Health Service Focus

11.01.16

Back to bank

Source: NHE Jan/Feb 16

Tyrone Roberts, deputy director of nursing at Stockport NHS Foundation Trust, explains how the provider cut down on agency by boosting the bank offer and building local relations.

Stockport NHS Foundation Trust was one of the five Greater Manchester providers to form a consortium in 2012 designed to help each member work within reasonable agency expenditure ceilings. 

Fast-forward four years and the trust has one of the highest bank fill rates in the country – one of the many benefits reaped from a series of schemes created to stamp out excessive agency use. During the first two weeks of January, for example, its A&E department worked with a bank fill of 86%, despite the spikes in staff needed during the winter months. 

The trust’s deputy director for nursing, Tyrone Roberts, added that the bank fill for nurses in Q3 was 62.3%, considerably over the national average of 50.6%, with less than 15% of staff hailing from agencies. 

Detailing Stockport’s more recent developments since the 2012 consortium, Roberts said his department has been revolutionised by a new Nursing and Midwifery staffing strategy, catalysed by a meeting with Professor Paul Fish from the Royal National Orthopaedic Hospital. There are eight specific workstreams underpinning the strategy that have dictated large increases in bank uptake last year. 

In-house staff flow 

The biggest one, he said, was shifting workers from potentially overstaffed areas to regions of greater need, helped by additional investment agreed by the trust board. “In the end, that was equal to about £2.5m, and that has enabled all the wards – not just in surgery, but medicine – to have the same staffing ratios and levels that you would expect across all areas,” Roberts said. 

“We also reviewed all the specialist areas, like theatres, ITUs and EDs, and we’ve just completed a very similar exercise with the community nurse workforce. We started that whole piece of work probably around summer 2014, with all the changes implemented on 21 September 2015.” 

Upping the bank offer 

Around the same time, the trust undertook a special scheme with critical care – where there was heavy reliance on agency – whereby it dramatically upped the bank pay rates by roughly 96%. In the first four weeks following the rise, there was a remarkable 480% increase in shifts being picked up by NHS Professionals (NHSP) staff rather than agency. Eight weeks in, the figure was 680% higher. 

“Interestingly, when the first agency caps came out [in November], we were only about £1 over,” he noted. “We’ve now reduced that to meet the caps and we’re still seeing the same uptake, so just by increasing the bank pay rates, we’ve managed to have our own staff fill those shifts. We’re also getting lots of positive feedback from staff saying they feel more valued and that they prefer working for our internal bank.” 

Asked about the impact this had on costs, Roberts said it was, in a way, a stab in the dark – but without any real risk attached with it, since attracting in-house staff could only lead to better quality incentives, reduced staffing inconsistencies and less agency expenditure. He now expects this scheme to be rolled out beyond just critical care, with the trust already having asked NHSP to model costs and outcomes for that scenario. 

Cross-provider collaboration 

Because of Greater Manchester’s health network geography, Roberts said there is a natural movement of staff from one trust to another, which has helped build bridges between providers. These relationships were later polished by NHSP, which provides all the agency data trusts rely on to assess their own spending figures and collaborate accordingly.

As a result of these relationships, the five north-western trusts are now jointly deciding which agencies to cut off from their rosters because they are not fully compliant with the capped rate. “Because we’re able to say that our four neighbouring trusts are also doing the same thing, the staff don’t really then have that option to pick up those shifts with a trust down the road,” Roberts explained. 

“A lot of success has come from the fact that we do the same thing rather than trying to compete with each other. We’re sticking together and agreeing who we’re going to work with and who we’re not. That has been pivotal.” 

International recruitment 

Despite the greater uptake in the new and improved bank offer, Stockport has also been focusing its efforts on the two biggest challenges in the NHS to date: recruitment and retention of permanent staff. The trust has had “quite a successful” EU international recruitment campaign lately, with around 130 predominantly Spanish and Cypriot nurses absorbed over the last 18 months. 

Asked whether the trust would benefit from nurses staying on the shortage occupation list, Roberts said it absolutely needs this to become a permanent fix.  “We’re getting a lot of newly qualified staff from overseas, which is why we’ve now had agreement from the board that we’re going to India in Q3, and we’re looking to get 60 to 80 nurses. 

“It’s not just about the numbers now – we need to make sure that we retain the experience,” he said. “We’ve got a deficit of around 70 [graduate nurses] that we either need to make up by attracting staff from other hospitals – but then we’re robbing each other – or we need to fill that with international recruitment, until such a point where our local numbers are increased.” 

Efforts to attract local nurses have also been poured into a new rotation programme, where staff can switch between acute, medical, surgical and community wards. In terms of rostering, the trust has established a new key performance indicator that monitors each six-week block of rosters produced. 

“That has driven lots of changes in how effective the rosters are to make sure that what they do have, based on that establishment, is right in the first place,” Roberts said. 

“We also reviewed our headroom and are happy that it is what it should be.”

Fundamental NHSP data 

Out of all national bodies focusing on reducing agency rates, Roberts said NHSP is the main source of support for the Manchester Consortium. “They’ve got access to data because of their size and back office support. It would’ve taken us much longer to get the data ready together, whereas they already have that and can then provide it between all the five trusts who’ve agreed to share things with each other,” he continued. 

With the rich scope of data NHSP holds, it is in a position to pinpoint individual agency demands by each organisation, the savings that would come from being compliant, all risks involved with cutting off an agency and how to best support migrating staff. 

On the latter, the trust has launched a marketing campaign designed to give staff advance warning of what agencies they will and will not be working with – and then later making it easy for them to join NHSP if they’re not already a member.

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