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”
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”
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.
Source: Neil O’Connor
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”
“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.
Further clampdown on agency spending by regulator
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