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Improve rotas to eliminate reliance on agency staff – Lord Carter

Running a good work bank and looking at the rates paid are critical factors in making sure trusts are not overly reliant on agency staff, NHE has been told by the Department of Health’s ‘procurement champion’, who said good rota design can eliminate the problem. 

Lord Carter of Coles, who recently released his ‘Review of Operational Productivity in NHS providers’ interim report,  told us that the NHS probably does have a national shortage of nurses, but some trusts have been overly reliant on using agency staff. 

His report identified that in 2013-14 the NHS staffing bill was £45.3bn – the largest area of spend – “so the sheer size of this necessitates scrutiny”.  However, he did note that over- and under-rostering suggests managers are being too flexible. 

In an interview with NHE at the Treasury, Lord Carter said: “A lot of people, since Mid Staffs, have felt vulnerable to inadequate staffing and in some places there has been a reaction where people have put on more staff. One of the questions we’ve been discussing with people is: were hospitals running unsafe care before Mid Staffs? Some were, but many weren’t.” 

Some trusts are practising ‘defensive nursing’ in quantity terms. “So, some people are taking agency when they don’t need it,” he said. “We’ve data to show that. One hospital in our cohort re-did all its policies around rotas and moved from a shortage of nurses to having 27 too many. There is an argument that says if you use our resources really well you shouldn’t need institutionalised agency. Plus, one of our hospitals let everybody go off on half-term; they didn’t have a roster policy saying you can’t go.” 

Lord Carter’s review revealed that in 2013-14, the cost of nurses in the NHS was £19bn. And with the increased focus on safer staffing and a 29% increase in the rate of nurses leaving the profession in the last two years, the dependency on agency nurses has risen significantly, doubling between 2012-2014. 

Following the recent announcements by Monitor and NHS TDA that NHS trusts and FTs spent in excess of £3.3bn on agency staff in the last year, NHE sent Freedom of Information requests to all of the trusts who sent copies of their draft accounts to the two organisations. 

We learnt that in 2014-15, two-thirds of trusts spent at least double what they had budgeted on agency staff (more on this in the July/August edition). Discussing our findings, Lord Carter said: “I think we are going to have to look at skill mix, productive time and all things like that will let us use those that we’ve got pretty well. 

“We all know that some agencies have really capitalised on this [shortage],” he said, adding that it won’t change “until we train lots of nurses which is probably – if you think about it – 2019-20”. 

Recently, Monitor set up a team of experts to reduce the amount of money being spent by the NHS on agency staff. The team has been set up to run an initial three-month trial at three foundation trusts, and comes after the regulator recently revealed that agency pay to contract staff at the end of the financial year amounted to £1.77bn, significantly higher than the £766m planned for the period. It was also up on the 2014 figure of £1.37bn. 

David Bennett, Monitor’s CEO, has also threatened foundation trusts with the loss of “their cherished freedoms” if they do not make efficiency savings to bring down a deficit that threatens to reach £1bn a year. 

Talking about this, Lord Carter said: “That’s for David Bennett to say. My thought is that you need to help these hospitals get there. They’ve been so beaten up they need help. Each of them is an important community asset and you have to sit down and understand. 

“Clearly, in some hospitals management is inadequate and should be removed. In other areas it is a CCG issue, each healthcare economy has its own challenges. What we need to do is really understand, in great detail, what is happening in each area. 

“And I think the key is giving hospitals and boards the opportunity to understand where they’ve done things wrong; getting them to accept and take action; and making sure they do this as a priority.” 

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