Healthcare leaders concerned about agency spend rules

Maximum hourly rates are among the new rules for nursing agency spend set out by Monitor and the Trust Development Authority (TDA)

Healthcare leaders have voiced their concerns about proposals contained in new rules for nursing agency spend set out by Monitor and the Trust Development Authority (TDA).

Foundation and NHS Trust executive teams have just over a week to email their initial responses to the plans which are due to be launched next month.

They include setting maximum hourly rates paid by a trust for agency staff, mandatory use of approved frameworks for procuring agency staff and an annual ceiling for total agency spending for each trust.

In 2014/15 NHS providers spent £3.3 billion on temporary staff. Under the proposals contained in a letter and consultation, Monitor and TDA will also expect trust boards to give ‘assurance and evidence on request’ that ‘best practice’ is undertaken in the short term.

This includes assessing patient dependency ‘to see how far the existing nursing skill mix could be flexed’ to meet patients’ needs cost effectively, considering not filling shifts when there is a short-term staff shortage and depending on the level of patient risk, engaging on a temporary and fixed basis professionally qualified staff such as allied health professionals and pharmacists to supplement the nursing workforce.

The proposals also include mechanisms for local managers and clinical leaders to override the new rules in the interest of patient safety but they would need to report to Monitor or TDA and explain non-compliance.

Unite head of health Barrie Brown said the expense of agency staff was not surprising after a two pay freezes and 1% cap for NHS staff: ‘Unite believes that has to be addressed as a key solution to the problem of uncontrolled agency costs in the NHS.’

He also criticised the possibility of an ‘absurd skill mix scenario’ using non-nursing health professionals for patient care who could be using their skills for patients in their own area of health expertise.

Susan Osborne, chair of the Safe Staffing Alliance and independent nursing management consultant said: ‘Although agency spend needs to be addressed and it is positive to zone in on agencies and cap their commission rates, these proposals appear to be very controlling and littered with quick fixes.

‘Monitor and TDA need to spend time finding the root cause of agency spend which may encompass high spend on medical locums. What they haven’t recognised is that even when trusts do look to agencies for staff, not all the requested places are being filled, so obviously we need to commission more nursing and midwifery places in higher education.

‘Also asking trusts to use staff from other disciplines to supplement nursing is very worrying. The cheaper solution may not always be the best one.’

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