{ "document_id": 11681, "filename": "60a7d91f-4db6-4d0a-8f68-d50655893460_CNSST-Outcome-Report-march-2026-HS_-_Harrogate_and_distric_NHSFT-artifacted.pdf", "engine": "paddleocr_vl", "source_run_id": 11792, "generated_at": "2026-10-29T09:57:12+00:00", "page_count": 7, "counts_by_type": { "figure": 6, "footer": 7, "footnote": 1, "heading": 12, "link": 5, "list": 3, "list_item": 11, "table": 4, "table_cell": 68, "text": 30, "title": 4 }, "timings": { "total_ms": 7115, "structure_ms": 398, "text_layer_ms": 20, "build_ms": 11 }, "pages": [ { "document_id": 11681, "page": 1, "width": 595.32, "height": 841.92, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 595.32, "height_pt": 841.92, "engine": "paddleocr_vl", "source_run_id": 11792, "item_count": 5, "counts_by_type": { "figure": 1, "footer": 1, "text": 2, "title": 1 }, "build_ms": 1, "items": [ { "id": "p1.1", "order": 1, "type": "figure", "bbox": { "l": 63.8, "t": 806.52, "r": 285.6, "b": 726.82 }, "text": "", "attrs": { "source": "pdf_image" }, "reading_order": 0 }, { "id": "p1.2", "order": 2, "type": "title", "bbox": { "l": 235.8725, "t": 565.92, "r": 531.7328, "b": 464.4 }, "text": "COMMUNITY NURSING\nSAFER STAFFING REPORT\nMARCH 2026", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 1 }, { "id": "p1.3", "order": 3, "type": "text", "bbox": { "l": 206.1185, "t": 451.2, "r": 531.013, "b": 433.44 }, "text": "Date of CNSST data collection: 02/03/2026-16/03/2026", "reading_order": 2 }, { "id": "p1.4", "order": 4, "type": "text", "bbox": { "l": 252.1892, "t": 373.92, "r": 492.3807, "b": 318.48 }, "text": "Adult Community Nursing Teams, Community Nursing Safer Staffing Tool (CNSST) Bi-annual Safer Staffing Review.", "reading_order": 3 }, { "id": "p1.5", "order": 5, "type": "footer", "bbox": { "l": 379.6035, "t": 120.72, "r": 524.7742, "b": 104.64 }, "text": "Holly Southcott- Matron", "attrs": { "block_label": "footer" }, "reading_order": 4 } ] }, { "document_id": 11681, "page": 2, "width": 595.32, "height": 841.92, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 595.32, "height_pt": 841.92, "engine": "paddleocr_vl", "source_run_id": 11792, "item_count": 15, "counts_by_type": { "figure": 1, "footer": 1, "heading": 2, "list": 1, "list_item": 4, "text": 6 }, "build_ms": 2, "items": [ { "id": "p2.1", "order": 1, "type": "figure", "bbox": { "l": 322.0151, "t": 798.24, "r": 523.5745, "b": 735.36 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" }, "reading_order": 0 }, { "id": "p2.2", "order": 2, "type": "heading", "bbox": { "l": 61.6676, "t": 724.08, "r": 113.4971, "b": 709.92 }, "text": "Purpose", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p2.3", "order": 3, "type": "text", "bbox": { "l": 60.4678, "t": 700.08, "r": 540.611, "b": 609.84 }, "text": "This report provides assurance regarding Adult Community Nursing workforce establishments following completion of the March 2026 Community Nursing Safer Staffing Tool (CNSST) review. The report demonstrates compliance with NHS England Developing Workforce Safeguards and National Quality Board expectations through triangulation of evidence-based staffing recommendations, professional judgement, quality indicators, workforce metrics and operational intelligence.", "reading_order": 2 }, { "id": "p2.4", "order": 4, "type": "heading", "bbox": { "l": 61.4276, "t": 574.56, "r": 412.2369, "b": 559.44 }, "text": "Community Nursing Safer Staffing Tool (CNSST) Background", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 3 }, { "id": "p2.5", "order": 5, "type": "text", "bbox": { "l": 60.9477, "t": 548.88, "r": 540.851, "b": 489.6 }, "text": "The Community Nursing Safer Staffing Tool (CNSST) is NHS England's evidence-based workforce planning methodology for community nursing services. It supports organisations to determine safe and sustainable workforce establishments by assessing patient demand, acuity and dependency alongside workforce capacity.", "reading_order": 