CNO Summit 2017, Day 1, 12.20pm Mark Radford, Director of Nursing, NHS Improvement. Susan Aitkenhead, Director of Nursing, Professional Development NHS England

1. CNO Summit 2017
Safe, Sustainable Staffing Resources Breakout Session
Mark Radford, Director of Nursing – Improvement, NHS Improvement
Susan Aitkenhead, Director of Nursing – Professional Development, NHS
England
14th March 2017
#nursingnhsi
#Lead2Add

2. We are using SLIDO audience interaction tool
•Go to www.slido.com
•Event code #7823

3. Workforce

4. Workforce
• The workforce, like many in other large sectors and industries, is
facing numerous challenges and the landscape of transformation, as
set out within the Five Year Forward View is being delivered so we
have health and care services that can adapt to the future. In this
changing landscape we know that we cannot rely on the traditional
solutions to some of our major workforce pressures and we need to
think differently moving forwards.
• National discussion and collaborative working across NHS
Improvement, Health Education England and NHS England is taking
place.
• Important to understand what unites us in our thinking about the
future workforce but also understand the issues that require further
debate and test out the issues so we speak and lead with that
common narrative.

5. NHS Workforce Profile – Nursing Numbers
5
Substantive Nursing Provider Workforce
Since 2012, the substantive Nursing workforce has increased by 18,400 WTE (6.2%) across the
provider sector.
Substantive Registered Nursing Workforce

6. Scale of the challenge – Nursing
6
Bank and Agency
Whilst a £700m reduction … reliance on bank and agency is significant.
What can we do to covert those agency and full time bank to substantive ?

7. EEA nurses
• EEA nurses and midwives have been a significant ad important composition of the
workforce
• Variation in regional positions exist related to EEA and overseas nurses
• An effect has been observed with reduced interest in EEA nurses working in the UK.
• Unclear on future

8. Slido Question
Current workforce challenges in NHS
1. I can’t remember a time that was more challenged
2. It’s a little more challenged
3. About the same
4. A little less challenged
5. No pressure at all

9. Leadership

10. Leadership Opportunities
• Choices here what we do – with
an opportunity to take control
and be a key part of the
leadership that creates a
modern workforce.
• Nursing recognised as the most
trusted profession according to
a recent survey run by Ipsos
Mori – more than 93% of
respondents said they trust
nursing staff.

11. Key Impact Areas:
• Nursing Associate role -.
• Nursing Degree Apprenticeship
• Reforms to the funding system
• Understanding the impact of a post Brexit era
• Recruitment , Retention & Turnover
• Education – NMC review.
• NHS leadership capability and capacity.
• Productivity – NHS I ‘Getting It Right First Time’
programme.
• Temporary staffing.
• Demand and Supply Assessments

12. Slido Question to audience
Key priorities workforce priorities for Nursing &
Midwifery to 2020
1. Supply
2. Overseas nurses
3. Retention
4. Agency control
5. Regulation
6. Education
7. CPD funding

13. Expectations of Commissioners
System Leadership as Clinical Commissioners
• A focus on the nursing and AHP workforce as a whole -
an awareness of the 'system' rather than individual
organisations and the need to work together as a system
given the movement of the workforce between
organisations.
• Challenging the status quo and ensuring that the nursing
workforce needs of both Primary Care and Care Homes
are explicitly heard and seen in the system as being of
equal importance.
• Bringing the system together and the opportunity of
collaboration rather than competition – opportunities with
STPs and ACPs to be a key enabler with this.

14. STPs and Leadership Opportunities
Exemplar of possibilities – Flo Panel-Coates (UCLH), Claire Johnston (NCL STP), Helen Donovan (RCN
& Barnet CCG) and Lorraine Szeremeta (UCLH) identifying that the early involvement of nurse leadership
at every level of the STP is essential:
• Application for membership of a clinical cabinet to ensure influence of the ToR and ensure that
nursing involvement was not tokenistic.
• Acceleration of work which had already been consulted and agreed by the London Leadership Group
under the Capital Nurse Programme - as members of the local WAB, a sub group of the STP they
have been able to influence and gain support.
• Organisation and leadership of a NCL chief Nurse/leader/HEI engagement event in December where
the group agreed to focus on 4 key improvements priorities:
1. Commitment to work together as cross sector leaders to direct and influence the STP clinical work
streams including establishing contact lists, a ‘WhatsApp’ group, sharing of local ideas;
2. Rapid implementation of the Career Clinic, based on the internal transfer list started at UCLH to
improve retention for early career nurses and to give them opportunities to move across the sector;
3. Develop a Capital Nurse career passport - personal records of achievement - soon to be on an app;
4. Local leadership development - planned to start in May – to enable local matron level leaders to form
a learning set focused on STP wide cross sector working - all Trusts/CCG primary care leads are
taking part to build a strong cohort of nurse leaders working to transform practice and services
collectively.
• Additionally supporting workforce colleagues to help with areas such as Statutory and Mandatory
training, and shaping the clinical Quality Impact Assessment support document

