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Further clampdown on agency spending by regulator

  • 13 Comments

The NHS has avoided spending £600m on temporary workers in the first year since the government introduced caps on hourly pay rates for agency staff, but trusts are still breaking the rules almost 47,000 times a week, official data has shown.

Extra measures will now be introduced in a bid to clamp down further on employers who spend too much on agency workers, according to regulator NHS Improvement, the body responsible for enforcing the rules.

“The NHS simply doesn’t have the money to keep forking out for hugely expensive agency staff”

Jim Mackey

The measures will include the publication of league tables detailing agency expenditure among trusts in each region across England, in order to highlight the best and worst performing organisations.

Caps on the hourly rates paid to agencies for temporary staff were introduced in November last year and have been gradually tightened. Since April, NHS trusts have not been allowed to pay agencies more than 55% above the basic hourly rate for permanent staff.

In addition, since July, trusts have had to comply with new rules setting out the maximum hourly wage that agency workers actually receive – set at a level similar to pay for substantive staff. However, trusts are able to break both of these caps on exceptional safety grounds.

“There’s much more to be done, especially to reduce how much trusts pay for medical agency staff and bringing staff back into the NHS”

Jim Mackey

The most recent NHS Improvement data, from August, shows the health service over-rode the price caps for the hourly rate paid to agencies on average more than 46,300 shifts every week.

It included more than 18,000 shifts every week worked by agency nursing, midwifery and health visiting staff (see table below).

Meanwhile, an average of around 17,500 shifts worked by agency medical and dental staff were in breach of the rules each week in August.

Agency shifts worked by healthcare assistants and other support staff accounted for an average of 900 breaches per week.

NHS Improvement noted that total agency expenditure had fallen since the rules were introduced last autumn for all 237 NHS trusts in England, with 73% of trusts managing to reduce their spending.

Jim Mackey

Jim Mackey

Source: Neil O’Connor

Jim Mackey

The rules saved more than £600m between October and July, compared to projected spending if they had not been introduced, said NHS Improvement.

However, the regulator noted that more needed to be done to bring down the cost to the NHS of temporary workers.

It has today announced a raft of additional measures to further rein in spending. They include publishing league tables, requiring trusts to report shifts that cost over £120 an hour, collecting data on the 20 highest earning agency staff per trust and on long-standing agency staff, and plans to bring in an approval process for appointing interim senior managers who charge over £750 per day.

Jim Mackey, chief executive of NHS Improvement, said: “The NHS simply doesn’t have the money to keep forking out for hugely expensive agency staff.”

“Many nurses have no choice but to take on agency work because they cannot live on their NHS salary alone”

Josie Irwin

“The progress we have made in a single year is really promising and trusts have responded well to the caps. They’ve worked hard to cut these bills and, in many cases, improved the way they manage their workforce,” he said.

“But there’s much more to be done, especially to reduce how much trusts pay for medical agency staff and bringing staff back into the NHS,” said Mr Mackey.

“We need everybody to pile in, and patients deserve that effort from us to make sure they’re getting the right care, from the right staff, at the right time. We’re committed to making sure hospitals can spend their money on their care and not on excessive agency fees,” he added.

But the Royal College of Nursing said the caps were not tackling the “root cause” of the problem, which it cited as the national nursing shortage resulting from poor workforce planning.

Royal College of Nursing

Further clampdown on agency spending by regulator

Josie irwin

Josie Irwin, RCN head of employment relations, said: “Many nurses have no choice but to take on agency work because they cannot live on their NHS salary alone, as government policy means nurses have suffered a 14% real terms cut in income since 2010.

“We need a workforce strategy which fixes the current problems and prepares for the future,” she said. “As part of this, to help resolve high spending on agency staff, the government needs to restore the cost of living gap in nurses’ pay.

“Collecting and publishing agency data in isolation will be ineffective without also publishing vacancy data, to help get to the heart of workforce planning problems by also looking at recruitment and retention patterns,” she added.

nhsi data on agency overrides in august

nhsi data on agency overrides in august

NHS Improvement data on weekly agency rule over-rides in August 2016

 

  • 13 Comments

Readers' comments (13)

  • Well Duh, when a trust is down by 25 RN and 15 HCA per shift what does the regulator expect Trusts to do? (Rhetorical question). I guess putting patients at risk is much more important than paying for their care to be provided. I am with the RCN's view the root cause is needed i.e the NHS needs to treat their staff better then retention of staff will not be a HUGE problem.

