Background
Highlighting the potential for transformation within ICB-commissioned services through cross-organisational collaboration, data-driven decision making, and phased implementation of reforms, NHS Commercial Solutions, as part of the NHS Workforce Alliance, led a significant initiative for systemic change in Continuing Healthcare (CHC) Temporary Staffing across the South East.
In December 2023, the Alliance and the South East Temporary Staffing (SETS) Programme, began a project within Continuing Healthcare (CHC) and All Age Continuing Care (AACC). It aimed to reduce rate disparities, optimise resources and deliver better value as well as addressing workforce shortages.
Challenges
CHC and AACC workforces are commissioned at ICB level, where regulation and oversight differ from the provider-led approach used in temporary staffing. National mandates like NHS England’s Agency Rules were not applied at ICB level, leading to low agency engagement, off‑framework use and significant cost variation across organisations.
A comprehensive analysis revealed several systemic challenges including limited supply of highly specialised staffing, allowing the market to set rates, off-framework use,
non-compliant placements and high efficiency disparities.
The project
A CHC workforce subgroup chaired by the Head of Operational Finance at NHS England committed to creating a plan developed by the NHS Workforce Alliance.
Standardised and aligned operations leading to cost reduction opportunities were priority. The Alliance created a pathway for the South East to reduce spend through efficient agency use by introducing agency max commission rates, agency regional benchmarking, agency engagement as well as looking at permanent / international recruitment to reduce reliance on agencies.
Outcomes
Between December 2023 and April 25 annual costs reduced from £7.8m to £0.9m, premium over cap reduced from £3m to £0.4m and off-framework agency use reduced by 32. Throughout 2025 positive progress continued as 100% of positions were brought inside of IR35 and framework compliant, and significant progress was made towards capped rates of all positions.
Going forward, a clear roadmap has been defined which includes consistent data feeds to track usage, compliance, and financial metrics. The roadmap also includes alignment of agency engagement, considering a bank first option, agreeing band and commission structure and continued work towards capped rate for all grades. A national workforce strategy to address retention challenges is also in scope.
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