Frequently Asked Questions (FAQs)
Why are we making this change now?
Cheshire and Merseyside’s health economy is continuing to face significant financial pressures, which is not helped by the extreme variation in rates that NHS organisations pay for temporary staff. This variation is unwarranted, and by acting together we believe that we can get much better value for tax payers’ money, whilst ensuring safe staffing levels at all times.
Who has been involved in the decision making process?
This process has been led by the Cheshire and Merseyside Health and Care Partnership in collaboration with Chief Executives of the 18 Trusts currently operating in the area. The Trusts implementing the new agency rates on 1st December 2019 are as follows:
- Alder Hey Children’s NHS Foundation Trust
- Clatterbridge Cancer Centre NHS Foundation Trust
- Countess of Chester NHS Foundation Trust
- East Cheshire NHS Trust
- Liverpool Heart and Chest Hospital NHS Foundation Trust
- Liverpool University Hospitals NHS Foundation Trust
- Liverpool Women’s Hospital NHS Foundation Trust
- Mid-Cheshire Hospital NHS Foundation Trust
- Southport and Ormskirk Hospital NHS Trust
- St Helens and Knowsley Teaching Hospitals NHS Trust
- The Walton Centre NHS Foundation Trust
- Warrington and Halton Hospitals NHS Foundation Trust
- Wirral University Teaching Hospital NHS Foundation Trust
The Trusts implementing the new agency rates on 1st April 2020 are as follows:
- Cheshire and Wirral Partnership NHS Foundation Trust
- Bridgewater Community Healthcare NHS Foundation Trust
- Mersey Care NHS Foundation Trust
- North West Boroughs Healthcare NHS Foundation Trust
- Wirral Community Health and Care NHS Foundation Trust
What process has been followed to make this decision?
A significant amount of time has been spent carefully modelling the agency rates that NHS organisations pay across Cheshire and Merseyside, with input from all Trusts. We have used this to identify the benefits of a standardised rate card for each Trust in the area. As well as this, Trusts were invited to provide feedback and comments before a recommendation was made to the Health and Care Partnership’s Collaboration at Scale Board and the Cheshire and Merseyside Provider Chief Executives Forum.
Following agreement in principle in September 2019 to adopt a standardised rate card based on the proposals and benefits, more detailed preparation has been undertaken with the ambition of going live 1st December 2019. An engagement session for Trusts was then held on 13th November, which allowed for further discussions about the benefit of making this decision and any exceptions or extenuating circumstances that required consideration.
Having completed a full assessment, and with the ability to vary when required to assure patient safety is our number one priority, Trusts have agreed to go live with the new rate card on 1st December.
What are the benefits of a standardised rate card for agency staff?
There are a number of specific benefits for Trusts as a result of adopting a standardised rate card for agency staff, including greater transparency and management of temporary staff. There is also a significant financial benefit, with potential savings of over £1.5 million across Cheshire and Merseyside. This money can be better used by investing in our staff retention and development, rather than as margins and profits to agencies.
What is Collaboration at Scale? Why is it relevant to this decision?
Collaboration at Scale is a programme of work led by the Cheshire and Merseyside Health and Care Partnership in which all 18 provider trusts work together to improve the quality and value of our corporate functions and some of our clinical support services.
A national review of corporate services conducted by NHS Improvement found that significantly better use of resources can be achieved when groups of corporate services work together. Adopting a standardised agency rate card is an example of Collaboration at Scale at work.
Our Trust is currently using a rate below the agreed standardised agency rate. Will we have to pay more for agency staff?
No, if your Trust is currently paying a lower rate than the standardised agency rate, you will continue to pay the lower rate. We will continuously review our standardised agency rate in collaboration with Trusts, to ensure that there is as little unwarranted variation as possible. This may result in the rate being lowered in the future, if we find that many Trusts are paying below the standardised rate.
Our Trust currently employs agency staff who are under contact beyond the 1st December 2019. Will their contract be voided?
No, an agreement has been made to honour existing employment contracts using a previously agreed rate. However, any extensions after the 1st December will need to use the new standardised agency rate.
What happens if we cannot fill a shift using the new rates, and there is a risk to patient safety?
We are not expecting 100% adherence in the early stages of adoption. Each Trust will retain the ability to ensure safe staffing, and will be able to do what is required. All we ask is that where possible, the standardised agency rate is used when arranging temporary staff beyond 1st December 2919. Where there is a need to stray from this, we ask that the reason for variation is recorded, so we can begin to understand the , and develop solutions that allow for safe staffing and good use of our resources.
How should we record variation from agreed rates?
As part of this work, we are developing a reporting system to understand compliance with the standardised agency rate. Within this, we intend to use data that is already collected by suppliers for all Trusts. As such, there will be no additional burden on each Trust to record or report variation unless this is something that individual organisations wish to do internally.
Using the collective compliance report, we will be able to better understand notable exceptions to the new standardised rate which will inform future planning as to the use of temporary staff. We can also use the report to assess whether a more ambitious adherence target can be set and to assess whether there are even lower rates that we could implement.
What happens if we don’t meet the ambition of 60% adherence to agreed rates?
The level of adherence will be recorded, along with the reasons for non-adherence, so that Trust Executives, the Health and Care Partnership and NHS England and NHS Improvement can understand and discuss the performance. This will enable us to work together to improve the rate card to support increasing adherence over time. We believe working together to understand the reasons behind non-adherence will help us improve and make this work, which is critical to avoiding the current unsustainable levels of spending on temporary staffing.