The must-read stories and debate in health policy and leadership.

Look at any trust or integrated care board’s cost improvement plans for 2024–25 and one thing stands out: the reliance on reducing spend on agency and other temporary staff.

In some cases, they are planning to reduce the number of bank and agency workers while simultaneously moving them into substantive roles, in the hope this will be cheaper and help to blunt some of the financial pressures they are facing.

So it is unusual for a trust to say it is planning to reduce its substantive staff as East Sussex Healthcare Trust has done. It says that, with the resources available, it can only afford 5 per cent fewer staff than its budget allowed for last year. It’s also planning to reduce agency and bank use and says that if it can make inroads on high-cost agency use, there may be a little more money to employ other staff.

How and who is going to go is less clear although it hopes to do most of this through natural wastage, with no redundancy schemes in place. It will be tough but possibly this is a more realistic approach than others’ plans predicated on massive reductions in agency use.

Good standards

The chief executive of a London trust has said it only sends patients to private providers rated at least “good” by the Care Quality Commission.

Speaking to HSJ, Oxleas Foundation Trust chief executive Ify Okocha said that when the trust has a contract with a private provider of mental health inpatient beds, they “carefully vet them, have discussions with them, and check (their) CQC (rating)”.

The trust does not send patients to units rated “inadequate” or “requires improvement”, despite this “choosy” approach sometimes being difficult in the “desperate situation [when] you just want someone found a bed”, he said.

“Our clinicians can readily access the units to see the patients and talk to staff, and so we feel confident that we’ve got people in the right places,” Dr Okocha said.

He also discussed the rise in out-of-area placements, driven by patients clinically ready for discharge but lacking accommodation. He noted that social care and housing support services have diminished over his nearly three decades in Greenwich, placing more reliance on the NHS. To manage housing shortages, the trust uses bed and breakfast accommodation, which, although “not ideal,” costs significantly less than an acute mental health bed.

Also on

After Wes Streeting committed a Labour government to hitting the four-hour accident and emergency target within a first term in office, the key question NHS leaders will want answering is “how?”, writes James Illman in this week’s Recovery Watch. And in CommentJulian Hartley asks what can be done to increase activity in the service while maintaining quality and safety.