Several trusts will struggle to reduce spending on agency nurses in line with the targets set by regulators, HSJ has been told.

  • Providers say agency spending “ceilings” over next four years are “impossible” and “unrealistic”
  • Monitor and TDA introduced cap to bring down agency staffing costs this month
  • Trusts spending a higher proportion on agency nurses will find it most difficult

Monitor and the NHS Trust Development Authority last month issued “ceilings” to each provider on the proportion of nursing expenditure they can spend with temporary staffing agencies.

The new targets, which vary depending on the amount trusts have previously spent, came into force at the start of this month.

The ceilings vary from 3 to 12 per cent. HSJ asked trusts across the range if they thought they could reduce spending as required. The responses suggest trusts currently spending a higher proportion on agency nurses will find it more difficult to meet their ceilings.

Tameside Hospital Foundation Trust spends 6-8 per cent of its nursing expenditure on agency staff and is expected to gradually reduce this to 3 per cent by 2018-19 (see table, below).

Ceiling trajectories

2014-15 nursing agency spend rateCeiling in Q3-Q4 2015-162016-17 ceiling2017-18 ceiling2018-19 ceiling
Under 3%3%3%3%3%
Over 12%12%10%8%6%

Chief executive Karen James said: “It’s going to be impossible to achieve a significant reduction in our spend [and] we can’t achieve the level we are being asked to this year.

“We can make a slight inroad in terms of the ceiling but we’ve been clear we’re not going to be able to achieve it and other trusts are saying similar things.”

Regarding the financial challenge facing the NHS, she said: “Everyone’s been working towards the [safe staffing] guidance and this has increased demand for agency nurses. This all could have been predicted.”

She described the staffing guidance as a “very crude tool” and called for regulators to account for the roles played by allied health professionals in making wards safe.

Kingston Hospital FT, which spends 10-12 per cent of its nursing bill on agency staff, said its ceiling for the rest of 2015-16 “looks achievable”. However, “next year and future years look unrealistic without any central intervention to change supply in the market”.

A trust spokesman suggested that current immigration rules would hinder progress, pointing out that a cohort of nurses recently recruited from overseas had been declined visas. This has also been flagged as a major concern by other trusts.

George Eliot Hospital Trust, which is expected to reduce its proportion of agency spend from more than 12 per cent, said it has agreed a series of reductions with the TDA but would not say whether these matched the original ceilings.

Karen James

Karen James said it would be ‘impossible to achieve a significant reduction’ in agency spending at Tameside

A spokesman for Bradford District Care FT, which is in the 4-5 per cent band, said the trust believes it is possible to meet its targets, but added: “This is challenging and requires numerous responses, some at a coordinated national level.”

An executive at another trust said their organisation had been asked to reduce its proportion of spend to below 3 per cent, and that this was “probably doable”.

Another trust executive said internal analysis suggested it was not possible to meet its ceiling, but regulators said it had to be met regardless.

NHS Providers chief executive Chris Hopson said: “Trusts tell us that while they are doing everything they can to control agency spend, some are finding it difficult to stay within the total agency spend ceiling each trust has been given.

“Faced with a choice of providing safe care or sticking to the limit, trusts are prioritising safe care, as the rules say they should. Trusts tell us they are also concerned about the level of bureaucracy these trust level agency spend ceilings involve.”

The rules say Monitor and the TDA will track spending and may adjust trajectories and ceilings based on the progress of the sector or individual trusts. Trusts can apply for an adjustment to their ceiling in “exceptional circumstances”.

Yesterday, regulators moved to clarify “contradictory” messages issued to NHS providers around financial concerns and safe staffing levels. They stressed that nurse to patient ratios “should not be unthinkingly adhered to”, and suggested allied health professionals could be considered when ensuring wards are staffed appropriately.

The Department of Health also revealed the cap on the hourly rate the NHS can pay agency staff will be 55 per cent above the pay levels of permanent staff, subject to consultation.

Monitor and the TDA have been approached for comment.