The workforce challenges across the NHS are complex, multi-faceted and widely publicised.
The focus on reducing the reliance on high-cost agency expenditure is an integral part of NHS central planning guidance and system-level operational plans. To support the NHS return to clinical, operational and financial stability, Arden & GEM has launched an innovative system-level workforce transformation programme.
Arden & GEM, in partnership with the Greater Manchester Provider Collaborative, delivered a system-wide temporary staffing review incorporating workforce planning, data analysis, systems and processes, and joint procurement and commissioning activities.
An estimated value of opportunity of £53m agency savings has been identified with the temporary staffing review providing targeted mobilisation of high impact deliverables to support benefit realisation. As a result Greater Manchester will be mobilising key workforce recommendations to realise this opportunity.
The challenge
The recovery of health and social care services and the building of system-level resilience is a key national priority across all Integrated Care Boards (ICBs) and provider collaboratives. Running parallel to this challenge is the target to reduce the reliance on high-cost temporary staffing. In 2023/24, ICBs will be measured on their system-level agency expenditure limit. Ambitions are for systems to further aim for a 3.7% expenditure target, although recognising that varying system characteristics may require a phased approach.
The overall aim of Arden & GEMs programme of work was to provide transparency on agency spend at a system level and to deliver actionable insights and recommendations that could support the reduction in expenditure levels in compliance with the NHS England system oversight framework and capability to implement the NHS 2023 ‘agency rules’.
Our approach
The Greater Manchester Provider Collaborative temporary staffing programme ran from January to March 2023. The governance arrangements for this programme comprised of the ICB chief executive as senior responsible officer with the Arden & GEM team reporting directly into the HR directors’ group.
Facilitating a baseline diagnostic
Our change management programme and finance leads facilitated a self-assessment baseline diagnostic of the provider collaborative’s collective system governance and procurement arrangements, control mechanisms and reporting tools - while benchmarking against NHS areas of good practice. This process included a workforce data analysis of temporary staffing arrangements that informed a system-wide view of workforce challenges and opportunities for efficient and sustainable use of NHS resources.
Nine providers from the acute, mental health and community settings were engaged and completed a bespoke set of Key Lines of Enquiry (KLOE).
Delivering engagement sessions
A range of engagement sessions were delivered to capture qualitative data and insights, alongside dissemination of system and trust level temporary staffing related strategies, policies and standard operating procedures. This enhanced collaborative system insights, the sharing of good practice and partnership working.
The programme, while providing a system-level overview, detailed synergies across the provider collaborative on what was working well and how sharing of resources and practices could deliver better value and a reduction in overall spending. Furthermore, actionable insights detailed maximum benefit realisation and laid the foundations of a strategic system-wide action plan.
The outcomes
Our Health and Care Transformation team delivered the final report findings, inclusive of efficiencies relating to the reduction in agency expenditure, to system-wide HR directors. Key areas of focus are in development through a director-level working group, reporting into the ICB.
The final report delivered key areas of consideration for the provider collaborative, aligned to ICB system workforce priorities and offered an NHS specialist consultancy service to support wider system impact. This included sharing what neighbouring systems are implementing, lessons learned and demonstrating the impact of optimal usage of NHS workforce deployment systems. Additionally, the team liaised with NHS England regional leads to offer specific system support where requested, and provided a signposting service inclusive of case studies, insights, tools and information sharing platforms. Through mobilisation of system workforce programme recommendations (aiming to support the 3.7% expenditure target), the estimated value of opportunity is £53 million agency savings.
Next steps
The next steps for Greater Manchester are to mobilise the key high impact areas detailed in their action plan. Arden & GEM is currently exploring options to support the delivery phase via our end-to-end transformation service offer. The programme methodology is applicable to all systems, provider collaboratives and individual providers.
In addition to the Greater Manchester review, we have also delivered this programme with Nottingham and Nottinghamshire ICB and are currently working with Lincolnshire ICB to deliver similar workforce efficiency programmes relating to the reduction of agency staff and mobilisation of interventions to increase workforce bank and substantive resource supplies.
Arden & GEM is currently accepting expressions of interest from health and care systems with a desire to engage with this programme.
For more information, please contact: Mui Wan, Associate Director of Finance & Performance Improvement (Health and Care Transformation).
NHS Provider Feedback
"The team have been very engaged, recognised capacity issues and worked alongside them. They have been a real asset."
"The comparison with other Trusts is helpful to drive internal plans for improvement."
"We have already used findings to inform and check our areas of focus."
"The team are a credit to Arden & GEM."
"We intend to develop an action plan that will be owned through the system’s recovery committee."
"A helpful and friendly process. Over to all in the region now to use this information to help deliver improvements!"
"Helpful, friendly and undertaken in absolutely the right spirit."