4 }, { "id": "p2.6", "order": 6, "type": "text", "bbox": { "l": 60.7078, "t": 475.68, "r": 540.851, "b": 416.16 }, "text": "The CNSST is aligned to NHS England's Developing Workforce Safeguards and the National Quality Board (NQB) guidance Supporting NHS Providers to Deliver the Right Staff, with the Right Skills, in the Right Place at the Right Time. It supports providers in meeting the national expectation for six-monthly Board assurance and annual workforce establishment reviews.", "reading_order": 5 }, { "id": "p2.7", "order": 7, "type": "text", "bbox": { "l": 59.9879, "t": 402, "r": 540.851, "b": 328.8 }, "text": "The tool compares funded, actual and recommended staffing establishments and provides an objective assessment of workforce requirements. 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"bbox": { "l": 97.6603, "t": 727.612, "r": 539.8912, "b": 696.24 }, "text": "should have a systematic approach to determining the number of staff and range of skills required to meet the needs of people using the service and keep them safe at all times.", "marker": "•", "reading_order": 0 }, { "id": "p4.2.2", "order": 4, "type": "list_item", "bbox": { "l": 98.1402, "t": 687.0519999999999, "r": 538.6914, "b": 670.56 }, "text": "must use an approach that reflects current legislation and guidance where it is available.", "marker": "•", "reading_order": 1 } ], "reading_order": 1 }, { "id": "p4.3", "order": 5, "type": "text", "bbox": { "l": 61.9075, "t": 632.88, "r": 503.6585, "b": 604.08 }, "text": "Meeting NQB's expectations helps providers comply with CQC's fundamental standards on staffing – for example, in the well-led framework and related legislation.", "reading_order": 2 }, { "id": "p4.4", "order": 6, "type": "figure", "bbox": { "l": 191.4814, "t": 593.28, "r": 410.3173, "b": 440.4 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 3 }, { "id": "p4.5", "order": 7, "type": "heading", "bbox": { "l": 61.9075, "t": 425.28, "r": 392.5609, "b": 410.64 }, "text": "HDFT Community Care Teams (CCT) CNSST Methodology", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 4 }, { "id": "p4.6", "order": 8, "type": "text", "bbox": { "l": 60.7078, "t": 397.68, "r": 541.0909, "b": 320.4 }, "text": "The March 2026 CNSST review was undertaken across all Community Nursing teams using the licensed NHS England methodology. Data collection was supported by trained clinical staff and subjected to validation processes to ensure reliability. The CNSST outputs were triangulated through professional judgement, workforce metrics, quality indicators and operational intelligence before review by senior nursing leadership.", "reading_order": 5 }, { "id": "p4.7", "order": 9, "type": "heading", "bbox": { "l": 61.9075, "t": 310.08, "r": 274.0248, "b": 295.44 }, "text": "CNSST Community Care Teams Data", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 6 }, { "id": "p4.8", "order": 10, "type": "text", "bbox": { "l": 60.9477, "t": 277.92, "r": 541.3309, "b": 173.04 }, "text": "Adult Community Services District Nursing teams cover four localities: Harrogate North, Harrogate South, Knaresborough and Ripon working across a large geographical area. The majority of patients are housebound and are seen either in their own homes or in residential care settings. Harrogate North also provides clinic appointments for patients who are not housebound. A catheter and PICC clinic runs three times a week at Knaresborough Road Health Centre, supporting patients from all four teams. 