Following the updated publication of the Agency Staffing Caps on Friday 20th November, HealthTrust Europe is working on behalf of all of its stakeholder partners to support them in finding a viable route forward and deliver transition in partnership. Full details of the Agency Caps and Monitor/TDA guidance can be found by following the link https://www.gov.uk/guidance/rules-for-all-agency-staff-working-in-the-nhs
HealthTrust Europe’s intention is to support stakeholder partners. We hereby outline some guidelines to support a successful direction of travel towards the objective to reduce agency spend. Our guidelines are intended to provide direction to our customer base and support our supply chain to regulate without the need for third party regulation. The comments herein are intended to establish good practice and continuity while reducing any conflict that may arise between parties.
Working with Agency Caps through the framework for those who choose to do so?
HealthTrust Europe does not need to re-tender any of its current agreements to work with the concept of Agency Caps and will not be issuing any immediate framework variations. It remains within the scope of our agreements for parties to work together to reach amicable solutions and we are actively encouraging partnership working.
All framework contract prices are ceiling rates therefore the mechanism to reduce rate is not an issue in driving the overall target to reduce agency spend, it is the core engagement of agency partners and workers to ensure compliance, fill and value are achieved to support safe staffing levels. Notwithstanding the above, we respectfully remind all Trusts that agencies are not legally obliged to meet caps and so any downward variations that agencies do make should in most instances be taken with the good will intended. For clarity, Contract Law takes precedence over the guidance issued by Monitor/TDA therefore unilateral renege or notification of non-payment of existing bookings that do not meet cap may lead to debt claims and withdrawal of services where agreements are in place. HealthTrust Europe does not consider that a “one cap fits all” approach will service the needs of the customer base therefore advocate the local engagement of key suppliers to plan the practical application of agency spend reduction.
In practice, guidelines could mean that customers work with suppliers to:
1. Identify & promote the existing position
Highlight and share which workers are at or below cap to consolidate existing supply and promote the level of compliant behavior that exists. It is worth logging how much below the caps the compliant workers are so that you build a ‘below cap credit’ which can be used to illustrate your net overall position once those above caps are accounted for. Be sure that the reality of your existing position is the same as the documented/contracted position. We have witnessed instances where rates have deviated locally from agreed rate cards and so by getting back to the contracted position the Trust has taken a step towards the cap. Any progress that you can make in such areas, no matter how small, will help build a case for Trusts to be allowed to regulate themselves in future.
2. Increase the compliance to caps
Highlight existing or alternative workers that can be conditioned to go below cap in a demonstrable, time bound manner. While in itself this will not get you completely under the cap immediately, it will put your Trust in a more positive light with regulators than those Trusts who are not moving in the correct direction. Log any savings, no matter how small, that can be achieved to build a case for self-regulation.
3. Generate, log & track savings in the spirit of caps
Review workers that may not be immediately conditioned to cap to develop mitigating actions that can deliver a positive direction of travel and operational savings. (E.g. Evidence that the position on pay or commission has been improved). These rates shall remain reportable to Monitor/TDA under Agency Cap guidance but will demonstrate a clear strategy of spend reduction. Do not discount agencies or workers that on their own will not get you below the cap because every saving made on each of those more challenging workers gets you towards your goal. Even if the reduction is minimal, log it and report the saving. In many instances there will be a noticeable repeatable pattern in the shifts, specialties and bands/grade that fall outside of the caps. Trusts should identify these patterns and build a demonstrable plan to fill these roles through the bank or substantive workforce in priority order of their incremental cost.
