Monitor has announced new measures decided to support trusts across the NHS in managing workforce challenges.
According to the healthcare regulator, data acquired by Monitor just last week on Q1 trust and foundation trust financial performance highlighted the need for concerted further action in the coming months and years.
This data indicated that the NHS is likely to face a deficit of at least £2 billion in the existing financial year.
In particular, Monitor has stated that it is important to address workforce challenges.
Thus, it is critical, according to the regulator, to address the rapid growth of spending on agencies, and to develop a more holistic approach to staffing decisions.
With this in mind, the healthcare regulator has announced that it is to take two important steps in order to address the situation.
These have been taken with the support of the national system leaders in the NHS, and it is hoped that this will enable healthcare professionals throughout the system to meet these challenges more effectively.
A joint letter from Sir Mike Richards, Mike Durkin, Jane Cummings, Sir Andrew Dillon and Ed Smith, has already been distributed to NHS employees, setting out Monitor’s view on how providers should approach the need to ensure safe, quality care for patients on a sustained, financially stable basis.
It was also considered important in the content of the letter to reinforce the need to use guidance and best practices in order to support local judgements regarding the best usage of resources.
Following on from this letter, Monitor has been encouraged by providers to take urgent national measures in order to address pay for agency staff.
It is hoped that this would help encourage workers back into substantive roles within the NHS.
Considering this to be an important issue for the health service, the health regulator has just taken the decision to accelerate the timescale regarding this process.
Subject to consultation, Monitor proposes to introduce hourly prices for agency staff across all staff groups, namely doctors, nurses and all other clinical and non-clinical staff.
Subject to the consultation process, the price caps would ratchet down in two further stages so that from 1st April, 2016, agency staff would not be paid any more than the equivalent substantive worker.
The intention is to put this process in place by 23rd November, 2015.
All trusts would be expected to limit and reduce their spending on agency staff over time, and Monitor will continue to work closely with all trusts to monitor and limit levels of agency use across the sector as the measures are implemented.
The proposed price caps have been developed with, and are fully supported by, clinical leaders in Monitor, TDA, Care Quality Commission (CQC) and NHS England.
Clearly action needs to be taken in order to address the huge deficit that the NHS faces, but many critics of government policy will suggest that increased funding would be more effective than cost-cutting, regardless of the legitimacy of these measures.
NHS trusts in the south west of England face continuing uncertainty regarding their procurement of agency nurses.
With a deadline looming for the health service, regulators have still yet to approve plans for the region.
From 19th October, there will be a barring on the usage of agencies that are not approved as part of new framework agreements.
Trusts will still be able to obtain specific approval in order to circumnavigate this regulation, but this could be a litigious, bureaucratic and complex process.
As the deadline approaches, four frameworks have been approved within the English health service.
However, numerous agencies that operate in Cornwall, Devon, Somerset and Dorset are not part of these overarching national schemes.
Trusts based in the south west region continue to collaborate with Peninsula Purchasing and Supply Alliance in an attempt to hammer out an interim agreement.
It is hoped that this can be achieved by the end of the week
Peninsula Purchasing and Supply Alliance is a procurement body representing 14 providers in the Southwest region. These 14 providers in question are as follows:
Cornwall Partnership Foundation Trust
Devon Partnership Trust
Dorset County Hospital FT
Northern Devon Healthcare Trust
Peninsula Community Health
Plymouth Community Healthcare
Plymouth Hospitals Trust
Royal Cornwall Hospitals Trust
Royal Devon and Exeter FT
Somerset Partnership FT
Torbay and South Devon FT
Taunton and Somerset FT
Yeovil District Hospital FT
It is notable that Salisbury FT has stated that it has a contract with a different provider, whose framework for agency nursing has already been approved.
The healthcare regulator Monitor has already stated that it is working closely with the Peninsula Purchasing and Supply Alliance in order to resolve the issue.
In a short statement, Monitor confirmed that it would be possible for trusts wishing to use an unapproved framework agreement or off-framework arrangement to apply to either the regulator or the NHS Trust Development Authority for approval.
Whether this would turn out to be a convenient process for trusts based in the south west region is highly debatable.
It would be necessary for any such trust to demonstrate “how their arrangements provide superior quality and value for money over existing approved framework agreements” if they are to gain approval.
Commenting on the subject, Mark Gronow, director of procurement for the alliance, said its “agency relationship agreements” were set up last year due to “significant use of non-framework agencies within the South West”.
“Given the increased challenges concerning the use of agency staff in light of the agency rules, the PPSA are working with Monitor to ensure that the agreements receive their approval.
“In doing so, the need for individual trusts to apply for approval of arrangements that fall outside approved frameworks will be alleviated. “This is the first step in developing a collective South West agency solution which will secure improved quality, governance and financial savings for the NHS.”
Another new element of the rules involves individual ceilings were set among trusts for the proportion of nursing expenditure to be spent on temporary staffing agencies.
This came into force on 1st October.