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"attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 4 }, { "id": "p5.9.6", "order": 75, "type": "table_cell", "bbox": { "l": 123.363, "t": 259.901522, "r": 177.90337, "b": 216.34273999999994 }, "text": "Funded Staffing WTE\n14.16\n6.8\n20.96", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 5 }, { "id": "p5.9.7", "order": 76, "type": "table_cell", "bbox": { "l": 187.137625, "t": 259.901522, "r": 236.983491, "b": 216.34273999999994 }, "text": "Inpost staffing WTE\n12.79\n4.8\n17.59", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 6 }, { "id": "p5.9.8", "order": 77, "type": "table_cell", "bbox": { "l": 250.161921, "t": 259.901522, "r": 284.227702, "b": 216.34273999999994 }, "text": "CNSST WTE\n14.13\n4.54\n18.67", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 7 } ], "reading_order": 8 }, { "id": "p5.10", "order": 78, "type": "heading", "bbox": { "l": 61.9075, "t": 163.92, "r": 121.1756, "b": 149.76 }, "text": "Summary", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 9 }, { "id": "p5.11", "order": 79, "type": "text", "bbox": { "l": 60.9477, "t": 132.96, "r": 541.3309, "b": 72.24 }, "text": "The March 2026 Community Nursing Safer Staffing Tool (CNSST) review demonstrates that the current District Nursing workforce continues to support the delivery of safe and effective care. While the CNSST identifies opportunities to optimise the workforce through an increase of 8.38 WTE Registered Nurses and a corresponding reduction of 11.67 WTE unregistered.", "reading_order": 10 }, { "id": "p5.12", "order": 80, "type": "footer", "bbox": { "l": 531.9728, "t": 60.24, "r": 539.4113, "b": 49.92 }, "text": "4", "attrs": { "block_label": "number" }, "reading_order": 11 } ] }, { "document_id": 11681, "page": 6, "width": 595.32, "height": 841.92, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 595.32, "height_pt": 841.92, "engine": "paddleocr_vl", "source_run_id": 11792, "item_count": 12, "counts_by_type": { "footer": 1, "heading": 1, "text": 9, "title": 1 }, "build_ms": 1, "items": [ { "id": "p6.1", "order": 1, "type": "title", "bbox": { "l": 321.7751, "t": 796.32, "r": 523.8144, "b": 735.12 }, "text": "NHS\nHarrogate and District\nNHS Foundation Trust", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p6.2", "order": 2, "type": "text", "bbox": { "l": 60.4678, "t": 725.28, "r": 540.611, "b": 694.08 }, "text": "staff (a net reduction of 3.29 WTE), these recommendations have been considered alongside professional judgement, quality indicators and local operational factors.", "reading_order": 1 }, { "id": "p6.3", "order": 3, "type": "text", "bbox": { "l": 60.9477, "t": 680.64, "r": 541.0909, "b": 574.8 }, "text": "The CNSST recommends a workforce skill mix of 75% Registered Nurses. The current District Nursing skill mix is 65.19%, indicating that future workforce planning should continue to strengthen registered nursing capacity. However, the review group concluded that the recommended reduction in unregistered staff is not appropriate at this time, as it would increase operational risk within a service supporting a high proportion of patients requiring routine interventions across a large, predominantly rural geographical area, where travel time and productivity have a significant impact on workforce demand.", "reading_order": 2 }, { "id": "p6.4", "order": 4, "type": "text", "bbox": { "l": 60.9477, "t": 561.84, "r": 540.851, "b": 501.36 }, "text": "This position is supported by CNSST benchmarking data, which demonstrates that Category 1 (routine, non-complex) patients account for 39.3% of the Trust's community caseload compared with the national benchmark of 19.3%, reinforcing the continued requirement for a balanced registered and unregistered workforce.", "reading_order": 3 }, { "id": "p6.5", "order": 5, "type": "text", "bbox": { "l": 60.7078, "t": 487.92, "r": 530.0532, "b": 412.32 }, "text": "Despite workforce pressures during the review period, including the deferral of some patient visits, triangulation with quality and workforce indicators provides assurance that patient care has remained safe and effective. Clinical quality measures remained positive, with consistently strong audit (captured via Tendable) performance, low levels of reported harm, positive clinical outcomes and no formal