This guide is part of a series of how to guides produced by NHS Employers to help promote good practice and offer guidance on a range of workforce practices aimed at achieving workforce productivity efficiencies. Aimed at assisting organisations in reducing their expenditure on agency and locum staff, it provides advice to trusts on a range of effective ways to reduce costs through the use of workforce planning, shift systems and maintenance of appropriate staffing levels.
By making the best possible use of substantive staff, NHS trusts can significantly reduce the requirement to use temporary and agency staff which often represent a significantly more expensive alternative. To ensure that the substantive workforce is used as effectively as possible, it is essential to have effective rotas in place that are based on clear and transparent criteria and supported by robust workforce planning. When developing rotas there are several key elements that are useful to take into consideration.
- Ensure that rotas are accurately aligned with activity. Look carefully at the activity patterns to support the planning of shift systems rather than using historical custom and practice.
- Develop clear rationale for the numbers and skills of staff required to be working at any time based upon this activity.
- Assign shifts to individuals, ensuring that the working time directive and contracts of employment are adhered to (this can be done through self-rostering and through the use of e-rostering software).
- Once rotas have been developed, it is important to then ensure that there is a sufficient number of staff working at all times, a process that requires robust policies to be developed and adhered to (see below).
It is important to ensure that the staffing ‘establishment’ for your ward or department is correct, and effectively aligned with activity. This will enable you to have the right number of people working with the right skills at any given time and in turn ensure that leave can be planned around rotas that minimise the requirement for the booking of agency staff.
Having good management information is a key step in being able to plan your workforce. Running regular detailed and accurate reports helps ensure consistency across departments in how staff are utilised. This can help trusts identify areas where staff could be better deployed and similarly where there may be unnecessary use of temporary staff.
The NHS Electronic Staff Record (ESR) has huge potential to support trusts with workforce planning. ESR has a range of tools and functions which enable employers to enter, store and analyse historical and current information about their workforce. ESR can help employers understand the data about your workforce, and what it means - not just in terms of numbers of staff, but their skills and competencies too.
Remember to consider the following when thinking about workforce planning.
- Think about the peak activity times for your service. Is there a day in the week where you can anticipate when activity will be high? This may be seasonal or even linked to specific external events e.g. Bonfire Night, football matches, local events.
- Look at patterns of absence –- how are your shift systems influencing this?
- Utilisation of resources such as theatres – how does this work within the organisation?
- Consider the existing staffing levels and shift systems in place within the organisation/department/ward – when were they implemented? Why were they implemented? Is there any way they could work more efficiently both for workforce productivity and cost effectiveness? It is crucial to challenge yourself into exploring new, more suitable levels and shift systems even though these might not be current practice.
Many NHS trusts are now implementing standardised shift patterns within their organisations. Although this can limit the opportunity for employees to work flexibly, it may produce a significant cost saving for the organisation. Having standardised structures for shift systems, can reduce the amount of shift overlaps and the requirement for handovers. With a more standardised set of shifts, less workforce planning should be required. When considering such an option, it is critical to engage staff in any changes process.
There are a range of tools available to organisations that can assist with workforce and shift planning. These range from intranet based tools for requesting annual leave to rotas and comprehensive e-rostering systems. Read more on e-rostering here.
When using an e-rostering system, NHS trusts have the opportunity to view detailed management information on which shifts are most frequently requested and similarly when in the week off duty is commonly asked for. This information can be useful to organisations looking to reduce the cost of temporary staffing as it allows them to consider the potential cost of replacement staff which can be greater during evenings and weekends.
Where there are disproportionally more requests for shifts early in the week, this can result in more vacant shifts towards the end of the week and at weekends. In order to cover these shifts, trusts may have to use agency and bank staff which can prove significantly more expensive. It is therefore important that NHS trusts balance the rights of staff to request flexible working patterns with the need to run an efficient and cost effective service.
When considering applications from staff to work long day shifts, it is important to be aware of the wider implications this can have on rostering. When long day shifts are in use in a roster, but not fully used across the roster, the auto-rostering systems often places more staff on long day shifts at weekends.
Each organisation is likely to have its own policies in place for flexible working, but it may be a good idea to revisit existing policies to ensure that poorly planned workforce issues from staff working flexibly are rarely used as a reason to book agency staff. By ensuring that policies are up to date and communicated well to all staff, workforce planners should always try to cover any flexible working patterns within the substantive workforce. It is important to carefully maintain the balance between the type of flexible working which is requested by the employee and that of the operational need. If a request for flexible working does not meeting the business need, then the request needs to be carefully considered as well as other options.
The following points could be useful to consider.
- A clear and transparent process for flexible working within the organisation – this should be fair and applied equally to all staff.
- Ensure that policies in place are communicated to staff clearly in inductions and throughout employment (using internal communications systems).
- All employees, line managers and HR should be clear on their roles and responsibilities
- Ensure that line managers have the correct level of support.
- When considering requests for flexible working use pilots/trial periods with a clear end date for assessing how the flexible arrangement is working for both the employee and the organisation.
- Undertaking an assessment of the organisational culture towards flexible working. Use this information to update the policy.
- Monitor and evaluate progress with flexible working among employees.
- Clear guidelines on how an employee should make a request for flexible working - it is good practice that a request for flexible working should be made in writing.
- Clear guidelines on the timescale for providing a response to a written request - a response will be provided to the request within a set timescale.
In the NHS, flexible working arrangements can also refer to practices such as employees swapping shifts and self-rostering using an e-rostering system. Employees may request to work evening or weekend shifts for example. However the request of the employee to work flexibly must fit in with the operational need of the organisation. Flexible working for the employee should not become ‘inflexible flexible working’ for the organisation.
Getting the right balance between offering flexible working to employees and maintaining patient safety is dependent one a number of factors listed below.
- Closely engage with HR to ensure that you are operating within a legal employment framework.
- Effectively align workforce plans with activity and ensure that robust policies are in place.
- Communicate effectively with staff across the organisation. As with all workforce planning scenarios, the key is to have the right people, in the right place at the right time doing the right things. Engage with your staff at a very early stage, let them know why you are looking at these issues.
- Ensure any changes planned are rooted in improvements to patient services.
Having robust and coherent policies in place to assist with the flexible working requests is clearly essential. However, unless managers employees and staff side representatives are fully aware of the policies, and the reasons behind them are fully communicated, it is unlikely that a policy will ever be truly effective.
It is essential to share with staff the rationale behind the policy and the approach being undertaken by the organisation – this isn’t about stopping staff having the work/life balance they need, but ensuring safe, quality patient services are delivered.
It is of vital importance that all line managers are fully familiar with the range of policies to ensure that they are implemented correctly, fairly and equally.
When considering implementing any changes to assist with the reduction of agency spend it is crucial to ensure that the focus is still on patient outcomes.
Controlling agency and bank usage, and reducing spend in these areas can be achieved by a variety of workforce strategies.