Background
Sussex Partnership NHS Foundation Trust (SPFT), like many providers of mental health, learning disability and neurodevelopment services, faced mounting workforce pressure in the years following the pandemic. Demand for services continued to grow but recruiting and retaining permanent staff remained difficult, especially in a broad and complex geography already known for workforce shortages.
As a result, the trust relied heavily on agency workers to fill gaps. In 2022 to 2023, SPFT spent £27.8 million on nursing agency staff, with 11 percent of usage off-framework. The trust needed a way to bring costs down without compromising safe staffing or care delivery and looked to work closer with their existing partners the NHS Workforce Alliance – a national collaboration of NHS regional procurement hubs and Crown Commercial Services – who specialise in workforce expertise and support.
Objectives
A Lead Category Manager from the Alliance worked alongside SPFT to design and implement a practical, trust-wide solution that would help regain control of agency spend while maintaining continuity of care.
In close collaboration with the trust’s temporary staffing team, both parties looked to create a revolutionised tiered cascade model that completely reshaped how agency supply was sourced and managed.
The Alliance’s role focused on the following key areas:
- Completing significant data analysis to understand the position of supply and rates, which was used to support the design of a new agency tiered cascade system. Agencies that agreed to NHS-capped rates were prioritised. Higher-cost agencies were used only when necessary.
- Guided and facilitated the trust to build stronger supplier relationships, ensuring KPIs were agreed and delivered.
- Introduced a fairer system where longer-term bookings and earlier access to shifts were offered in return for lower rates.
- Helped bring teams together across workforce, finance, clinical operations and procurement so that staffing decisions became more informed and joined up.
- Encouraged oversight processes, including a daily control panel and a weekly steering board, to monitor shift fill, spending and problem areas in real time.
- Established future planning to continue the reduction of rates and enhancing positive supplier relationships.
The goal was not only to reduce costs but to build a smarter, coordinated staffing model that SPFT could manage long term.
Challenges
SPFT’s situation was complex. Mental health roles are difficult to fill, and many of the usual recruitment strategies were not effective.
Historically, different functions of the trust supported the temporary workforce pool including operational teams, procurement, the workforce team managing an internal bank and rostering, and finance looking at agency spend. The challenge therefore was to develop a more collaborative approach to join internal departments to reduce agency spend.
Outcome
- In the first three weeks, weekly agency costs dropped by £133,000
- £5.6 million in savings on nursing agency spend in just one year
- Annual spend on agency staff reduced from £27.8 million to £22.2 million
- Annual spend on agency staff further decreased to £12.8 million in the following year
- Off-framework usage eliminated entirely
- More shifts were filled at Band 5, reducing dependency on higher-cost Band 6 roles
- The changes were implemented with no disruptions to care or service delivery
Following its success, the model has been shared with other NHS organisations across England and is now seen as a national example of how trusts can control and manage agency costs and improve workforce collaboration.