WORKFORCE: Pressures on staffing levels and skill mix at University Hospital Southampton Foundation Trust have led to an increasingly likely risk of “catastrophic” clinical governance failures, reduced income and negative publicity.

The trust’s risk register for January gave risks around staffing the highest possible rating of “catastrophic” for potential damage caused, and the second highest rating for likelihood, giving an overall risk score of 20 out of 25.

The risk score was the only one to rise between quarters two and three of 2011-12, with an increase of five points. Board papers noted that a second phase of “ward staffing investment” had not been agreed.

The risk register said: “Insufficient staffing levels impact on quality and safety of patient care and lead to risks associated with clinical governance failures, inability to deliver access targets and negative publicity. Potential reduced income to the trust. Potential impact on compliance with CQC Outcome 12.”

The document also listed control measures to mitigate the risk. These included: “Workforce plan to predict staffing requirements and monthly monitoring” and “recruitment to ward staffing agreed levels to reduce use of agency [staff].”

In December the trust’s Division A, which includes surgery and cancer care, reported “nursing pressures in surgery and critical care due to agency usage, higher activity than plan, vacancies and higher short term sickness and maternity leave levels.”

The trust said “there was also continued pressure on non pay spend in surgery… largely due to high emergency activity and additional elective work”.

Division A’s pay bill fell by £200,000 in December from £6.6m with a fall of 46 whole time equivalents worked.

“This is due to increased vacancies, non ward based nursing covering some shifts, medical staff rotation changes, and higher maternity leave and sickness being absorbed within the remaining workforce.

“The division is trying to manage the financial position by holding vacant posts without using overtime or agency to backfill and holding non-pay expenditure where possible.”