Why Establishment Control Is Key to Reducing NHS Agency Spend: The Right People in the Right Place
In the fourth and final part of our blog series focusing on workforce spend, David Jones-Stanley addresses the final piece of the puzzle – ensuring the right people are in the right place across the NHS...
4 August 2025
David Jones-Stanley, Customer Operations Director, Liaison Workforce
NHS organisations are being urged to take stronger action to bring their workforce costs under control. Meanwhile, they are also tasked with increasing productivity to tackle growing waiting lists. Making better use of technology to manage processes is key to achieving both of these targets.
The recent publication of the NHS 10-Year Health Plan reinforces the urgency for transforming the workforce model, and ensuring sustainable staffing, reducing agency usage, and improving patient outcomes.
This is where the concept of ‘the right people in the right place’ becomes critical, and where Liaison Workforce can offer real solutions. By helping trusts take control of their workforce establishment, we support them in ensuring that staffing strategies are led by operational demand, not agency availability.
The tension between cost control and productivity
The NHS faces a dual mandate: reduce costs and boost activity. Yet too often, trusts are forced into reactive staffing decisions, plugging gaps with agency staff because of short-term pressures. This quick fix may fill a shift, but it undermines strategic workforce planning.
What’s needed is a proactive, data-led approach to workforce management – one where staffing levels are planned around real clinical demand, and where trusts have full visibility over their establishment.
Workforce demand should drive strategy – not agency availability
Agency use should be a last resort, not a default setting. Too frequently, however, the availability of agency staff dictates workforce deployment. This undermines both financial control and patient care.
Liaison Workforce supports trusts to flip this model. Through our bank-first approach, we help trusts and systems to offer existing employees flexibility, and use agencies strategically, with cost-efficient, compliant methods such as direct engagement.
Our approach reduces reliance on agency workers, ensures cost-effective staffing, and strengthens workforce stability.
Establishment control in practice: Stockport NHS Foundation Trust
A powerful example of effective establishment control comes from Stockport NHS Foundation Trust, as highlighted in the HFMA’s recent report.
Stockport’s success stems from its commitment to accurate and aligned reporting, supported by Liaison’s technology and workforce platform. The Trust developed a comprehensive reporting suite that consolidates data from the Electronic Staff Record (ESR), financial ledgers, and actual spend across substantive and agency staffing. A monthly reconciliation process ensures data integrity and generates full staffing lists for budget holders, enabling efficient corrections of mis-posted costs.
This ‘single version of the truth’ underpins a strong governance framework:
- Staffing approval group: Meets fortnightly to approve or reject recruitment requests, strictly limited to posts within the agreed establishment.
- Workforce efficiency group: Monitors temporary staffing using statistical process control (SPC) charts, allowing early intervention when usage trends shift.
- Directorate performance meetings: Use accurate workforce data to inform decisions and drive accountability.
The results speak volumes. The system has enabled consistent reporting to NHS England, streamlined recruitment approvals, and significantly improved forecasting. Most impressively, Stockport has reduced its agency spend by an estimated £1million per month – all while improving patient safety and clinical quality through increased substantive staffing.
The role of Liaison Workforce
As shown in the example above, Liaison Workforce provides the expertise and tools to help trusts replicate these kinds of outcomes. From advanced workforce planning to identify future vacancies, through to e-rota and e-roster management, and local, collaborative and national banks, we empower NHS organisations to build robust, future-proof workforce strategies.
By shifting the focus from agency-led backfilling to demand-driven planning, trusts can regain control over their staffing models – delivering financial sustainability, workforce stability, and better care outcomes.
In a system under pressure, the right people in the right place – and at the right time and the right rate – isn’t just a goal. It’s a necessity.
For support to improve your organisation’s establishment control, get in touch.
