NHS Agency staffing hit the headlines back in June 2015 with a co-ordinated attack on NHS staffing agencies and the NHS overspend on temporary staffing by the chief executive of the NHS and the Secretary of State for Health.
What’s the problem?
The health service plans to “clamp down on some of the staffing agencies ripping off the NHS”, the chief executive of NHS England has said.
Simon Stevens admitted that NHS hospitals were “over-spending” on temporary staffing.
He said: “What we’ve got to do is convert that [agency] spending into good, paying permanent jobs.”
He said the rise was partly due to hospitals putting more nurses on wards, following the public inquiry into the Stafford Hospital scandal.
Though he admitted it was “very hard” for individual hospitals to take action against agencies, he said “collectively the NHS can take action here and we will be doing that”.
Tackling staffing agencies is part of a package of measures that will help to cut costs while improving frontline care. This action will help the NHS bring down spiralling agency staff bills, which cost the NHS £3.3 billion last year. This was more than the cost of all that year’s 22 million A&E admissions combined.
The NHS is paying agencies up to £3,500 per shift for doctors.
Health Secretary Jeremy Hunt said:
The path to safer, more compassionate care is the same as the path to lower costs. Simon Stevens said the NHS needed an extra £8 billion by 2020 and the government has invested that. Now the NHS must deliver its side of the bargain for patients by eliminating waste, helped by the controls on spending we’re putting in place.
What is being done?
On 1st September the Trust Development Authority (TDA) and Monitor announced new rules to address Agency Staffing costs in the NHS.
New Agency Rules
- An annual ceiling for total agency spend for each trust between 2015/16 and 2018/19; trusts are being sent individual ceilings and will have the opportunity to apply for exceptions if there are specific local needs
- Mandatory use of frameworks for procuring agency staff
- Limits on the amount individual agency staff can be paid per shift, which will be implemented later in the year.
The agency rules apply to:
- All NHS Trusts
- NHS foundation trusts receiving interim support from the Department of Health (DH)
- NHS foundation trusts in breach of their licence for financial reasons
- All other NHS foundation trusts are strongly encouraged to comply.
In the current financial year it is hard to see how the agency staff crackdown will do much to improve finances. The real benefits of improved contract compliance, better rostering and general demand management will be medium term as the NHS super tanker takes some while to change course.
For NHS Procurement the focus on Agency staffing is good news. In particular the mandatory/strong encouragement towards use of frameworks, an opportunity for procurement to show what they can do, however the Agency staffing problem runs much deeper than contract compliance.
The increased demand for qualified nurses has been mainly on the grounds of patient safety following the Francis report and safe staffing guidance but Mr. Hunt insists that ‘safer care is cheaper care’.
NHS Managers have their own phrase ‘I would rather be sacked for the money than for the quality’ this saying probably has more resonance ! If you are overspent you will be little more than a footnote but if the quality of care in your trust is challenged you will be national headlines.
The new rules allow trusts to apply for exceptions. Acceptable exceptions may include –
- Patient safety will be compromised
- Major service reconfigurations
- Special measures trusts
- Other trusts with recruitment problems (local competition)
- New care models
- Demand pressures
Potentially a shopping list long enough for a determined trust to find a reason for non-compliance. The application process in its own right may act as a deterrent. Lets hope the benefits of compliance outweigh those for non-compliance.
So for NHS procurement an opportunity. Not to reinforce the ‘financial policeman’ role it so much wants to leave behind but rather an opportunity to work with clinical and non-clinical staff to address a high profile initiative and make a real difference to patient care and NHS finances.