Feature / Well placed

E-rostering offers trusts a chance to deliver more effective staff management, reduce temporary staffing costs and create back office efficiencies – all of which will help improve morale among clinicians. Seamus Ward logs on

Control over workforce costs, particularly temporary staff costs, is one of the holy grails of NHS management. In recent years permanent staff numbers have increased and temporary staffing costs have fallen as the health service has tried to control bank and agency spending by setting tougher rules for their engagement, However, temporary staff costs remain a significant issue.

The key to greater control over staffing costs is to ensure best use is made of existing permanent staff when planning ward rotas or rosters. This can be a daunting task, yet most ward managers create rosters using a paper spreadsheet. The National Audit Office (NAO) and an increasing number of trusts recognise this is no longer sustainable and that technology must be used to get to grips with temporary staff spending.

In its report on temporary staffing in the NHS in 2006, the NAO found that the NHS had reduced temporary staff expenditure from 10% of total nursing spending in 1999/2000 to 9.4% in 2004/05. While some trusts were spending as little as 5% of their total nursing spending, others spent as much as 29%. It urged trusts to improve these figures by moving to electronic rostering.

Rostering challenges
The difference between paper and e-rostering is stark. As they begin to put together a roster (typically for four weeks), ward managers will know how many members of staff and the skill mix they will need for each shift. Then they have to take into account absences for sickness, maternity, study and annual leave and working time regulations. An additional layer of complexity is added by NHS flexible working policies and the need to be fair to all staff. No wonder ward managers report that it can take them a day or more to create one roster on paper.

E-rostering offers a quicker and more equitable alternative that should reduce temporary staff costs by making better use of permanent staff.  There are several systems on the market but typically they allow each ward or department to set rules such as nurse numbers, skill mix and temporary staff protocols. Using computer terminals in the ward, or sometimes over the internet from home, nurses can then request particular shifts, which can be accepted or rejected by the ward manager.

Once all the requests have been made, the manager can complete the roster, if necessary by moving nurses to different shifts, and see where temporary staff are needed. The time spent completing the roster is dramatically reduced – in most cases down to a few hours.

Andrea Hester, head of employment services at NHS Employers, says the savings generated depends on each trust’s starting point – those with greater control over their agency and bank costs will have less to save than those with less control.

Trusts are beginning to put figures on their savings. Clare Edmondson, director of workforce development and human resources at the Royal Berkshire NHS Foundation Trust, which uses Powertec’s Optimize e-rostering system, says savings through e-rostering has been the single biggest item in its cost efficiency plan this year. ‘Optimize has helped us to deliver in excess of a £1m saving on our pay bill, largely in nursing costs, and bearing in mind we only started half way through the year, Optimize has undoubtedly exceeded our expectations,’ she adds.

Tony Ive, managing director of Powertec, claims that trusts would save as much as 50% of their temporary staff spending in even the most efficient wards.

E-rostering systems also interface with the new NHS human resources and payroll system, the electronic staff record (ESR), helping ensure payslips are accurate. Manpower Software, which provides its MAPS Healthroster solution to 37 trusts in England and Wales, has checked the accuracy of staff pay and found discrepancies of up to 80%.

‘At almost all the trusts we are working with every staff member is asked to record the enhanced hours they have worked in the last month,’ says Manpower Software’s head of healthcare, Paul Scandrett. ‘That can be a laborious process – they have to remember when they worked and then interpret this into what enhancements are due. This has to be checked by the ward manager. But we know when staff have worked and automatically calculate the enhancements and link directly to ESR, passing all the enhanced hours information directly to it, ensuring accuracy is increased.’

Not just about savings
It is understood that the Department of Health will introduce charges for the use of the ESR/ e-rostering interface from this April. This has worried some suppliers but Mr Scandrett believes it will be a ‘small charge that will just cover their costs’ and will not hamper the introduction of e-rostering.

NHS trusts and the companies that sell e-rostering packages are quick to point out that the initiative is not solely about saving money. E-rostering can help ensure that appropriate and safe staffing levels are maintained on wards at all times. 

‘The main reason to adopt e-rostering is to manage more effectively the peaks and troughs of your staffing demand and to plan for when you have gaps. It doesn’t eliminate totally problems of people not being available – staff will go off work at short notice, for example through illness. But it is effective as a long-term planning tool,’ says Ms Hester.

There are other, less tangible, benefits, including reduced absence and improved morale. ‘E-rostering is about replacing subjective with objective,’ Mr Scandrett says. ‘Flexible working makes life difficult for ward managers but the system can put in a framework around how many requests for particular shifts nurses are allowed to have over a given period. This gives managers the objective means to manage their teams.’

Whether it is a management tool, a vital element of cost reduction plans or even a morale booster, e-rostering has many strings to its bow and the NHS is taking note.


Salford targets safety and efficiency
Salford Royal NHS Foundation Trust had two aims when it decided to introduce an e-rostering system 12 months ago: to cut its temporary staffing costs and to ensure wards had safe levels of staff at all times.

