New data suggests agency price cap is working

According to the data from Monitor, the total number of shifts breaching the price caps set last year dropped by 40 per cent between the weeks starting 23 November and 28 December. The total number of shifts dropped from 35,662 to 21,277 (see chart below).

However, an expert warned it is difficult to draw conclusions from the data and called on Monitor to publish ward level information.

The largest drop occurred in the qualified nursing, midwifery and health visiting group, which fell by 47 per cent from 14,913 breached shifts to 7,848.

The number of medical and dental shifts that breached the capped rates fell by 23 per cent, from 10,358 to 7,944.

Allied health professionals fell by 43 per cent; health science staff dropped 19 per cent; and support staff such as healthcare assistants fell by 22 per cent.

Hospitals are allowed to breach the new price caps if they satisfy exceptional circumstances criteria, including ensuring protection of patient safety.

HSJ reported yesterday that more than a quarter of trusts asked Monitor to raise their ceiling on agency spending last year.

Monitor would not answer HSJ’s questions on the total number of agency shifts there were in the NHS during the six weeks to allow a comparison of the overall proportions, nor did it supply data for the first weeks of 2016. It was too early to say how much money has been saved by the policy, which the Department of Health estimated would lead to £400m in savings.

HSJ understands Monitor intends to publish more substantial data on the implementation of the agency caps in coming months.

Sally Gainsbury, senior policy analyst at the Nuffield Trust, said: “We don’t know what the baseline for this data is. What we really need to know is how these reductions, whatever they are, have been achieved. Is it through converting agency staff to substantive or bank? If so, fabulous. Or are they being achieved through reducing agency rates? If so the caps have done their job.

“The problematic one is are they being achieved by hospitals opting not to fill gaps in rotas, if that is the case this would be a real cause for concern.

“We need Monitor to publish detailed ward level data to reassure the public and staff that patient safety isn’t being compromised.

“If Monitor want to convince people that the caps are working we need to know that not only are hospitals spending less money on agency staff but also still maintaining quality and patient safety.”

Monitor chief executive Jim Mackey said: “The measures we’ve introduced to drive down the cost of agency staffing in the NHS are having a positive impact. Now we need to keep up the pressure.

“Staff who work through agencies or as locums need to realise that the market is shifting. In future, they will be better off seeking substantive employment within the NHS and picking up extra shifts through staffing banks rather than relying on the high rates paid by agencies.

“This is still a seller’s market with the NHS on the losing side and while agency staff can be vital for the NHS, their overuse is unaffordable and unfair on other staff not working an agency shift.”

The agency cap came into force in November and set the maximum total hourly rate that trusts could pay for agency workers. Initially the level was set at 55 per cent above basic pay for non-clinical staff; 100 per cent for nurses, clinical staff and consultants; and 150 per cent of basic pay for junior doctors.

On 1 February the price cap will drop to 100 per cent for junior doctors and 75 per cent for other staff. On 1 April it will drop again to 55 per cent of basic pay for all staff.

This rate includes money payable to the agency, so workers will receive less than the headline rate.

NHS trusts are only able to source agency nurses from approved national frameworks with fixed prices. From 1 April these rules will be extended to doctors and other staff.

The changes were brought in to tackle overspending by the NHS on temporary staff. NHS leaders said last week trusts will spend £4bn on bank and agency staff in 2015-16.