Northamptonshire’s NHS spend on agency staff predicted to hit almost £50m this year
Board meeting conversation reveals the issue in Northamptonshire is worse than in other areas
By Sarah Ward
“The county has a more substantive workforce than it has ever had before and the agency is higher than it has ever been before. And we are delivering less activity across the board.”
Spending on agency staff across the county’s three NHS trusts to fill vacant posts is hugely over budget, with the figure projected to hit just under £50m.
Just five months into the financial year the county’s integrated care board (ICB) has reported the NHS trusts that run the county’s two general hospitals and the mental health and community services have spent £20.7m on agency staff and predicts that amount will have reached £49m by next March.
The target for the year set by the NHS England is £32.2m, meaning the agency spend could be £17m over budget if it carries on at its current rate. Last financial year the NHS hospitals and community services spent £46m on agency staff.
Staff vacancies, sickness and a retention problem are a big part of the issue, but at the latest board meeting, two board members made the suggestion health system bosses are not being realistic about the issues and there is also a productivity issue in the county.
Chair of both hospital boards, Alan Burns, told the meeting during a discussion of the financial position:
“I think there is a mindset problem here which is that the money is less of a problem than the other major targets . I’m not convinced that is still the case. Every time we talk about this we tend to get to the position, where, ‘it is what it is and that’s kind of alright’. “Because we have all these explanations. But actually it feels to me that we are beginning to cut adrift from the pack a little bit and I think we need to recalibrate to a sense of where the biggest risk to us and our patients sit.”
The ICB’s chief finance officer Sarah Stansfield concurred with Alan Burns and said local NHS leaders needed to challenge themselves on the narrative. She said while there was a significant challenge around the amount being spent on agency staff, she did not think the ICB was at the point where it was an outlier, but changes did need to be made.
She told the board, which included the chief executive of Northamptonshire Healthcare Foundation Trust Angela Hillary:
“There is a little bit of challenging ourselves we need to do. So what I’m about to say is going to be unpopular.
“The county has a more substantive workforce than it has ever had before and the agency is higher than it has ever been before. And we are delivering less activity across the board. I know that’s uncomfortable and I can’t describe an acceptable answer.
“But we do need to challenge ourselves therefore on some of the rhetoric we are using. Demonstrably from a numerical point of view, workforce productivity is one of our biggest challenges. The numbers of workforce [sic] is not one of our biggest challenges but the productivity issue is significant.”
In response Angela Hillary agreed there was a significant challenge and pointed to the pressures the cost of living was adding to agency spend . She said recent conversations with staff had led her to conclude:
“People are satisfied with the work, but the cost of living is driving them out to agency. Because that is what they need to do to support their families. It is bigger and it is different to what we’ve experienced before. We’ve got to do more on that.”
She also said agencies were increasing their prices due to market factors. (Read a recent BBC report on this issue).
The ICB was set up this summer and replaces the former clinical commissioning group (CCG). The ICB is the NHS organisation responsible for developing a plan for meeting the health needs of the county’s population, managing the NHS budget and arranging for the provision of health services in the ICB area. Its chief executive is Toby Sanders, who was also the chief executive of the former CCG.
Toby Sanders acknowledged that the Northamptonshire health system was in a ‘really difficult position’ regarding agency spend but did not put forward any solutions. He said the board needed to make some space to look at the issue more closely.
Last week members of the Royal College of Nursing voted for the first time in the union’s one hundred year history to go out on strike. The nursing workforce, which worked under extreme conditions throughout the Covid pandemic, is calling for a wage increase linked to the cost of living and better terms and conditions.
The government has not reached an agreement with the RCN so members will go out on strike during the coming weeks. Nurses at Kettering General Hospital will strike, but the threshold was not met at Northampton General Hospital.
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