NHS trusts will be allowed to breach a proposed cap on agency spending if they need to ensure wards are safely staffed, Monitor has said.

  • Consultation document shows exceptions to proposed agency spending cap
  • Trusts will be allowed to hire more staff “where patient safety would be compromised”
  • Breaching the rules could prompt investigation by Monitor or TDA

In a consultation document published yesterday on the proposed cap, announced by health secretary Jeremy Hunt in June, Monitor has set out a list of possible exceptions trusts could use to justify going over the spending limit. These include:

  • where patient safety would be compromised without additional staff;
  • where significant demand pressures above contracted activity put patient safety at risk;
  • complying with Care Quality Commission warning notices on staffing;
  • major service reconfigurations;
  • special measures trusts with permanent recruitment difficulties;
  • other trusts with problems recruiting permanent staff;
  • trusts where trainees have been removed; and
  • trusts where in-year service changes require an increase in staff, such as “double running” for new care models.

The list of exceptions, which are also expected to apply to non-FTs, could significantly weaken the effect of the proposed cap, which is being introduced to tackle the cost of temporary staff. In the last financial year this cost the provider sector £3.3bn.

One of the main causes of this spending has been the increased demand for qualified nurses on grounds of patient safety, following the Francis report and new safe staffing guidance for acute wards published by the National Institute for Health and Care Excellence.

HSJ reported last month that more than four-fifths of trusts were failing to meet their own plans for nurse staffing.

When a trust expects to breach the new rules it will need to report this to its board and to Monitor or the NHS Trust Development Authority. This would be seen as a potential governance issue by Monitor and the TDA, which could then investigate the trust.

The Monitor document said: “For these rules to be effective, all trusts must keep to them. Patient and staff safety must be prioritised, but we expect overriding the rules to be rare.

“There are some exceptional circumstances where the rules might be suspended or flexed. To qualify, trusts will have to apply to the joint Monitor/TDA team and make a case that reasons outside the trust’s control justify an adjustment.”

It added: “The rules will not be adjusted to accommodate poor rota planning or poor planning of overall workforce requirements.”

In exceptional circumstances and at short notice, trusts will be able to override the restrictions but will again have to report this to the board and regulators after the event and justify their reasoning.

A fixed maximum rate of pay for temporary nurses and their provider agency is expected to come into force next month, but the hourly rate as not been revealed.

In the consultation document, Monitor said it would propose a maximum hourly rate for agency nurses and publishing pay frameworks with agencies.

Trusts will not be allowed to use agencies not on frameworks unless they get approval from Monitor. They will only be able to act without approval “in response to an urgent, exceptional short term staffing requirement where patient safety would be compromised by failing to secure additional nursing staff”.

The document also reveals plans to set a cap on agency nurse spending for each trust based on a percentage of their overall nursing staff spending.

A common ceiling will be applied to most trusts but the pace at which they will be expected to achieve it will depend on their current circumstances.

The document suggests an indicative rate of 3 per cent for trusts where current spending on nurse staffing is less than 12 per cent.

Trusts will be allowed to breach agency spending cap