Feature / Your flexible friend

While demand for flexible workers is on the rise, NHS Professionals aims to help trusts push temporary working costs in the opposite direction. Finance director Andy Leary explains how the special health authority is meeting the challenge

Service reconfiguration, 18-week wait times and the increasing involvement of the private sector are increasing demand for more flexible, creative workforce solutions from NHS organisations.

A shift to a more contingent-based workforce appears inevitable as trusts juggle the conflicting demands of service delivery and financial spending targets. Going forward, trusts will need to ensure they can match their staffing demands to activity.

NHS Professionals (NHSP) is a national initiative to provide a co-ordinated approach to temporary and flexible staffing in the NHS. Working in partnership with NHS organisations, NHS Professionals provides nurses, midwives, care support workers, hospital doctors, allied health professionals, interim executives and administration and clerical staff with the opportunity to work flexibly. It is the leading provider of flexible workers’ services to the NHS.   

Over the past year, NHSP has seen demand for flexible workers increase by as much as 20% across almost all of its trusts and staff groups. As a result, the special health authority has recorded its largest ever number of shifts filled – in March 2008 the organisation filled more than 175,200 shifts and the monthly average over 2007/08 has been around 150,000 shifts filled.

Indications are that this trend will continue and NHSP expects demand for flexible workers to remain strong for the next one to two years.

It is in the key areas of workforce planning and high quality standards that NHSP is best placed to support trusts in managing their temporary staffing demand.  NHSP is driven by the need to provide a good value for money service to the NHS.

Not only can the organisation help trusts source quality staff recruited to the same or better standards as any other NHS organisation at competitive rates, but it also provides detailed management information to support effective use of existing resources, which helps drive down demand for temporary staff.

One trust to benefit from this innovative approach is Nottinghamshire Healthcare NHS Trust. Associate director of nursing Michelle Persaud says: ‘Prior to the implementation of NHS Professionals, this trust was spending around £2m per year on agency staff and a further £2m on overtime payments. This was a situation that couldn’t continue. We knew we had to become more efficient with temporary staffing and decided NHS Professionals was the best option.

‘One year on, we anticipate savings of £500,000 and we have reduced our agency usage to a few shifts per month.’

Dawn Pike, assistant director of nursing at Central Manchester and Manchester Children’s University Hospitals NHS Trust, shares these views. She adds: ‘Working in partnership with NHS Professionals means we now have a robust structure and process in place to manage our temporary staffing demands and this is delivering results both in terms of savings and quality of staff.’

Increasing the savings
Nursing agency expenditure where NHSP manages the agency relationship has declined by more than 50% in the past two years. This is mainly as a result of NHSP actively recruiting to its bank as well as managing more ‘no agency’ agreements on behalf of its partner Trusts.

This, together with more efficient use of flexible staffing, is delivering savings for its partner trusts. For example, in the first year of implementation East Kent Hospitals NHS Trust reduced its temporary staffing spend by 24%, while South Manchester Hospital NHS Trust cut 40% from its spend.

Since its inception, NHSP has delivered a steady programme of developments to its IT platform and infrastructure to help deliver improved services and to increase automation. It is now close to its vision of a fit-for-purpose, integrated platform that:

• Allows trusts to book and monitor shifts online and have all key management information available when wanted
• Allows flexible workers to maintain their personal data, indicate availability and to book themselves on appropriate shifts
• Allows agencies to view and fill shifts online as appropriate
• Integrates with NHS systems such as Electronic Staff Record (ESR) and NHS  Jobs to capture the value of being part of the NHS – streamlining recruiting and payroll, providing a complete view of employees from a Working Time Directive perspective.

Latest figures show that trusts are logging 85% of their shift requests over the web interface and the percentage of flexible workers who are booking on line is rapidly growing. This, combined with other changes, has led to a significant improvement in the organisation’s productivity.

NHSP is now exploring the concept of full-time ‘contingent’ working for people who want the guarantee of flexible working across a group of trusts. This has encouraged people who previously may not have considered flexible working to apply.

The ability to offer longer term placements is a new way of working from NHSP, but in some areas the organisation can guarantee full-time work for those who want it and who are prepared to work in areas where their skills are most needed.

To support this, the organisation is exploring ways of improving its ability to forecast demand and to use the information to deliver the right options to address workforce shortages. This could include working with partner trusts to provide preceptorship schemes for newly qualified nurses who have yet to secure a full-time role or offering opportunities for skilled and qualified international workers.

It will also provide greater ability to attract people from other locations for interim assignments, which is critical to help mitigate supply/demand imbalances.

The organisation is introducing high-priority initiatives to drive up fill rates:
• Conducting a high-level recruitment campaign in national, regional and trade press based on extensive research into what motivates flexible workers
• Establishing direct links with NHS Jobs to speed up recruitment
• Launching an incentive scheme for flexible workers to encourage them to work more day shifts – a key demand
• Increasing the number of service centre outbound calls.

Recruitment improvements
To support this, improvements have been made to the recruitment processes for the 6,000 flexible workers NHSP recruits:

• Making changes to ensure that time-critical efforts – mandatory training, Criminal Records Bureau, occupational health – run in parallel
• Launching an e-learning system to reduce the delay and cost of mandatory training
• Implementing weekly reporting for each trust that shows the pipeline of recruits.

In addition, the organisation is piloting electronic timesheets, which will further enhance and streamline the service.

NHS Professionals has gone through a period of great change and improvement but it is optimistic about its future. Its focus remains on organisational performance, quality and responsiveness to NHS needs.

Andy Leary is director of finance at NHS Professionals

More details: www.nhsprofessionals.nhs.uk


Improved efficiency
NHS Professionals has made good progress in reducing its operational costs by rationalising the operational processes and improving the service provided to its partner trusts. The support for the business operation from the Department of Health has declined from £20.9m (not including working capital) in 2005/06 to planned support of £9.5m in 2008/09 – a reduction of £11.4m.

Recurrent operational costs                                                                   

                                                        2004/05     2005/06     2006/07     2007/08

Operating Exp £m                        260             296             255             255*     

Net operating expenditure
after income £m                           30               23               19                17*      

Government Financing 
(less working capital) £m           31              20.9            20                 17*      

* Awaiting final accounts audit review and includes £11m in-year major restructuring costs.

Specific actions have been taken to:
• Change and rationalise the organisational structure
• Reduce the estates footprint
• Establish a commercial office function to ensure value for money from negotiated contracts
• Invest in IT systems to improve processes and improve e-based functionality
• Revise the product offering and re-establish customer contact and partnership relationships
• Develop new business and new product lines
• Outsource back office functions.

The above actions and new measures in the current business plan show a continued improvement in financial performance for 2008/09 and 2009/10 and will hit financial targets in 2010/11.


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