Managing the Flexible Workforce Webinar 28 February 2011

1. Managing the Flexible Workforce Webinar 28 February 2011 Peter Hall, NHS Equality Delivery Team

2. Quality, Innovation, Productivity and PreventionTwo-pronged approach to the QIPP Programme: Working smarter not harder doing the right things in the right place in the right way at the right time To drive out inefficiencies from the way system currently deploys staff To create improvements in the way in which services are delivered. • Quality • Fundamental cultural change in the NHS that has held the view that improving quality automatically means higher costs. • Preventative • improve health as well as sickness services, with more emphasis on prevention, earlier intervention and standardised care based on proven methods. • People-centred • integrated services designed increasingly around patient needs. • Productive • whole scale transformation of healthcare systems to ensure we raise all to the standard of the best. • decommission relatively ineffective interventions • shift care into more cost effective settings, normally closer to home • drive quality and cost improvements in all providers • reduce variability

3. The challenge Change in real current spending “We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014 – between £15 billion and £20 billion across the service over the three years.” (David Nicholson, The Year, May 2009) Secretary of State has been explicit that every penny saved will be reinvested back into patient care.

4. Action to meet this challenge will be needed at every level of the system 1 integrated planning process for the NHS National action – 13 national workstreams provide additional support to the NHS Regional action – SHAs coordinate action and creating integrated plans Subsidiarity Local action – local commissioners identifying opportunities and commissioning to improve quality and efficiency QIPP – driving up quality and driving down costs Current NHS Future NHS QIPP is the bridge between where we are now and the future changes laid out in the Health and Social Care Bill

5. Agency Costs QIPP Targets QIPP plans to reduce spend on agency (non-NHS staff) to 2008/09 levels of at least £1.4bn by 2013/14. This equates to an efficiency saving of approximately £500m against a 2008/9 baseline or £800m applied against the total spend in 2009/10 of £2.2bn. • Programme Aims • Agency spend is reduced and managed as efficiently as possible whilst maintaining high quality services. (Agency spend necessary in order to deliver high quality services locally). • If used in an unplanned way, agency spend can be expensive and will not deliver value for money for the NHS and taxpayers. • Concerns amongst some staff representative bodies addressed via engagement through the Social Partnership Forums. • Efficient and planned use of Agency resources, will free up resource for investment elsewhere. • The lack of progress towards reducing spend means this is now a high priority.

6. A National Mobilisation Programme Mobilisation Programme to be delivered through NHS Employers over the next 12-18 months • The Mobilisation Programme • will have 3 dimensions: • High Impact HR Actions including support tools • Review and re-shape of National Contracts • Communications and engagement strategy • Systematic approach to delivery, • guided by the three domains of quality: • safety, • effectiveness and • patient experience. • Each region to establish an ‘Agency Cost Leadership’ group. • Develop a local plan shared nationally with others through WLG. • Regional groups feed into, the National Mobilisation Programme to share learning and best practice.

7. HR High Impact Policies & Engagement Strategy High Agency spend is linked to a range of inter-locking HR policies and actions. Early products from the programme include: Benchmarking tool Workforce (both substantive and temporary) at specialty level within Trusts. ‘5 High Impact Changes supplemented by 5 subject specific High Impact Changes: E-rostering, improved financial reporting, establishing internal controls. Learning Clusters NHSE will work with 3 clusters on trialling the High Impact Changes. ‘Academic, Industry Body and ‘think tank’ evidence collated and built into the Learning Zone, so that good practice from other sectors can be used by the NHS. ‘Good Practice Case Studies 20 NHS good practice case studies will be delivered by end July 2011. Published on the Agency Good Practice Learning Zone. Agency Good Practice Learning Zone (part of the NHSE website). • The Engagement and Communications strategy will aim to: • Raise the issue up the agenda of NHS Leaders across the system; • Champion and explain what works, where and why; • Generate debate as a means of encouraging performance improvement.

8. Is this programme helpful? What would you not do? What else might help? Your Say Slower? Faster? Grander scale? Concerns?

9. National Framework Contracts • National Framework Agreements (Buying Solutions) cover four main temporary staffing groupings below. • Spend on the national frameworks in 2009/10 was £706m,which represents 32% of the reported £2.2bn • Evidence from NHS Scotland’s experience, suggests suitably tailored contracts could make significant savings. • medical locums, nursing, AHP & HSS staff, non-medical and non-clinical staff. • National Framework Contract usage (32%) is low because: • awareness of National Contracts is low • lack of internal controls by employers when booking Agency staff • alternative deals are developed locally by employers • national frameworks don’t meet local customer needs • local planning is not being done effectively to make best use of National Contracts • To address this issue we propose to: • review the current national contracts, • establish a Buying Solutions Senior Customer Board, • ‘sell’ and promote usage of National Frameworks and create case study evidence of the efficiencies and improved quality which have been achieved.