complaints attributable to staffing levels.", "reading_order": 4 }, { "id": "p6.6", "order": 6, "type": "heading", "bbox": { "l": 62.1475, "t": 398.64, "r": 175.8845, "b": 384 }, "text": "Recommendations", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p6.7", "order": 7, "type": "text", "bbox": { "l": 60.7078, "t": 368.88, "r": 541.3309, "b": 262.56 }, "text": "Following a workforce review held on 22[p6.8.1] of May 2026 with the Executive Director of Nursing, Midwifery and AHPs, Matron, Locality Managers and District Nursing teams, it was agreed that no establishment changes would be made at this time due to the wider Community Services Review taking place this year. The triangulated review demonstrates that the current funded nursing establishments across all community nursing services remain evidence-based, appropriate to patient acuity, dependency and service demand, and continue to support the delivery of safe, effective and high-quality patient care.", "children": [ { "id": "p6.7.1", "order": 8, "type": "text", "bbox": { "l": 60.7078, "t": 368.88, "r": 541.3309, "b": 262.56 }, "text": "^{nd}", "attrs": { "inline": true, "text_offset": 39, "text_span": 8, "bbox_estimated": true }, "reading_order": 0 } ], "reading_order": 6 }, { "id": "p6.8", "order": 9, "type": "text", "bbox": { "l": 61.1877, "t": 250.08, "r": 540.611, "b": 203.76 }, "text": "It was agreed that Knaresborough and Ripon teams would be supported to skill mix unregistered workforce hours into Registered Nurse hours when vacancies arise, as required. An Equality Impact Assessment (EQIA) will be submitted to support this proposal.", "reading_order": 7 }, { "id": "p6.9", "order": 10, "type": "text", "bbox": { "l": 60.9477, "t": 191.04, "r": 540.851, "b": 145.44 }, "text": "To strengthen the reliability and validity of future CNSST data, all waiting lists will be incorporated into the District Nursing daily caseload. This will ensure that any deferred care is accurately captured across all teams.", "reading_order": 8 }, { "id": "p6.10", "order": 11, "type": "text", "bbox": { "l": 60.9477, "t": 131.76, "r": 541.0909, "b": 86.4 }, "text": "While the service review is ongoing, work is underway to improve service delivery. This includes the development of self-care initiatives, deferred care, care undone reporting and improvements to roster governance. In addition, the Matron is sourcing a pool car for", "reading_order": 9 }, { "id": "p6.11", "order": 12, "type": "footer", "bbox": { "l": 531.7328, "t": 60.24, "r": 539.8912, "b": 49.68 }, "text": "5", "attrs": { "block_label": "number" }, "reading_order": 10 } ] }, { "document_id": 11681, "page": 7, "width": 595.32, "height": 841.92, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 595.32, "height_pt": 841.92, "engine": "paddleocr_vl", "source_run_id": 11792, "item_count": 4, "counts_by_type": { "figure": 1, "footer": 1, "text": 2 }, "build_ms": 0, "items": [ { "id": "p7.1", "order": 1, "type": "figure", "bbox": { "l": 321.7751, "t": 796.8, "r": 523.5745, "b": 734.64 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" }, "reading_order": 0 }, { "id": "p7.2", "order": 2, "type": "text", "bbox": { "l": 60.9477, "t": 725.52, "r": 540.851, "b": 693.84 }, "text": "Knaresborough CCT to support the challenges associated with high mileage and a large geographical patch.", "reading_order": 1 }, { "id": "p7.3", "order": 3, "type": "text", "bbox": { "l": 60.9477, "t": 680.88, "r": 540.851, "b": 635.28 }, "text": "Prior to the next planned CNSST further work is required to review headroom allocation, review and standardise maternity leave allowance percentage and the introduction of daily fill rate reporting is to be coordinated by the Matron.", "reading_order": 2 }, { "id": "p7.4", "order": 4, "type": "footer", "bbox": { "l": 531.7328, "t": 60.24, "r": 539.6512, "b": 49.92 }, "text": "6", "attrs": { "block_label": "number" }, "reading_order": 3 } ] } ] }