Cost of living pushing more staff to ‘off-framework’ agencies

Clinicians are increasingly choosing to join ‘off-framework’ staffing agencies which pay higher day rates, pushing up trusts’ costs, according to information shared with HSJ.

NHS Professionals, which supplies bank staff to around 100 trusts, says inflation and the increased cost of living are driving more people to work for agencies which are not supposed to be used by the NHS.

This is despite the government claiming that eliminating the use of such agencies was a priority.

Trusts are required to bring in agency staff through framework agreements that have been approved by NHS England. But substantial numbers of clinical vacancies, coupled with rising demand, means the supply from sources constrained by the pay cap is soon exhausted.

NHSP says trusts have therefore increasingly had to use off-framework agencies, which are typically more expensive.

Data from more than half of its members suggests off-framework agency spending has tripled in the two years to March 2022. If extrapolated to the whole sector, this would imply spending had risen from £6m to £18m.

However, NHSP chief executive Nicola McQueen told HSJ: “Banks, on-framework agencies and off-framework agencies are all competing for the same talent. There are many in this talent pool that are highly motivated by pay, and this is particularly the case as the cost of living rises.

“Organisations that are constrained by pay caps [NHS staffing banks and on-framework agencies] experience difficulty in flexing pay rates to accommodate these market conditions, which make it much easier for the off-framework agencies, who can, to attract workers.

“This makes it much more likely for shifts to be unfilled by banks and on-framework agencies as the talent pool is attracted by the higher pay on offer by the off-framework providers.”

In December 2020, former care minister Helen Whately told trusts that eliminating off-framework spending was a “priority” and set a target to eradicate it by the end of 2022.

Off-framework spending makes up a small proportion of the total agency bill, which peaked at £3.6bn, before being reduced to around £2.4bn per year (around 4 per cent of the total pay bill) due to the introduction of pay caps and approved frameworks.

In written evidence submitted to the health select committee, NHSP highlighted concerns about trusts’ inability to flex pay caps within the agency management framework “to deal with extreme pressures in supply, such as those being experienced at the moment”.

Its report added: “This has the potential to push supply ‘off-framework’ and lose the benefit of the price caps which the frameworks mandate. This is definitely not in the interest of the NHS.”

The latest NHSE data shows there was a 10.5 per cent vacancy rate among registered nurses at the end of 2021, a slight increase from the same period from the previous year, when it was 9.7 per cent.

The 5.8 per cent vacancy rate for medical staff had also increased from 5.1 per cent.

Miriam Deakin, director of policy and strategy at NHS Providers, told HSJ: “Trusts know they must prioritise the health and wellbeing of their staff who cannot be continually called upon to work extra hours.

“In some instances, they’re having to increase temporary pay rates to try to staff these shifts which inevitably has a knock-on impact on trust finances.”

A Department of Health and Social Care spokesman said: “We know the NHS has been under unprecedented pressure… We have record numbers of overall staff working in the NHS, and there are over 4,200 more doctors and over 12,100 more nurses than last year.

“We also have recently commissioned NHS England to develop a long-term workforce strategy and will set out the key conclusions of that work in due course.”

NHSE was also approached for comment.