Look forwards into a planned roster and we'd hope to see staffing levels balanced over the days with minimum staffing counts achieved at the prescribed band mix. At this stage, we don't know what our patient acuity/count is going to be.
As we get closer to the working day, we'll be able to predict with greater accuracy whether we need extra staff, for specialing (the "demand side") or to cover staff sickness (the "supply side"). We're counting on Professional Judgement to get this right as we move staff around wards, or raise short notice cover requests.
One concern is that the Ward Manager who is an expert negotiator can make a stronger case to take staff from less well represented wards at daily staffing meetings.
Looking backwards, without Acuity targets the ward is likely to look overstaffed. In fact, without Acuity targets, we have no effective way of knowing whether we were overstaffed or not.
If additional resource ceases to be ad-hoc, and becomes perennial and predictable, we'd advise determining the triggers driving the need. It may be that key skills are missing from staff, the ward should recruit up (all things being equal, substantive staff are cheaper than Thornbury) or that a highly skilled Trust "staff pool" is created.
We do not say Acuity targeting is a panacea, it has its downsides too - in additional admin effort for the Wards and in its subjective nature. However, just like establishment reviews, we believe that triangulation - that is to say - the use of multiple methodologies to guide us to a strong, considered solution is worthwhile.