Daily Insight: Bank spend bubbles

The bank bubble

Agency staffing is at a scary intersection of market economics, government action and avoidable patient harm.

Not long ago “rip off” agencies were public enemy number one in the NHS, with national media being fed stories about the lavish lifestyles of company bosses grown rich on the NHS staffing crisis.

Caps on spend were introduced by NHS Improvement and trusts closely monitored on their spend.

Did it work?

It did for nurses, not for agency doctors.

Trusts often had little choice but to pay “break-glass” rates for the relevant specialist medics.

But overall, NHSI has trumpeted its success in reducing agency spend.

But like the bump on a cartoon character’s head, the pushing down of agency spending leads to another bump popping up elsewhere - in this case, bank staff spending.

NHSI forecast trusts would spend £2bn on bank staff in 2017-18, it now looks worse than that by £843m – quite a miss.

Staff banks run by trusts themselves should in theory pay lower rates than agency and employ mainly trust staff who are more familiar with how the hospital operates.

In practice, the inexorable force working on the healthcare labour market - that there are not enough people - hits banks just as badly.

So overall spend can’t help but rise - something is clearly up when the projection is out by 40 per cent.

True, big banks mean at least that none of that money is paying for a company director’s Aston Martin, but there is a danger.

Some agencies say trusts, fearful of NHSI, are simply leaving shifts understaffed if their bank cannot fill the place – shifts that need to be filled.

Disturbing news emerging from Kent shows what can happen when basic care and oversight isn’t delivered. A stillbirth at a London trust seems to have come from the organisation trying to cover a shift on the cheap.

Galling as it might be to see agencies take fat cuts off the NHS pay bill (government should have planned the workforce better), safe staffing wins.

Pathology plods on

Pathology consolidation has been tried many times before, with varying degrees of success, but a national attempt to deliver £200m savings got underway last September.

Progress on NHSI’s plans to create 29 pathology networks between acute non-specialist trusts has been mixed so far, HSJ analysis has found. Of the 29 areas proposed, less than half have agreed to NHSI’s plans.

But the majority of remaining networks are either forming alternative plans or awaiting decisions from individual trusts, and only five of 29 networks suggested by NHSI are trusts yet to confirm any kind of plan.

Reasons for trusts disagreeing with NHSI’s plans differ across the country, but include existing arrangements with other trusts, plans put in place prior to NHSI’s project, and concerns over distances between trusts, IT connectivity, and workforce implications.

NHSI is currently reviewing the responses from trusts, and will publish “updated networks” at a later date.