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  • Start paying nurses what they deserve. Stop freezing pay. Learn a lesson from agencies......pay staff within days of completing an extra shift, do it at overtime rates and do it soon.

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  • I worked for 10yrs NHS they wanted to save money so I applied for the voluntary resignation and got a lump sum. So then I joined an agency not for the money so much but to prove a point as now it's costing them more so how is that saving. In reality it's a FALSE ECONOMY

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  • The NHS works on cheap labour but cut back on the many band 8+ that don't do much they are in there thousands stop paying CEO's crazy salaries and bonuses and stop paying the vanguard services over a million a year per trust and invest the money in improving local services

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  • I agree with all previous comments: start planning staff levels better, pay the staff at their real value instead of paying agency staff. Value your staff and they won't turn off when you need them! I am an agency nurse who used to work for NHS.

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  • I agree, paying nurses their worth, 14% pay cut in real terms, more so, in high cost areas such as London, where they can't afford the cost of living, they have no choice but to do agency work. The thing is it will get worse with the abolishment of the bursary and student nurses having to take out student loans to fund they're training, its a shambles, such a mess

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  • NHS just needs to pay staff fairly. Government needs to be rational about increments as they presumably do when reviewing MPs increments. Also working conditions for nurses and doctors should not be just dictated on whims of the Health Secretary.

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  • I wonder if NHSi will triangulate this so called saving with the number of SI's, high level incidents, falls and pressure sores, delays for patients getting to and from theatres and absence rates of staff with the savings and above all look at the patient and staff experience of the current NHS as a provider and employer? Just need to remind them about the so called 'open and transparent NHS' we should be working in & receiving care from.
    Getting rid of +band8's as suggested is random offensive statement. Many matrons and lead nurses and midwives work their socks off to challenge the status quo for their staff and patients and don't earn quite as much as some think. What is needed is proper pay and conditions for staff & that includes AHP's, path staff, porters etc not just nurses and midwives in order to do that NHSl and NHSE should take a long hard look at what is going on in CCG land and their own front room. Suggest you start looking there for savings and tighter banding of roles and give them some real work to do. After all a deputy chief nurse or a band 7 contracts (non clinical) manager etc would fall to the ground after a heavy week in acute/community/mental health/midwifery clinical areas. CEO's should not earn more than the prime minister. And most of all lets just get on and focus on the nursing /midwifery skill mix, refocus training and deal with the changes needed ASAP; in other words stop talking about it and to use the awful words in the article if we all 'pile' in and stand our ground on what is right for patients. Every nurse/midwife can make a difference & complete a incident form when you consider your shift to be unsafe, when you have been prevented from caring for your patients properly and ensure the 'red flags' are bought to the attention of your managers.

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  • If i filled in an 'incident form' every time something unsafe occurred I'd have no time at all for patients. Also, it wouldn't sit well... as I'm an Agency Nurse.
    The NHS really is top heavy but I'd apply to join the official payroll if I could afford it

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  • we never hear that bankers get paid too much

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  • Train the person who does the roster, not only to be fair, also not use it as a tool and some staffing shortages will go away

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  • Calling all Nurses - Its basic supply and demand even the NHS , RN's you are a valuable resource, your skills and knowledge are in high demand across the globe. The USA needs 1.1 million new nurses by 2020, read the 2 studies below and you will realise that even the government knows what a valuable resource you are so not sure why the profession is being treated with such disregard.

    http://www.nhsemployers.org/case-studies-and-resources/2016/01/2015-nhs-registered-nurse-supply-and-demand-survey-findings

    The labour market for nurses in the UK and its relationship to the demand for, and supply of, international nurses in the NHS

    https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/535657/The_labour_market_for_nurses_in_the_UK.pdf

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  • Calling all Nurses - Its basic supply and demand even the NHS must understand that concept , RN's you are a valuable resource, your skills and knowledge are in high demand across the globe. The USA needs 1.1 million new nurses by 2020, read the 2 studies below and you will realise that even the government knows what a valuable resource you are so not sure why the profession is being treated with such disregard.

    http://www.nhsemployers.org/case-studies-and-resources/2016/01/2015-nhs-registered-nurse-supply-and-demand-survey-findings

    The labour market for nurses in the UK and its relationship to the demand for, and supply of, international nurses in the NHS

    https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/535657/The_labour_market_for_nurses_in_the_UK.pdf

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