Price caps on the hourly rate the NHS can pay agency nurses may not take effect until December, after regulators received more than 100 responses to a consultation on the controversial plans.
Monitor and the NHS Trust Development Authority will today write to all NHS provider chief executives to give them individual ceilings for the proportion of nursing expenditure their trusts can spend with temporary staffing agencies.
The new targets, which vary depending on the amount trusts are currently spending with agencies, come into force from 1 October. This will be the first aspect of health secretary Jeremy Hunt’s “clampdown on rip off staffing agencies” to take effect.
A second aspect of the clampdown, which will ban trusts from securing nursing staff from agencies that are not on approved “framework agreements”, will come into force on 19 October, the letters confirm.
“We want to ensure we set caps low enough to generate savings, while not so low as to discourage staff from working agency shifts”
Guidance on nursing agency rules
However, the regulators still have not set a firm date on which they will impose the most controversial aspect of Mr Hunt’s plan – price caps on the hourly rates trusts can pay for agency nurses.
Monitor nursing director Ruth May told Nursing Times’ sister title HSJ that price caps would be announced by 1 December at the latest, although she expected it to be sooner.
She said there had been over 100 responses to a short consultation on the plans that Monitor ran last month, and added: “We have listened to what people have said around the caps and people unanimously want caps per shift put in place, but this is very complex and we can’t afford to get it wrong for organisations or patients. So we are going to take a bit more time to work with colleagues to work out what that cap will be.”
Guidance, published by the regulators today, says: “We recognise that price caps on the rate paid to agency workers per hour are useful tools to enable trusts to reduce expenditure on nursing agency staff.
“However, it is complex to set reasonable caps across different nursing roles and all the regions of England. We want to ensure we set caps low enough to generate savings, while not so low as to discourage staff from working agency shifts where needed. We are therefore undertaking further work with directors of nursing and finance directors to get this balance right, and plan to implement price caps later in 2015.”
“We must support trusts to improve incrementally on their agency spending and that’s why we have taken a fairly cautious approach”
The individual ceilings given to trusts today are intended eventually to bring all providers’ agency spending to within 3 per cent of their overall nursing expenditure.
However, trusts that currently have the highest rates of agency nursing spend will be given years to reach this target. The guidance shows that trusts with agency expenditure in excess of 12 per cent are expected to be at 6 per cent in 2018-19. Their target for the remainder of the current financial year will be to keep agency spending to 12 per cent.
In contrast, trusts with spending at 3-4 per cent are expected to stay at 3 per cent for the remainder of this financial year.
Ms May said of the trajectories that had been set for trusts: “We have been absolutely clear that we must make sure we do this in incremental steps. We must not allow a trust to go off a cliff on this. We must support trusts to improve incrementally on their agency spending and that’s why we have taken a fairly cautious approach.”
A Monitor spokeswoman said the controls were expected to save the NHS up to £500m on its agency bill for 2015-16, following a £3.3bn total agency bill last year.