Reducing agency spend in East Anglia

Sarah Ball

Sarah Ball, head of organisational development and human resources at Norfolk and Suffolk NHS Foundation Trust, has  written a blog exploring her trust's efforts to reduce agency spend through flexible working. 

We’ve spent hours contemplating whether science can clone people to meet our staffing needs or if we can simply knit more staff. Unfortunately, these aren’t options so we find ourselves, like other NHS organisations looking at how we recruit, engage and retain clinical staff, and manage our reliance on bank and agency staff, while reducing costs.

We’re a mental health trust in East Anglia covering two rural counties which include urban conurbations. Once we recruit staff, we tend to do well at retaining them. Attracting staff to what are often perceived (wrongly) as holiday or retirement destinations is not easy, but we’re doing well.  

Our clinical vacancy rate is 10.99 per cent against an average vacancy rate within equivalent trusts nationally of 13 per cent. Why then have we seen registered nurse demand rise by over 27 per cent in the same period?  Vacancies continue to be the biggest reason (52 per cent) with increasing demand for specialist mental health services coupled with increasing patient acuity, alongside a trend for increasing levels of one-to-one patient observations (specialling) in inpatient areas (34% of demand).

We partner with NHS Professionals for the provision of our bank for all but non-medical, non-clinical roles, and while we very slightly exceeded our agency ceiling in 2016/17, we reduced spend by £4.2m.  

So what have we done and what are we planning to do?

We’ve tackled the challenges in a range of ways including:

  • an ongoing focus on recruitment, engagement and retention
  • making the most of our resource. We are monitoring the efficiency of our rosters and our e-rostering team works closely with managers to improve efficiency where there may be issues
  • where bank supply cannot meet demand,  we stick to framework agencies; will only pay capped rates (including for doctors); and have taken a tough approach with agencies only paying invoices where bookings have been taken through the NHS Professionals cascade system
  • implementing a clinical support worker development programme to engage bank clinical workers who have no previous clinical experience to develop competencies in a supportive environment, resulting in some going on to be successfully appointed into substantive posts
  • piloting plans to reduce specialling
  • trying to ‘grow our own’ bank of registered nurses by increasing our bank rate to incentivise our own staff to join and agency staff to transfer
  • automatic enrollment on the bank on appointment
  • encouraging agency workers on longer term placements to move onto bank, fixed term or even substantive contracts. 

We’ve established a safer staffing working group, with senior leadership, which focuses on clinical skill mix, temporary staffing and rostering.  We’ve spent the last two months meeting our locality operational teams to explore their recruitment and retention challenges, rostering efficiency and use of bank and agency staff. Following each meeting, a collaborative action plan is drawn up setting out actions that the locality and the supporting corporate services will take forward. Actions have included changes to skill mixes and the development of an accelerated care certificate competency approach for bank exclusive staff.  

We’ve learnt that what works for one area, doesn’t always work for another. We’ve been impressed by the innovation already taking place to meet the challenges of medical and registered nursing skills shortages and the appetite in many areas to do more.

The board is taking a keen interest in the results and we’ll be revisiting each area to ensure progress against the plans is on track, that good practice is shared and that corporate plans are aligned to support.

Our next steps include developing a plan to stop agency use altogether, but in the meantime, if anyone uncovers the secret to cloning, please let me know!

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