Effective management of agency staff is key to providing flexibility in care delivery.
However, too often they are not used in a managed and strategic way, which can result in escalating costs.
Agency expenditure in the NHS has increased in recent years and we have to reduce it by over £300m by 2014.
To understand what organisations could do, we spoke to a variety of trusts who had cut agency costs considerably. While their actions differed, there were some common themes.
First, each trust took action to understand the problem they faced.
Often they improved workforce and management information, which was provided to team leaders and managers on a regular basis. Implementing e-rostering was a common action.
Whatever the action, each trust identified the cause of the problem by finding out exactly what they were spending and the reasons for it.
These trusts took control of their use of agency staff, sometimes implementing central agency booking teams, or introducing processes for authorising agency bookings.
Five high-impact actions to reduce expenditure on agency staff
● Increase your and your manager’s understanding of the issue
● Manage the process and take control
● Manage your workforce by creating a sustainable supply of staff with appropriate skills
● Work collaboratively with other wards to share resources more effectively
● Engage with staff about the importance of what you are doing
Those that achieved a continued reduction in agency spend sustained and maintained this control though good management practices.
An investigation of agency expenditure inevitably led to critical examination of the cost of the whole workforce.
Trusts often realised that considering how they used their substantive staff was the first step in addressing high spend. Often trusts re-examined work patterns or looked at how they authorised planned leave. In other words, successful trusts adopted a whole-workforce approach to agency spend.
While significant savings can be made by all the actions above, even greater savings can be made by working collaboratively. This can be done across wards and units, or regionally, for example by sharing staff banks or agreeing prices for some agency staff.
Completing actions often required staff to think differently about how they worked and to implement change. As one manager told us: “E-rostering just gives you the information. It is up to the managers and staff to do something with it to make a difference.”
Where staff were engaged and where trusts saw their approach to reducing agency spend as a change process, greater savings were achieved.
We are now working with trusts to see if there are successful actions in each of the five areas above that consistently reduce agency spend. As a start, the five high impact actions in the box above will provide a framework.
Read more at nhsemployers.org/highimpact
Ruth Warden is deputy head of employment services at NHS Employers. She has responsibility for three key work streams: flexible workforce (agency working), modernising scientific careers and health, work and wellbeing.