15. Thoughts and feedback from Flo on this work so far:
• The local delivery groups are in their infancy and as nurses, leaders, and experienced ‘deliverers’ we need
to help shape these so there is a focus on the right patient pathways.
• Biggest risk is workforce - not just about nursing numbers and skills but also cultural and behavioural
barriers in transformation - nurses need to be exposed to primary care or social care settings earlier -
trying to change this so nurses have the confidence and ambition to work in these settings.
• Must be in tandem with developing nurses - which is where the specialisms review for Capital Nurse
comes in - e.g. Urgent and Emergency Care and CAMHS nurses collectively agreeing learning outcomes
which newly qualified staff and early career nurses, as well as advanced practitioners need.
• Leading to confident ENPS who can be the solution to reducing activity for the STP in EDs - working
alongside colleagues and reducing pressures - and the evidence demonstrates this.
• The STP UEC plan aims to reduce the 3000 admissions to UEC from nursing and residential home
settings. The nursing contribution to hospital avoidance here is key to success – a dedicated matron post
has significantly reduced these numbers and built more confident care home staff.
• Preventive health - nurse consultant in mental health primary care on the work stream who is making a key
contribution to some of the cross cutting themes such as social prescribing and self-managed care.
Advice:
• Working together, demonstrating what impact we can have, not just for nursing but also as experienced
leaders.
• A willingness to put time in and not wait to be invited or offended as the cause is greater than our feelings.
• Now is the time to share and learn from each other and not be reluctant if it was not our idea, most issues
are transferable under a number of subtle headings.
• Our experience is our colleagues and system need us more than ever, whether it is initially obvious or not
it soon becomes so….

16. • What stops clinical workforce
redesign?
1. Managers
2. Frontline Medics
3. Frontline Nurses, Midwives and AHPs
4. Colleges and Associations
Slido Question to audience

17. Quality
Safe staffing

18. Safe, Sustainable Staffing Improvement
Resources

19. Care Setting Chair
Inpatient wards for Adult
Acute Hospitals
Professor Hilary Chapman, Chief Nurse, Sheffield
Teaching Hospital
Urgent and Emergency Care Pauline Philip, CEO, Luton and Dunstable NHS Trust
Maternity Services Professor Mark Radford, Director of Nursing –
Improvement, NHS Improvement
Children’s Services Michelle McLoughlin, Chief Nurse at Birmingham
Children's Hospital and Birmingham Women’s Hospital
Community Services Dr Crystal Oldman, CEO The Queens Nurse Institute
Learning Disability Services Professor Oliver Shanley, Regional Chief Nurse London
– NHS England / NHS Improvement
Alison Bussey, Director of Nursing/Chief Operating
Officer South Staffordshire and Shropshire NHS
Foundation Trust
Mental Health Ray Walker, Executive Director of Nursing Merseycare
NHS Trust
Setting-Specific Safe Staffing
Improvement Resources

20. Setting-Specific Safe Staffing
Improvement Resources - progress
Engagement
starts 14th of
March

21. Adult inpatient for acute hospitals
#nursingnhsi
#Lead2Add

22. 23
Survey respondents: adult acute inpatient
Chair, 1 CEO, 1
Medical Director, 3
HR Director, 2
Nursing
Director, 8
Associate Director of
Nursing, 9
Head of Nursing, 4
Deputy Chief Nurse / Assistant Chief
Nurse, 13
Ward Manager / Ward Sister / Charge
Nurse / Nurse Manager, 4AHP Lead, 16
Matron, 4
Specialist Nurse, 2
Staff Nurse, 9
Academic/education staff, 1
Other*, 33
Acute adult inpatient
'Other' respondents include:
Quality Improvement
Nurse Patient Experience
Committee Lay Member
Clinical lead for 2 AHP departments
Head of Adult SLT Consultant Podiatrist
Head of Therapies (OT and PT)
Deputy HR Director
Safer Staffing Lead
General Manager

23. Staff impact: adult acute inpatient
24
Threshold values
Weighted mean >1
Net balance >15%
0
5
10
15
20
25
30
35
40
45
As a direct result of this improvement resource do
you anticipate that registered nurse (or midwife)
staffing levels at your trust will:
As a direct result of this improvement resource do
you anticipate that clinical support worker staffing
levels at your trust will:
As a direct result of this improvement resource do
you anticipate that other clinical staff levels at
your trust will:
Numberofresponses
Acute adult inpatient (Leadership)
Increase a lot Increase a little Stay about the same Decrease a little Decrease a lot
(n = 61
Dont knows =
11)
(n = 60
Don't knows = 10)
(n = 61
Don't knows =
14)

