Leaked guidance signals tougher controls on agency spending

In 2024-25 each integrated care system will be set a cap on overall spending on agency staff, which will fall to 3.2 per cent of the overall pay bill, down from the current 3.7 per cent this year.

As part of this push, ICSs with the greatest level of spend will be required to make the biggest reductions. The bulk of agency spending within ICSs is done by provider trusts.

The guidance says: “NHS England reserves the right to set lower limits where systems return a deficit plan and an additional 10 per cent reduction may be required from those systems in these circumstances.”

The document is marked as a draft “provided for engagement purposes and subject to change”. It has been issued amid an ongoing delay over the health service’s planning guidance for 2024-25, which is yet to be published.

As reported in December, trusts’ spending on agency staff surged to £3.5bn in 2022-23, after several years in which they had managed to shrink these costs.

The annual planning guidance sets the service’s key priorities for the year and is normally published before Christmas. However, it is reported to be held up due to rows over the efficiency ask, elective requirements and bed numbers.

The draft guidance also suggests core recurrent allocations for local systems are set to rise by less than 2 per cent in real terms.

Other sections of the guidance confirm ICSs will have to start repaying any historic debts back to NHSE.

This obligation is made up of deficits inherited from the predecessor clinical commissioning groups as well as any subsequent overspends racked up since 2022-23.