Modernising temporary staffing

A drive to revolutionise temporary staffing at.Homerton Hospital trust.has resulted in.tangible benefits for patients and staff, as.Jennie Negus and Karen Daniels explain

Spending on temporary staffing across Homerton University Hospital foundation trust.was extremely high, with nursing at the top. Signing up to the London Agency project had helped but only by.containing costs, not reducing.them.

The trust signed a single-provider service-level agreement with one agency to cater for all nursing and midwifery needs, which enabled it to foster strong partnership working. This took care of.the cost of agency nursing and the focus then shifted to.reducing usage.

For many years, Homerton had a small staff bank for nurses, but it was unable to meet demand. In January 2006, a clinical manager was appointed. An intensive review of the service was done, including why temporary staff were needed.

Wider workforce efficiency strategies in recruitment and an electronic rostering system were introduced. The following staff bank initiatives were implemented:

• Paper systems were abandoned and computer software installed that set parameters for bookings and monitoring.
• All requests for temporary staff were routed first through the bank. Only in specific circumstances were areas permitted to contact the agency directly.
• An out-of-hours availability list was drawn up and given to the clinical site managers to contact bank staff at short notice.
• A unique booking reference number was supplied for all requests. This number was required on timesheets in order for temporary staff to receive their pay. It also enabled detailed tracking through the system.
• A targeted recruitment drive increased the pool of bank nurses and pay rates were reviewed to ensure they were in.line with.Agenda for Change and competitive with agencies.
• A 48-hour booking rule was introduced. The previous practice of booking weeks ahead, rarely reviewing and often not cancelling significantly reduced the availability of staff, was inequitable and did not encourage exploring alternative options.
• Guidelines for booking nurse specials and escorts were developed and agreed.

Red alert

A daily traffic light alert system was developed to indicate.the number of shifts that had been booked. This provided a heightened awareness across the directorates. The alerts were calculated against vacancies and then e-mailed at noon. For example, a.green alert equated to 30 shifts booked, amber 30-40 and red 40 or more.

In the event of red alert, only matrons and senior nurses were permitted to book further staff and they had a 30-minute lunchtime meeting pre-planned every day in their diaries where usage was reviewed and means of managing the demand explored. These meetings eventually tailed off as the controls and systems became embedded in day-to-day practice. Monthly meetings are now held.

Regular reports ensured budget holders had up-to-date information on their usage and spend. This was presented in.regular finance and human resources meetings to discuss anticipated.needs.

For the bank staff themselves, closer dedicated management and support, coupled with clear expectations in terms of standards and performance, built a sense of worth and value. Complaints dramatically reduced and positive feedback increased.

Outcomes

• Agency spending fell by£1.2m in the third quarter of 2006-07,.compared with.the same period.in 2005-06. The figures show.a continued downward trend and greater expectations for end of year figures.
• Agency shifts fell from 2,949 in 2005-06 to 1,250 in 2006-07.
• Other staff groups adopted the system.and the bank now covers administrative and clerical roles, advocates, porters, sonographers, therapists and many others, with continued recruitment to cover all areas.
• Consideration is now being given to include medical staff.
• Ninety-eight per cent of shifts are filled from the staff bank.

Tight controls and close monitoring are behind.these changes. However, acceptance of these controls by clinicians and managers was fundamental to the project's success. While some of the controls.were non-negotiable, such as financial controls for audit reporting and the requirement that all requests go via the bank, the majority were developed with managers. This guaranteed ownership and commitment. Managers at all levels, from the ward sister to the directorate senior nurse, could see that their efforts were paying off.

Seeing results is a natural motivator. Nursing led the way for the trust and, having proved that the systems could work efficiently with such a large staff group, others groups clamoured to come on board.

The trust is now heading down the 'bureau' route, whereby all temporary staffing, without exception, will be managed through the bank. Cost containment in-year is crucial; cost reduction where possible is important; providing a flexible, responsive and high-quality service is paramount.

Jennie Negus is deputy director of nursing and Karen Daniels is clinical manager of Homerton staff bank at Homerton University Hospital foundation trust.