must focus on these processes to determine where the faults can be fixed. Payroll fraud can happen in a number of ways: some examples include employees claiming overtime for hours not worked, false expense reimbursement claims and lastly, unauthorised changes to an organisation’s payroll systems (such as an employee adding ghost employees to the payroll who either do not exist or do not work for the organisation).

A report from the National Fraud Authority echoes this and states that payroll fraud costs the public sector £335 million a year. In reality, the figure is probably even higher– not all payroll fraud is accounted for because it can go unnoticed with unreliable systems in place. Fortunately, this doesn’t have to be the case.

Many parts of the NHS still rely on “weak data” to run their payroll and workforce management systems, rather than leveraging real-time data to show staff availability and validate that rosters are being worked as planned.Yet, the latter is important not only for accurate shift allocation, but even more so for patient safety. For example, a recent report from the London School of Economics and Policy Analysis Centre shows that even an inaccuracy of 0.09% in the NHS payroll equates the cost of the employment of up to 2,000 additional nurses!

In order to eliminate payroll fraud, NHS leaders and staff need to embrace the latest Time and Attendance (T&A) systems and integrate them with payroll. The London School of Economics and Policy Analysis Centre report supports this by voicing potential savings of £71.5million from the use of T&A systems in the NHS.

For this vision to become a reality, the image of industrial-style “clocking-in” systems must be scrapped. Modern self-service biometrics terminals allow staff to quickly, easily and securely record their activity, thereby ensuring accurate payroll and preventing fraud occurring. The Royal College of Nursing (RCN) issued guidance earlier this year, describing good quality data as “the cornerstone of effective staff planning and review”. Now, when the topic of fraud arises, NHS leaders must remember that good quality data and reliable systems will be the answer for prevention.