A new method for measuring nurse and healthcare assistant staffing in the NHS is to be extended in future beyond hospitals to other settings, including mental health and community, according to latest plans.
The care hours per patient day (CHPPD) metric, which was recommended in Lord Carter’s review of productivity among acute hospitals in England earlier this year, takes into account the average hours of care provided by both registered nurses and healthcare assistants in a 24-hour period.
It was introduced in May for all acute trust inpatient wards and has now become one of the central features of a new national staffing framework for all NHS providers, which was launched yesterday.
“We are testing it [CHPPD] right now across the whole of England in acute inpatients and we’ll be rolling it out for other settings”
The framework – called Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time – has been drawn up by a group of national organisations, including new regulator NHS Improvement, which together form the National Quality Board.
It replaces 2013’s NQB guidance on nursing, midwifery and care staffing and will allow nurses to “use their professional judgement more” when calculating staffing levels, according to NHS Improvement’s executive director of nursing Ruth May.
She also said NHS Improvement would roll out the CHPPD metric to other settings including community and mental health services, as well as maternity units and learning disability services.
“This refreshed framework says no longer are we just going to look at inputs, we must look at outcomes as well”
“We are testing it [CHPPD] right now across the whole of England in acute inpatients and we’ll be rolling it out for other settings in the next while,” she told Nursing Times.
“We will absolutely be bringing it to services including community, mental health and learning disability. It will come to all of the areas, but right now we are focussed on acute,” she added.
Plans to include allied health professionals within the metric will also be developed from later this summer, she said.
The metric has previously been criticised by nurse workforce experts as being a “blunt instrument” for calculating nurse staffing levels.
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Among the concerns were that it only measures an average amount of care across a 24-hour period, which could hide unsafe staffing levels at different points in the day, and also that it does not include hours of care left undone.
CHPPD is calculated by adding the hours of registered nurses to the hours of healthcare support workers and dividing the total by every 24 hours of in-patient admissions – or approximating 24 patient hours by counts of patients at midnight.
During early testing of the CHPPD method, the NQB’s framework document noted the metric’s requirement for the number of patients to be recorded at midnight meant this “did not capture all the activity on ward areas”.
Ms May told Nursing Times she acknowledged the metric “isn’t perfect” but that data collection at this time was the least burdensome point in the day for trusts.
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“I will be listening and engaging with directors of nursing and nurse leaders across England over the next couple of months. If there is a better way of doing it, we will look into it and will amend the data collection accordingly,” she said.
She said the CHPPD measurement was beneficial because it looked at care provided by the whole multi-professional team.
In addition, because it was a standardised measurement, it meant directors of nursing could compare levels of care between wards and address any unwarranted variation, added Ms May.
She said the Care Quality Commission – one of the organisations that helped to develop the new NQB framework – would also use the CHPPD metric in its inspections, but alongside other measurements of safe care as well.
“This refreshed framework says no longer are we just going to look at inputs, we must look at outcomes as well,” she said.
“But we do need to triangulate inputs and outcomes with outcomes for patients and staff. That is something the CQC is wanting to do,” said Ms May.
“The CQC is clear it will want to use care hours per patient day as one of their metrics when assessing safe care,” she added.
Saffron Cordery, director of policy and strategy at NHS Providers, which represents health service trusts, said the body supported NHS Improvement’s ”approach to safe staff levels”.
“It recognises the pressing need to update thinking to balance quality with an extremely challenging financial climate,” she said. ”The view of trusts and foundation trusts was that the previous, effectively nationally mandated approach was unsustainable, both in terms of costs and an undue reliance on agency staff.
“We particularly welcome the emphasis on local decision making and local discretion,” she added. “We will work with both NHS Improvement and the CQC to help providers interpret the guidance and engage staff to ensure that patient safety and compassionate care is maintained.”