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Back in 2009, we developed a concept where one Hospital can share its surplus contingent workforce with participating organisations and in the process, reduce the demand on agencies. An additional benefit was that the supplying organisation is rewarded with income for the service provided and the customer saved in the region of 25% on the cost. The worker also benefited from a good pay rate, fast payment, first in line for consideration and no hassle.

Over the same period, Direct Engagement as a concept played a vital role in saving a Trust cash without cutting back on services. Fast forward 12 years…The NHS is a different beast than what it was 10-15 years ago. Still a beast but with different needs so we to need get back to basics and try and establish what this beast needs today and what can we anticipate over the next decade.

Outsiders looking in often have an opinion about waste in the NHS or opportunities to save costs and since more than 70% of the total NHS bill is people cost, it is natural to want to start there. I often feel agencies take the brunt of the blame and yet, if you compare their income and operating cost associated with recruitment, compliance, and transactions- their net operating margins are far less than providers of consulting services, consumables, products etc. They do provide an incredible service and one must recognise their role in mobilising a fractious workforce.

So where should providers and commissioners invest their energies?

  1. Training

Over an above the known issues on poor attrition rates or people leaving the sector once they are qualified is people leaving the country after the government spent tens of thousands of pounds training a doctor or a nurse. (travel restrictions has had a positive impact but that will not last forever)

By delaying the graduation after the completion of a 2 years of service might slow down the departure as long as it does not lengthen the qualification process. More needs to be done to entice professionals to want to stay.

  1. Collaboration

For the next 3-4 years, the NHS will be playing catch-up in clawing back the surgical waiting list, whilst still maintaining the current requirement. All Trusts are constrained by physical capacity; resources (surgical teams) availability; recovery and rehab capacity. We need to develop different solutions that gives better regional visibility over resource and physical capacity and distribute reward within the NHS marketplace. To merely outsource the low-risk patients to expensive private sector providers should be the very last option. In many cases, it will be NHS doctors and nursing staff that will be performing the procedures.

  1. Mobility

We see the need for a digital passport as an enormous step forward in mobilising the workforce. Whether it is done through a lead employer structure or a central employer with unlimited secondment arrangements, technology makes this possible. Cost savings aside, it removes enormous barriers for fulltime and part-time employees who would love to continue their career as a valued member of the NHS community.

  1. Automation and Augmentation

Based on interviews, we found that a significant proportion of front-line staff are taken up by admin that could be automated or at least, semi-automated to reduce the time spent. The sad thing is that people unconsciously fill up their time with admin. Even though they hate it. Automating a process to give clinicians and medical staff their time back should be reflected in their job plans. i.e. less sessions allocated to admin and more in direct clinical care.


In practical terms, how can we increase the utilisation of our workforce through collaboration:

  1. Know your workforce- the digital passport should give us an instant view (skills audit) over the demographics of our workforce.
  2. The Shelford group are making headway in designing staffing combinations based on dependency and acuity.
  3. The ability to view and act on moving resources around internally (frictionless) is key to reduce the demand on contingent resources.
  4. The ability to make shifts available to collaborative organisations and deploy under-utilised resources in different settings.
  5. Change the mindset of our wider complementary/ contingent resource pool. By reducing the transaction cost and making it more efficient for workers to take up short shifts at reasonable rates will reduce the admin headache for the executive teams.