Agency and NHS Improvement James Mackay Head of Workforce Efficiency 14 April 2016
Today I will cover Context Agency rules Workforce improvement 2
NHS Improvement s approach to agency Agency rules Delivered through the regulatory teams formerly in TDA / Monitor Regional teams Eyes and ears of the organisation manage relationships and delivery with trusts Provider sustainability Supporting short-term operational improvements, longer term sustainability solutions and leadership development NHS Improvement Nursing directorate Lead on workforce policy and improvement issues 3
Is based on two approaches Agency rules Delivered through the regulatory teams formerly in TDA / Monitor Regional teams Eyes and ears of the organisation manage relationships and delivery with trusts Provider sustainability Supporting short-term operational improvements, longer term sustainability solutions and leadership development NHS Improvement Nursing directorate Lead on workforce policy and improvement issues 4
Regulation: agency rules implementation 01/09/2015 Trusts sent annual ceilings for agency nursing staff 01/02/2016 Agency price caps reduced 01/04/2016 Trusts required to procure agency staff via approved framework agreements 15/10/2015 Price cap consultation launched 23/11/2015 Price caps and reporting implemented 01/04/2016 Further reduction in price caps 19/10/2015 Nursing framework rule takes effect 13/11/2015 Price cap consultation closes 01/04/2016 Annual ceilings to apply to all staff 5
How we collect and collate your data Wednesday Thursday Friday Monday - Tuesday Trusts submit weekly monitoring template (Noon deadline) Deep dive information submitted (9am) Agency Monitoring Panel reviews report and agrees actions for next week Regional leads mobilise teams to address the weeks actions Data processed and monitoring reports generated Agency Implementation Group reviews report and actions and cascades to regional teams Safety and governance issues follow up begins 6
How we review your data TRUST DETAILS IN WEEK PRICE CAP OVERRIDES PER WTE (% SHIFTS) 4 WEEK AVGE IN WEEK RANK 4 WEEK RANK NURSING FRAMEWORK OVERRIDES (% SHIFTS) IN WEEK 4 WEEK AVGE IN WEEK RANK 4 WEEK RANK NURSE AGENCY EXPENDITURE CEILING, % (January 2016) IN MONTH YE TARGET # GOVERN ANCE ISSUES IN WEEK SAFETY & PATIENT EXPERIENCE ISSUES SERVICE CLOSURE(S) FLAGGED PATIENT SAFETY ISSUE FLAGGED QUALITIATIVE IMPACT EFFORT TO FILL SHIFTS HELPFU LNESS A B C 7
and then use it for decision making Agency Monitoring Panel Meet weekly to discuss level of overrides and impact on safety and quality issues Engagement from CQC and NHSE Discuss regional trends and high and low performers Provide governance overview Agency Implementation Group Operational action implementation meeting Reviews monitoring report and actions passed down from Agency Monitoring Panel Actions cascaded to regional teams Shares soft intelligence Informs communications plan Shares best practice 8
What the high level picture tells us Financial savings and number of overrides moving in the right direction Board engagement needs strengthening Data quality improvements required Soft intelligence is vital. Series of workshops with trust executives scheduled over next 6 weeks. 9
But some issues remain Poor data quality Gaming Misinterpreting the rules Inappropriate application of the break glass clause 10
Workforce Efficiency Team focus Facilitation and process mapping Programme Management Support Workforce Efficiency Team Diagnostics Sharing best practice 11
We typically start with diagnosis... This tool focuses on five areas/domains that we need a good understanding of as we engage with trusts on understanding the root cause of the agency problem and decide ways. 2.Technology 3.Controls and information 1.Leadership 4.Staff engagement, recruitment and bank 5.Procurement 12
and tailor the approach to suit your needs Advisory support Offered to trusts requiring initial guidance in identifying areas for improvement. It includes the deployment of the agency diagnostic toolkit, knowledge sharing and provision of some advice as required. Light touch + Light touch builds on the advisory support offering and is provided to trusts requiring external facilitation to understand and analyse and respond to the current situation. Intensive support This level of support provides the full range of capabilities. It includes in depth review of challenge areas, programme management support for implementation and rigorous monitoring to ensure that improvements are embedded within the organisation. 13
Other support includes... Webinars Reducing use of agency staff: Identifying issues in your trust Effective rostering Agency controls Workforce Innovation Top tips E-rostering Bank use Retention and recruitment Other Support Eg executive/ improvement coaching, OD review for workforce transformational plan etc. Advocacy at national level e.g. MAC 14
The Workforce Efficiency Team can be contacted at NHSI.Workforceteam@nhs.net