Agency cost reductions

improve our financial position and reach NHS targets and ceilings

University Hospitals Plymouth NHS Foundation Trust, South West, Acute

The problem

The trust and its finance team needed to manage agency costs, otherwise we would have found our financial improvement plan even more challenging than it already was. It also created increased operational pressure with significant disparity in staff pay. If we did not manage and reduce our agency spend, we would not have met the NHS England agency requirements, including the maximum £8.8million agency spend cap, which we were significantly exceeding at the time.

The challenges

  • How might we reduce our agency costs from £13.2 million so that we might reach the maximum £8.8million agency spend ceiling that NHS England introduced?
  • How might we increase our knowledge of the frameworks, our spend, and agency contracts so that we might decrease our spend while still supporting the circa 200 registered general nurse (RGN) vacancies?
  • How might we resolve our lack of data intelligence on this issue, so that we are able to challenge our agency use and inform our decision making?
  • How might we streamline our agency processes to reduce the time spent on the new increased reporting requirements on agencies?

The outputs

The tangible outputs that came from our innovation were:

  • Reducing our total agency spend from £13million in 2016/17 to just under £6million in 2018/19.
  • Theatre enhanced pay reduced agency usage from c500 shifts per month in March 2017 to c100 shifts per month in 2019.
  • We designed a bank incentive based on worker utilisation factors – we increased nursing bank hours by c10k per month over the winter, which avoided a use of high-cost agency staff during this period.
  • In our ICU, we have been agency free since January 2017. Largely nursing agency free since 2020.

Not clear what this covers. Can’t be in the ICU as that has been agency free since 2017.

The outcomes

The benefits to the organisation because of the innovation were:

  • we created complete visibility of nursing agency spend and usage
  • a reduction in agency use which saved multiple departments’ time as there is now less processing required
  • we have now got more data intelligent thanks to the use of NHSP, Allocate Healthroster and PlusUs. This increased data intelligence has allowed us to continually review our agency use.

The Innovation

Read the full innovation on achieving agency cost reductions

All the documents and resources relating to this innovation can be found in the downloads section at the bottom of the page.

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What the peer-reviewers said

“This innovation clearly evidences the benefits of efficiency delivered through business intelligence and greater use of systems and technology to plan and better utilise human resources”

“This was a really good piece of learning which will enable other organisations to learn from”

“This innovation demonstrates a different way of working to address a joint problem of reliance on temporary workforce, which in itself has a number of risks”

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Here are all of the documents and resources related to this innovation

Innovation P4

Achieving agency cost reductions to improve our financial position and reach NHS targets and ceilings


Supporting evidence P4

Managing Agency costs presentation – Powerpoint