Ambulance trusts now subject to NHS caps and controls on agency spend

29 Jun 2016



The final round of caps on agency spend in the NHS are to be introduced to ambulance trusts and ambulance foundation trusts on 1 July.

In what has been labelled an effort to “ease the financial pressure facing the NHS”, the Secretary of State for Health, Jeremy Hunt, announced back in 2015 measures to reduce the use of agency nurses and locum doctors by capping pay rates so that they mirror those of substantive, permanent staff, and by ensuring all procurement is now via an approved framework agreement.

Since that announcement, we have seen caps introduced across NHS trusts and foundation trusts, with mixed results. Nearly eight in ten (79 per cent) healthcare recruitment agencies told us in a recent survey that they are working with NHS trusts who are having to routinely break the caps.

The vast majority (87 per cent) of healthcare agencies also reported that they have really struggled to find staff since the caps were introduced.

Our concern is that these issues are only going to be exacerbated now the caps are being rolled out to ambulance trusts as well.

David Cranmer, MD at specialist healthcare agency, Medicnow, agrees.

“Medicnow specialises in providing paramedics to ambulance trusts. Without properly trained and vetted ambulance professionals available on-demand, we will only exacerbate the pressures on the NHS.

“We want to pay paramedics a good wage and provide a good service to patients, and we would hate to see these caps get in the way of that. Like other parts of the healthcare sector, there is an acute shortage of paramedics and caps and controls on agency pay will only serve to drive more ambulance professionals away from working in the NHS via Medicnow into the private sector.

“The caps will do nothing to reduce the bills faced by the NHS as they will need to bridge demand by engaging private ambulance providers to maintain service levels. Expenditure on frontline private ambulance provision has risen to £68.7 million, more than three times the amount spent in 2011/12, yet this provision will not be subject to these caps.”

It remains unclear why NHS Improvement are extending the caps to ambulance trusts. It is time for NHS Improvement to reveal their data and properly evaluate the impact of the caps that are already in place.

It is not just recruitment agencies who are reporting that trusts are breaching the caps. Following a Freedom of Information request, the BBC reported that the caps are being breahed more than 50,000 times in a week. And in its recent review of NHS Clinical Staffing in England, the Public Accounts committee commented:

“It is unacceptable for the Government to blame staffing agencies for the growth in spending in this area when its own mismanagement is a major contributor to the size of the bills.”

What we need is a more comprehensive approach to control spending in the NHS. Agency spend accounts for less than five per cent of total NHS expenditure. The REC and our members stand by ready to help NHS Improvement and the Department of Health in a root and branch analysis of the future staffing needs of the sector, as experts in workforce planning.

The areas we need to focus on include: making nursing especially a profession of choice to attract new entrants, training up adequate numbers of healthcare professionals each year, and changing internal work processes to retain existing staff.

That is the way to affect real change, rather than through the piecemeal and largely unsuccessful measures we have seen over the last year.

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