• More than a quarter of trusts ask Monitor permission to breach “ceiling” on agency spend in September
  • Nearly a quarter are successful
  • New price cap due to take effect next week

More than a quarter of trusts asked Monitor to increase their agency spending cap last year, HSJ can reveal.

A Freedom of Information Act request shows 69 trusts applied to the regulator last September to alter their overall spending limit on agency staff.

Of the 239 NHS and foundation trust acute, ambulance, community, specialist and mental health organisations given a “ceiling” by Monitor, 54 made successful applications to have that altered.

The regulator would not reveal which the organisations were or by how much they had asked to lower their “ceiling”. It said of the 54, 31 applications were only “partially successful” – with the total being lower than the original but higher than the trust’s proposed total.

The news comes as Monitor prepares to further lower the maximum prices agency workers can be paid per shift.

Next week the final reduction of three is due to take effect, and from 1 April trusts will be ordered to employ agency workers only from an approved framework of firms.

The executive report submitted to the first joint meeting of Monitor and the NHS Trust Development Authority as NHS Improvement said the price caps so far had had a “positive effect”.

The paper said the “number of shifts exceeding the price caps is 40 per cent lower than the first week of implementation”, which was at the start of December – although this may have been affected by this December being less difficult than December 2014.

Monitor has refused to release any detailed information on the effect of the measures so far but NHS England chief executive Simon Stevens and NHS Improvement boss Jim Mackey last week told the House of Commons Public Accounts Committee the agency bill would hit £4bn for 2015-16.

In an impact assessment published in October, Monitor said the sector was “on trend” for a 2015-16 agency bill 30 per cent higher than in 2014-15, when it hit £3.3bn.

The previous year’s bill was £2.7bn.

The executive report to the joint board on Thursday said the regulators would “require fundamental changes to the way frameworks operate to ensure frameworks enable and control the NHSI capped rates”. Bailout funding will also be made conditional on not breaching agency staff rules.