24. Staff impact: acute adult inpatient
25
Threshold values
Weighted mean >1
Net balance >15%
0
2
4
6
8
10
12
As a direct result of this improvement resource do
you anticipate that registered nurse (or midwife)
staffing levels at your trust will:
As a direct result of this improvement resource do
you anticipate that clinical support worker staffing
levels at your trust will:
As a direct result of this improvement resource do
you anticipate that other clinical staff levels at your
trust will:
Numberofresponses
Acute adult inpatient (Staff)
Increase a lot Increase a little Stay about the same Decrease a little Decrease a lot
(n = 24
Don't knows =11)
(n = 24
Don't knows=11)
(n = 24
DK = 11)

25. Implementation: adult acute inpatient
26
0
1
2
3
4
5
6
7
8
9
10
We have already
implemented it*
It will take less
than 6 months to
implement
It will take more
than 6 but less
than 12 months
It will take more
than one year to
implement it
We are not likely
to ever fully
implement
Don't know
Numberofresponses
Acute adult (Leadership)
(n=21,
Don't knows=3)

26. Implementation: adult acute inpatient
27
0
2
4
6
8
10
12
14
We have already
implemented it*
It will take less
than 6 months to
implement
It will take more
than 6 but less
than 12 months
It will take more
than one year to
implement it
We are not likely
to ever fully
implement
Don't know
Numberofresponses
Acute adult (Staff) (n=53,
Don't knows =11)

27. Learning disability services
#nursingnhsi
#Lead2Add

28. 29
Survey respondents: learning disability
CEO, 2
Ops Director/COO, 1
Nursing Director, 3
Associate Director of Nursing, 4
Head of Nursing, 3
Deputy Chief Nurse / Assistant Chief
Nurse, 0
Ward Manager / Ward Sister /
Charge Nurse / Nurse Manager, 8
AHP Lead, 9
Consultant Nurse, 2
Matron
, 3
Specialist
Nurse, 4
Staff
Nurse, 3
Nursing Support Officer, 1
Other*, 31
Learning Disability
'Other' respondents include:
Pathway Manager
Consultant clinical psychologist
Practice Governance Coach
Professional Lead for Occupational
Therapy in Learning Disabilities
Highly Specialist Physiotherapist
Specialist Physiotherapist
Non Executive Director
Chair of the Sae Staffing Alliance
Physiotherapist Occupational
therapy professional
Safeguarding Adults Lead
Head of integrated services

29. Staff impact: learning disability
30
Threshold values
Weighted mean >1
Net balance >15%
0
5
10
15
20
25
As a direct result of this improvement resource do
you anticipate that registered nurse (or midwife)
staffing levels at your trust will:
As a direct result of this improvement resource do
you anticipate that clinical support worker staffing
levels at your trust will:
As a direct result of this improvement resource do
you anticipate that other clinical staff levels at
your trust will:
Numberofresponses
Learning Disability (Leadership)
Increase a lot Increase a little Stay about the same Decrease a little Decrease a lot
(n = 39
Don''t knows =
10)
(n = 38
Don't knows =
6)
(n = 38
Don't knos =
6)

30. Staff impact: learning disability
31
Threshold values
Weighted mean >1
Net balance >15%
0
2
4
6
8
10
12
14
16
18
20
As a direct result of this improvement resource
do you anticipate that registered nurse (or
midwife) staffing levels at your trust will:
As a direct result of this improvement resource
do you anticipate that clinical support worker
staffing levels at your trust will:
As a direct result of this improvement resource
do you anticipate that other clinical staff levels at
your trust will:
Numberofresponses
Learning Disability (Staff)
Increase a lot Increase a little Stay about the same Decrease a little Decrease a lot
(n = 24
Don't knows = 4)
(n = 23
Don't knows =
3)
(n = 24
Don't knows =
3)

31. 32
#nursingnhsi
#Lead2Add
Contact Details:
Mark Radford, Director of
Nursing – Improvement, NHS
Improvement:
mark.radford2@nhs.net
Susan Aitkenhead, Director of
Nursing – Professional
Development, NHS England:
susanaitkenhead@nhs.net
Questions around safe
staffing improvement
resources?
Please contact:
nhsi.safestaffing@nhs.net

32. Safe staffing evidence research
http://www.southampton.ac.uk/healthsciences/research/projects/implementation-impct-and-costs-of-policies.page