Stephen Kennedy (pictured), the trust’s deputy director of finance, says it has sought to reduce its spend on temporary staff, particularly nursing staff, for years. ‘With agency staff there is a profit component so for every pound spent on agency nurses, 25p, say, is disappearing on paying for something other than the nurses themselves. If you spend £1m, that’s £250,000 poured down the drain.

`The trust has tried a number of ways of reducing agency spending, including allowing wards to have an establishment that gives them some flexibility and cover for sickness, holiday or study leave. While the tactic helped reduce spending on temporary staff, it did so only up to a point before ‘coming to a grinding halt’, he adds.

‘Savings levelled off for two years or so – we had reduced costs by 20%, but then we stuck at that level no matter what we did. We had policies about how and when to bring in temporary staff and what to do when people are on maternity or sick leave, but we believed compliance with a number of these polices was patchy.’

The trust’s paper-based system did not help. ‘It’s subjective and nurse managers can apply the rules differently because it’s a paper-based system. It is very difficult to be able to make sure you get compliance with policies on an ongoing basis.’

Around 18 months ago the trust began looking into e-rostering, starting with a trial, which was part of a pilot initiated by the strategic health authority (NHS North West). In early 2007/08, the trust opted for the SMART rostering system, which Mr Kennedy says offered the trust the best value for money.

He adds that the trust is working out how much it has saved in financial terms but is confident that the benefits are material. He insists savings will not happen in ‘a massive blinding flash of light’  but occur through strict adherence to protocols. For example, if a nurse on a night shift hands over to the day shift at 9.15am, they are paid more because any time worked after 9am is paid at enhanced rates. They will be paid at a lower rate if protocols are applied and the hand-over occurs at 8.45am.

The trust set up a project team, which assessed rostering policies on each ward and came up with rules on staff numbers, skill mix and policies on the use of temporary staff. Although around 90% of nursing staff are now on the system, he admits implementation took longer than anticipated. ‘Some of this was due to us underestimating what was required to implement the system in the way we wanted it to be,’ Mr Kennedy says.

‘We had to spend time thinking about how people were working, whether it was appropriate and how you staff a place like the intensive treatment unit,’ he adds.

Salford is looking at extending e-rostering into its facilities directorate, which includes staff such as porters and domestics. In the longer term it hopes to develop the information from rostering for use in service line reporting and management.


Rostering gains: South Devon healthcare
Although South Devon Healthcare NHS Foundation Trust has relatively low sickness levels and temporary staff spending, it has been in the vanguard of trusts implementing e-rostering.

Paul Crocker, the trust’s chief business analyst and head of management accounts, says a number of objectives drove the implementation of its e-rostering system. Among these was improving clinical governance (by being able to prove the right staff were being employed in the right place) and management reporting, as well as reducing spending on agency staff and making better use of bank staff.

It started using HMT Systems’ Rosterpro in December 2006, initially introducing the system to 1,200 users across 14 wards. A scoping survey of each ward’s staffing and rostering needs was carried out before they moved onto Rosterpro to gather details of skill mix, shift times and individual staff members’ working time agreements – term time only working, for example. These were then built into the roster template. Rosters are prepared around four to six weeks in advance and members of staff are given a window to request particular shifts.

At the same time, the system automatically allocates shifts to use up staff members’ available contract hours. If too many nurses request a particular shift, the system uses a scoring mechanism to make a decision. Ward managers can post shortages directly to the trust’s bank office for filling.

Mr Crocker says the system has helped reduce temporary staffing and total nursing costs, though some wards will need more support to get the most out of the system. Temporary staff costs fell by £350,000 over the 15-month implementation period. ‘Total nursing expenditure decreased by 1.42%. This is closer to 4.8% in real terms, once pay inflation and incremental drift has been taken into account,’ he adds. ‘Whilst the total savings might not be totally attributable to Rosterpro, these are impressive statistics and, from a financial perspective, provide strong evidence to continue with the project.’

The trust’s executive board has now given the go-ahead for phase two, which will see time and attendance data interfaced with the ESR. Mr Crocker adds: ‘We have learned lessons from the implementation – for example, not to be too ambitious initially with the roll-out and to maintain a consistent level of implementation resources throughout.

‘As well as a full-time project manager, it’s important to have significant input from finance, payroll, IT, senior nurse management and recruitment. Some staff are still nervous about IT and so they need additional one-to-one training to boost confidence prior to going live.’

The trust is also developing a management dashboard with HMT to show the cost of rosters against budget in real time, with a traffic light system highlighting any potential overspend. Mr Crocker has also worked with the firm to develop key performance indicators’ and matrons’ dashboards that will give monthly reports on, for example, budgeted performance risk rating.

Sam Elleray, a ward manager at the trust’s Torbay Cardiac Centre, says paper-based rostering was stressful and time-consuming.

‘I would dread coming into work after the duty went out as I would find a mountain of Post-Its on my desk from staff who wanted to change shifts or could not do the shifts that were allocated to them. This would be very disheartening considering that the rota could take a whole shift – 7.5 hours – to complete and I would inevitably take it home to finish.’

The move to Rosterpro has had an immediate, positive effect. ‘The rota now takes me only a few hours to complete and I am sure that time will be reduced. The Post-Its seem to have vanished from my desk and staff are very positive about their shifts,’ says Mr Elleray.