The sum spent by hospital trusts hiring off-framework agency staff grew by 41 per cent over the last financial year, HSJ analysis reveals.

  • Spending on off-framework agency staff jumped 41 per cent during 2014-15
  • Trusts have struggled to fill rotas  at short notice with staff from framework agencies

The increase outstrips the overall growth in agency spending from 2013-14 and 2014-15, which rose by 22 per cent from £2.7bn to £3.3bn.

Most trusts are signed up to framework deals that aim to leverage the buying power of multiple organisations in order to get better deals, with minimum and maximum prices per shift. In practice, trusts have been struggling to fill rotas with framework agency staff and often resort to more expensive, off-framework agencies at short notice.

Health secretary Jeremy Hunt said in June he would ban the use of off-framework agencies.

HSJ analysis of the 57 acute trusts who supplied detailed data shows off-framework spending becoming a larger proportion of the agency spend total, year on year.

Of the £673m spent on agency staff in 2013-14, £147m was with off-framework agencies. In 2014-15 the 57 trusts spent £882m with £207m off-framework.

HSJ’s research looked at three different factors affecting the position of individual trusts on agency staff: substantive nursing headcount over two years; total agency spend; and the framework/off-framework breakdowns.

The headcount analysis showed that overall the number of full-time nurses working for hospital trusts increased by 5.5 per cent from quarter one of 2013-14 to quarter one of 2015-16, but with a sharp slowing of growth in the middle year.

The difficulty in recruiting full-time staff is illustrated by the number of trusts that have a lower headcount in the most recent data than they did at the start of 2013-14.

West Hertfordshire Hospitals Trusts saw a decline in headcount of 4.2 per cent over this period, and said one factor was staff leaving when they worked alongside agency nurses and saw how much better the pay was.

The trust said it had increased its nursing established by 269 posts after the publication of the 2013 Francis report, but “with so many NHS bodies reviewing their establishments and competing for staff at the same time, many of these [posts] could not be filled”.

The statement added: “We therefore brought in large numbers of agency staff. Many of our existing frontline staff found themselves working with agency nurses, often on higher headline rates of pay and with more flexible working patterns, and we found it difficult to retain our staff.”

West Hertfordshire is also hampered by having to compete with prestigious trusts in the capital that can offer London weighting.

A spokesman said the trust “expects” more than 150 nurses recruited from Europe and the Philippines to start early next year.

From quarter one 2013-14 to quarter one 2014-15, Barts Health Trust in London saw its substantive nursing headcount fall by 4.5 per cent. Over the two financial years the trust’s agency bill leapt from £44.2m to £83.6m.

It has since managed to reverse the decline in substantive nursing staff. The trust told HSJ it had introduced recruitment events where nurses can be interviewed and offered a role on the same day. It also recruited “dozens” of specialist nurse from the Philippines, a spokesman said.

The 12 trusts with a fall of more than 2 per cent in substantive nursing headcount over the two years together predicted a deficit of nearly £2m in this financial year.

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The data in this story comes from a larger analysis of agency spending by HSJ.

The research will be discussed and full findings revealed at the War on Variation Summit, in association with McKinsey. Trust directors interested in attending this event please contact HSJ commissioning editor

Analysis: Growth in off-framework agency spending revealed