Through detailed analysis and strategic governance frameworks, we reduced the usage of agencies for staffing, leading to notable reductions in agency costs and enhanced compliance with national targets.

Background

NHS Birmingham and Solihull Integrated Care Board commissioned NHS Midlands and Lancashire to provide system-level assurance on the recent performance of NHS trusts in reducing bank and agency staff usage and costs. The goal was to support the trusts in developing their agency reduction plans for 2024/25 by creating a baseline assessment and reviewing recent trends in the use of agencies and costs for five NHS trusts. Additionally, a governance framework was needed to ensure ongoing assurance of delivery against agency reduction plans and national/local agency key performance indicators (KPIs).

Action

NHS Midlands and Lancashire undertook several strategic steps to address the challenge:

– Developed a workforce data pack for each NHS trust, showing the latest position and trends for substantive, bank, and agency workforce, including workforce costs. The data packs included analysis by staff group, compliance with price caps, and agency usage details.

– Created key lines of enquiry from recent performance data to inform initial discussions with each NHS trust regarding their current position and planned actions.

– Conducted meetings with each NHS trust to perform deep dives into their current positions, understand immediate plans, and set expectations for the programme moving forward.

– Presented outcomes of trust discussions as a strengths, weaknesses, opportunities and threats (SWOT) analysis, identifying areas for further discussion and clarification.

– Developed a state of readiness assessment framework incorporating KPIs on governance, finance, culture, and leadership, and performed initial assessments of the NHS trusts against this framework.

– Held further discussions with NHS trusts to review their state of readiness assessment scores, seek additional evidence for assurance, and make recommendations for next steps.

– Reviewed the NHS trusts’ operational plan submissions (workforce and finance) against the 2024/25 3.2% target for agency spend as part of the total pay bill.

– Created an overview dashboard showing system and trust compliance and progress against agency KPIs to support monthly monitoring.

– Developed system and trust-level information packs and a highlight report to identify key metrics, performance, data quality, areas of improvement, and good practice.

– Established a governance process to enable regular reporting between the trusts and the ICB, including quarterly self-assessments against the state of readiness assessment framework.

Impact

The strategic efforts led to significant improvements in agency reduction across the system:

– 4,000 fewer agency shifts in March 2024 compared to March 2023. As of August 2024, this reduction has sustained to an annual average of 2,447 less shifts per month, when compared to the previous year

– Percentage of price cap overrides reduced from 55% to 46%

– Maintained low admin and estates agency usage across the system with NHS England business cases in place

– This led to the the system reducing agency costs by £5.5m in Q4 of 2023/24, compared to Q4 of 2022/23

– 4 out of 5 trusts achieved 100% framework compliance, reducing non-compliant shifts from 39 to 8 (0.3% to 0.1%)

– 3 out of 5 trusts achieved the 3.7% agency as a percentage of pay bill target in 2023/24

– 3 out of 5 trusts achieved zero Health Care Assistant (Band 2 & 3) agency usage.

By providing detailed analysis, strategic oversight, and robust governance frameworks, NHS Midlands and Lancashire effectively supported Birmingham & Solihull ICB in reducing agency costs and improving compliance with national agency KPIs.

Feedback

“The project ran smoothly; the team were adaptable and delivered to time throughout. The entire team were excellent with complementary skill sets. They really added value to the system.  The project ran fully as expected, there was nothing to improve and the ML teams technical knowledge and skills, quality of outputs and delivery approach were all excellent.” Sarah Copley | Birmingham and Solihull Integrated Care Board

For more information

For more information and to learn how we can help you reduce your agency costs, please contact us.