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More than a quarter of trusts asked to breach agency cap

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More than a quarter of trusts in England asked the regulator Monitor to increase their agency spending cap last year, it has been revealed.

A Freedom of Information Act request shows 69 trusts applied to the regulatory body last September to alter their overall spending limit on agency staff.

Of the 239 NHS and foundation trust acute, ambulance, community, specialist and mental health organisations given a “ceiling” by Monitor, 54 made successful applications to have that altered.

The regulator would not reveal names of the organisations or by how much they had asked to lower their “ceiling”. It said, of the 54 applications, 31 were only “partially successful” – with the total being lower than the original but higher than the trust’s proposed total.

The news comes as Monitor prepares to further lower the maximum prices agency workers can be paid per shift.

Next week the final reduction of three is due to take effect, and from 1 April trusts will be ordered to employ agency workers only from an approved framework of firms.

The executive report submitted to the first joint meeting of Monitor and the NHS Trust Development Authority – the two are set to be merged into a new body called NHS Improvement – said the price caps so far had had a “positive effect”.

The report said the “number of shifts exceeding the price caps is 40% lower than the first week of implementation”, which was at the start of December – although this may have been affected by this December being less difficult than December 2014.

Monitor has refused to release any detailed information on the effect of the measures so far, but NHS England chief executive Simon Stevens and NHS Improvement boss Jim Mackey last week told the Commons’ public accounts committee that the agency bill would hit £4bn for 2015-16.

In an impact assessment published in October, Monitor said the sector was “on trend” for a 2015-16 agency bill 30% higher than in 2014-15, when it hit £3.3bn. The previous year’s bill was £2.7bn.

The executive report to the joint board meeting, due to take place on Thursday, said the regulators would “require fundamental changes to the way frameworks operate to ensure frameworks enable and control the NHS Improvement capped rates”.

Bailout funding will also be made conditional on not breaching agency staff rules.

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