Safety recommendation
HSSIB recommends that The Shelford Group reviews and updates the Mental Health Optimal Staffing Tool on a regular basis following collection of recent data from mental health inpatient settings. This is to ensure the tool remains valid for potential changes in patients’ needs and the level of care they require, and to support providers to make decisions about workforce requirements that support therapeutic and therefore safe care.
Response:
The Shelford Group welcome the findings of the recent investigations and subsequent report into mental health inpatient settings by the Health Services Safety Investigation Body. The Mental Health Optimal Staffing Tool (MHOST) was developed by the Shelford Group in partnership with NHS England and launched in 2019. It is widely used in the NHS in England via a licence provided at no cost by Imperial College Innovations. It is also available for a fee to NHS and non-NHS organisations outside of England as well as private healthcare providers.
The Shelford Group is committed to the ongoing sustainability and development of the suite of Safer Nursing Care Tools (SNCT), including the MHOST. We recognise the impact that new healthcare policies as well as changes to the way care is delivered and the introduction of new roles can have on safer staffing requirements. The SNCT and the MHOST calculate clinical staffing requirements based on patients’ needs (acuity and dependency) which, together with professional judgement, guides chief nurses in their safe staffing decisions. This professional judgement is paramount in ensuring that the tool is applied appropriately.
Plans are in place to review and refresh the MHOST, with the inaugural meeting of an expert project review group in October 2024. The review process is expected to take 18-24 months with an intended launch in late 2026. Details of the scope of the review are included in the below action plan.
Actions planned to deliver safety recommendation:
Phase 1.
- Agree scope and research approaches.
The inaugural meeting of an expert project review group took place in October 2024. Organisational lead: Shelford Group, Subject matter expert and NHS England. Resources in place to deliver actions:
- Project lead
- Safer Staffing Faculty, NHS England
- Shelford Group SNCT committee (oversight)
- Shelford Group Secretariat (admin, project management and comms)
- Expert project review group
- Safer Staffing Faculty Fellow.
Additional comments: The scope of the review has been agreed as follows:
- Reviewing the skills in ward teams, such as nursing associates and allied health practitioners, to develop a multidisciplinary toolkit if appropriate.
- Reviewing the classification and recording for 1:1, 2:1 and 3:1 enhanced care with associated multipliers (staffing resource)
- Generating Care Hours per Patient Day (CHpPD) metrics based on acuity and dependency to support interpretation of the Carter CHPPD.
- Reviewing the current speciality specific decision matrix for the following settings: 1) adult in-patients 2) Older adults 3) Psychiatric Intensive care, 4) Child and Adolescent Mental Health 5) Eating Disorders 6) Forensic Medium/ High Secure patients 6) Perinatal (Mother and Baby) and 7) Forensic Low Secure/ Rehabilitation Wards, to agree if all these specialties are relevant and required in 2024 mental health care service provision
Reviewing all the above settings to provide a speciality specific decision matrix and multipliers in the agreed specialties in number.
Phase 2.
- Infrastructure development.
- Education & data collection.
- Data analysis, building new multipliers for each specialty & initial testing, by 2025.
Phase 3.
- Approval to move to Beta testing (SNCT steering committee)
- Beta test and User Acceptance: Testing (UAT) & incorporation of feedback from alpha pilot
- Public launch of the refreshed version of the MHOST, by 2026.
Response received on 27 December 2024.