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Southern Trust’s overspend on agency and bank staff makes for ‘quite stark’ reading

Craigavon Area Hospital

An analysis of the Southern Health and Social Care Trust’s overspend on agency and bank staff makes for “quite stark” reading, according to a non- executive director on the Trust’s board.

The comments were made at a meeting of the Southern Health and Social Care Trust’s board on Thursday, following the presentation of a paper on the analysis of agency, medical locum (on Trust payroll) and bank spend from 2018/19 to 2022/23.

If the current trends continue, the report estimates agency spend will increase by 14.5 per cent to £66.4 million in 22/23, up from £57.99 million in 21/22 and bank spend will increase to almost £19.7 million in 22/23, up from £19.4 million in 21/22.

Board members were also notified of a savings target from the Minister of Health on the Trust to reduce off-contact agency spend by £2.507 million by year-end.

Non-executive director, Hilary McCartan said the figures are quite stark and asked if these are areas in which the Trust is expected to implement the savings requested by the Health Minister, Robin Swann MLA.

“The analysis of agency and bank overspend is quite stark isn’t it,” said Ms McCartan.

“In terms of agency expenditure alone, the forecasting for 2022/23 is £66.4 million against last year’s figure of just under £58 million. Is that where you are expected to implement savings of £2.5 million?”

The Trust’s assistant director of finance – financial management, Carol Cassells, told the meeting that was the case but assured members options are currently being considered to achieve that target.

“I suppose the point we are making there is if we do not make a change in terms of the usage, that is where we could end up,” said Ms Cassells.

“Obviously we have our target reduction to make there and we have a range of options to look at as to how we might achieve that. These include moving from the use of ‘off’ to ‘on’ contract agency, increased usage of bank staff and looking at targeted reductions in area of highest usage.

“Agency is the highest spend out of all our total flexible spend and the increased trend of the last few financial years is a response to the Covid pandemic. This is a regional issue not unique to the Southern Trust.”

A table showing the trend of the past four financial years and this year’s project spend on agency, locum and bank staff in the Southern Health and Social Care Trust.

The analysis provided to members of the Trust’s board states “the Trust continues to rely heavily on the use of flexible means to address gaps in the workforce” which it says is largely as a result of the Covid-19 pandemic.

The three main categories of flexible spend are agency, medical locum (on Trust payroll) and bank staff.

For the financial year 2022/23, as of August, payroll expenditure stands at £253 million, £9.5 million over budget. This follows the same trend as in previous financial years with the main areas of pressures and overspend in medical and nursing staff.

Payroll payments to agency, bank, locum, overtime and additional duty hours have cost the Trust £40.5 million or about 16 per cent of total payroll spend. At present, 1,398 working time equivalent staff are employed on these flexible arrangements.

In 2018/19 the Trust spent £33.6 million on agency workers, £13.4 million on bank staff and £3.7 million on locum staff. This is a total of £50,697,640.

In 2021/22 these figures had increased to a spend of £57.99 million on agency workers, £19.4 million on bank staff and £4.4 million on locum staff. This is a total of £81,856,320.

The report notes if current trends continue, it is expected that agency spend will increase by 14.5 per cent to £66.4 million from 21/22 and bank spend will increase by a further 1.4 per cent to almost £19.7 million.

“The largest areas of spend with agency continues to be nursing, midwifery and medical. These areas alone equate to 86 per cent of total agency expenditure based on 21/22 data,” states the report.

A breakdown of agency expenditure is also provided and shows that in 21/22 £30.7 million of the £57.99 million spent on agency staff was spent on nursing and midwifery staff. This figure is projected to increase to £35.138 million in the 2022/23 financial year.

The biggest percentage increase in agency spending is, however, in the professional and technical staff category where a 53 per cent projected increase in expenditure between 2021/22 and 2022/23 is anticipated.

In 2021/22, £1.93 million was spent on professional and technical agency staff. In 2022/23 it is projected this figure will hit £2.95 million.

According to the analysis, this increased costs is “largely due to Covid”. It also notes “medical agency [cost] is increasing at a slower rate compared to nursing and midwifery but at current levels in 2022/23 it is expected to increase by a further 13 per cent to £21.6 million”.

“Medial locum spend has remained relatively consistent in comparison.”

The analysis highlights how nursing and midwifery has had a heavy reliance on off-contract agency staff in the first quarter of the 2022/23 financial year.

According to the figures, the Trust has spent 84 per cent (£7.366 million) of its on-contract/off-contract agency split on off contract resources. The other 16 per cent ( £1.413 million) has been spent on on-contract agency staff.

As for bank expenditure, the largest areas of spend for bank staff are within nursing and midwifery and social services and in 2021 equated to 91 per cent of the total bank expenditure.

However, despite increasing from £11.545 million in 2018/19 to £15.426 million in 2021/22 the spend on nursing and midwifery banking staff in 2022/23 is expected to cost £15.366 million.

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