4. Break glass & authorisation
You will inevitably encounter shortages on niche areas of supply where demand exceeds the markets ability to fill. In such instances you need to decide if patient safety would be compromised if the shift was not filled. ‘Breaking glass’ is the redefined term for escalation or deviation from the cap designed to promote transparency of inability to hit cap targets. The break glass process will be pivotal in the identification of core safety issues and the modelling of future rate cap ratchets. Rates that break glass will be reportable to Monitor/TDA and subject to review as defined in the Agency Cap guidance. Notwithstanding the fact that instances of break glass have to be reported (and authorised by the Trust board), Trusts should not be afraid to break glass where they need to. The regulators themselves have modelled their savings projections on Trusts needing to break glass 3 times in every 10 shifts they fill, see page 5 following the link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/468469/Impact_assessment_-_agency_rules.pdf The link at the top of page 1 talks Trusts through the break glass process for clarity.
5. Reduce off framework spend
Actively share existing Off Framework supply with key framework suppliers to aggregate supply and generate an action plan for meeting targets through a rationalised supply chain. If off framework issues exists at a Trust, this action will usually deliver the single largest saving within an overarching strategy. Frameworks will continue to offer the most robust route to market to achieve compliance, fill rates and value. By using a reputable framework you will be assured of worker verification and a robust, independent audit service. Keep a record of all spend you have been able to take from off-framework to on-framework as this will prove useful when documenting your direction of travel and successful outcomes.
6. Advocate partnership
Openly engage agencies and work collaboratively with those who are prepared to work to common objectives and vice versa. Having an open door policy on your strategic aims and engaging with those that share objectives will deliver a healthy supply chain that is beneficial for all parties and reduce conflict. Be aware that this is not a broad-brush recommendation to move from higher cost agencies to lower cost agencies. Higher cost agencies often offer a premium service and high fill rates, be aware that you may lose these if you move to lower cost agencies. Work internally to firm up demand forecasts. The longer the period of work on offer, the more attractive the rates most agencies will be able to provide. Partner with neighbouring trusts where possible. Aggregated demand will get agencies to the negotiating table more quickly than stand-alone trust volume.
7. Review the supply chain, processes & controls
Review the structure of your agency supply; can you enhance contracting mechanisms such as Managed Service or Preferred Supplier Lists? Would the use of technology support greater controls at the Trust or are Service Level Agreements suitably tailored to deliver requirements. A tailored approach to your procurement of agency will support the overall objective of achieving spend reduction whilst maintaining a buoyant supply chain. Do not forget that the Agency Cap guidance does not cover all aspects with respect to agency spend reduction, simple actions regarding the amount of time given to release and respond to vacancies will increase your leverage. Consider the use of PAYE workers, unified breaks policies, non-residential on-call discounts, service credits for late cancellation/no shows and offering longer shift worker to generate buy in to rates. Consider if there are value-added tasks being carried out by the agencies that are luxuries you can no longer afford to pay for. Are you reaching levels of compliance that are over and above the required levels and at what financial cost? This is not intended to be a check list of things to review, rather an example of the types of areas that may be worthy of review.
8. Fixed-term and permanent recruitment strategy
Develop a short, medium and long term strategy to agency usage by considering all resourcing options; bridge the gap between your temporary and permanent resourcing teams. Consider the use of fixed-term workers as an alternative to agency whilst developing long term permanent solutions. Review a holistic workforce strategy using national and international permanent recruitment options for substantive positions in all worker groups to recruit to vacancy and reduce the pressure of shortages.
9. Temp to Temp, Temp to Third Party & Temp to Perm Introduction Fees
Please do be aware of regulation around any approaches to transition agency workers to substantive or bank posts without the engagement or agreement of your supply chain. All engagement of agency workers should be fair, proportionate and transparent to ensure minimum exposure to financial risk. A link to further information on appropriate action and timeframes can be found following the link: https://www.gov.uk/employment-agencies-and-businesses/fees-to-hiring-companies-transfer-fees
The guidelines we have offered are intended to support successful outcomes in the project to reduce agency spend and to create a more structured approach to using agency staffing. HealthTrust Europe will continue to assist and support both customers and suppliers in its practical application to tailor requirements and work to mediate solutions between all parties in line with any local strategy.
We encourage local relationships between agencies and Trusts but if you are not already in discussion with us and would like immediate support regarding these changes, please call our dedicated agency line on 0845 887 4976.