This week, the Welsh Audit Office (WAO) released figures showing that there has been a 171% increase in the amount spend by NHS Wales on temporary staff over the past seven years. £135.7million was used on agency expenditure – around 82 per cent of which was used to fill vacant positions.
The recently published NHS long term plan makes it clear that workforce growth has not kept up with need, partly due to increasing demands on the NHS and partly because the NHS has not been a sufficiently flexible and responsive employer. Staff are feeling the strain, particularly due to substantial and unsustainable vacancies and, so too, are the finance teams who are under increasing pressure to meet rate caps and find savings to reinvest into healthcare.
Through our work with health boards in NHS Wales and NHS Scotland we’re starting to see significant cost savings and efficiencies in the use of locum workers. We’ve introduced new methods of engaging locum workers – switching from standard placement to agency direct employment and reducing overall reliance on agency staff through a significant growth in the use of own medical staff banks by the health boards.
For example, Hywel Dda University Health Board was facing a substantial budget deficit and had been putting measures in place to cut agency spending – which had been steadily rising due to difficulties in recruiting staff. One urgent challenge was the need to take control of temporary AHP spend. Managers knew spending was too high and needed to find ways of understanding where the money was going and to bring costs down. In their first year of using Liaison Workforce’s TempRE agency direct employment service for AHPs, Hywel Dda increased agency direct employment take up by 150% and saved £148,633.
To achieve this rapid rate of progress, Hywel Dda knew it was important to tackle both new and existing bookings. For new bookings, success came from bringing agencies and booking staff on board with an agency direct employment approach. For existing bookings, it was data from the system – as the Board had hoped –that proved key. It was stressed again by the WAO this week about the need for NHS Wales to have visibility of ‘consistent and comparable data’ when it comes to tracking the volume, nature and cost of agency staff used and other temporary staff costs such as overtime and internal staff banks.
At Hywel Dda, critical steps have included starting to review contract arrangements for long-term temporary agency workers. As contract renewal dates approach, workers previously on standard placement agency contracts can now be identified, contacted, and transferred to agency direct employment. Significantly, the Board has had success in agreeing mutually acceptable PAYE arrangements with umbrella workers.
Just a year into the TempRE contract, the results show that the service is delivering both the data and the cost savings hoped for. Progress has been very much a joint effort, with Liaison Workforce providing advice and practical support and committed Board managers and staff taking the action needed to make a difference.
Contact me for a discussion around controlling agency expenditure.
Account Director – Liaison Workforce