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How to reduce your agency spend


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.


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.


Readers' comments (5)

  • Has anybody considered that if you employ enough staff full time and have enough permanet work force you improve patient care, staff moral and do not have to employ agency staff-surely this is not rocket science??? Solutions are all very well but why not spend all of that money on permanent staff-works for me

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  • Exactly Kirsty!


    My god, the stupidity at the top is unbelievable. Yet with titles like '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.' I bet they are getting a damn decent wage for doing sod all.

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  • In a nutshell colleagues!! In a nutshell...

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  • Contrary to Lansleys stance that he is ignorance that nurses of all grades (althought a lot of senior nurses[ bands 6/7, are being plucked away] in a bid to get rid of senior pay packets) are loosing their jobs enmass across the UK.I can tell you they are MR LANSLEY, All that experience is beng lost to the dole que. Wards are having staff cut to the barest minumum and staff are on their knees, they despair as they race to get people up/to the toilet/washed fed etc, on my last shift I was told patients were stillin bed after lunch as they had not been able to get them up by then! This adds greatly to the tensions when it comes to trying to staff wards -e-rostering has been introduced where I work. For us it's been the biggest disaster - and staffing problems have increased as nurses struggle to maintain their home needs with work demands as the random selection of shifts is foisted upon us as managers ( not affected by rostering) impose thier random will through keyed in limitations - ie no senior staff at weekends and BH's and soon to come nights too as they get away with no night siters too - this means junior staff can run my place of work ( up to 80 general beds and some over night surgery beds)for up to 4/5days on BH's and no doc either!. 1 request per mth for pt time and 2 for FT. Duties are not released until barely the week before they start. It puts severe strain on staff and families which we all have - we do not know whether we are coming or going - Yet managers swan around with blank faces to our dilemmas - staff are often so stress they get ill/run down trying to get it right for work and home. The rightious would say no doubt - well don't do the job if you can't commit - ok lets all of us trying to cope with the night mare give notice to quit ! That way the agencies can step in and fill the gap.BUT - DON't DAMN THE AGENCIES, FRANKLY IN MY OPINION THEY AT LEAST PROVIDE A LIVING WAGE AND CHOICE AND THAT IS WHERE I AM HEADED - GOODBYE NHS WHILST YOU'RE STILL THERE THAT IS. Because this Tory goverment wants shot of you - they are leaning us up for tendering - just like I hear they are doing so ruthlessly in North Gloucestershire community services through their enterprise plans set up as soon as the coalition came in ----
    It would help if we had managers with more recent hands on experience as it is all of our that I know have not done pt care for years and years and have lost touch - not however with auditing which on top of pt care they dvise and we try and fit in around the times when we should be doing caring!!
    I'm like everyone else too worried about consequences to want my name displayed.Apologies but I'm sure all nurses recognise this huge worry.

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  • How come since I started my job and since the goverment said they would be getting rid of some of the layers of managers - my place of work has seen a big incease? We have gone from a Matron and PA - to Matron, deputy matron, PA, secretary, administrator and a bed manager - we are a community hospital. Staff on the wards has been capped to levels that make it really difficult to give safe levels of care - no one listens to us - we put in complaints and we are ignored and/or told not to keep doing it. You're here to work, get on with it!
    All staff from cooks/cleaners nurses DN's in my Trust ( or what ever it's called now - frankly who cares as it's all more unnecessary expence - new signs and letter heads are very very costly) have had to have new uniforms even if their own was perfectly ok - this at a cost of hundreds of of thousands of pounds - Why? My uniforms were all new - my DN friend and colleagues gave their "Old New coat" to a charity shop when she got her "New DN Coat"!!!!! Am I missing something here?
    I see that the office staff have add had fancy new desks and fancy cupboards they cost thousands, we ask for staff and get told to take a hike or spend hours trying to ring around asking staff if they can help - oh and yes it has to be at less pay as the managers have said all over time has to be paid at the lowest amount for that grade or the next possible lowest - well only but the desperate or the most guilt ridden will turn in - not many. Even our very good team of hospital staff nurses/sisters ENP's have been told their is to be a pay drop - so most have voted with their feet. The upshot being for example the minor injuries unit has to close at the drop of a hat - a vey serious accident waiting to happen! Managers just don't prioritise spending correctly, frankly I think good safe levels of staffing come before new desks and new unifroms where none was needed - I'm sure my thinking is common amongst front line carers?
    Where is all this going - I'll never ever believe that the NHS is safe in conservative hands again.Some of the previous goverments actions were not all good buy care improved and waiting lists all but disapeared - Would I like to be a patient in my unit NO THANKS

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