How a comprehensive workforce management review produced winning results for patient safety, efficiency,
continuity of care and cost savings.

The Challenge

A large NHS Acute Trust serving half a million people found itself in extreme financial difficulty and facing major
reputational and service issues in having to close an A&E at night due to lack of medical staff. The Trust
undertook an extensive business review with the intention of making significant cost efficiencies as well as
re-examining its core service offerings.

As part of this it determined that its spending on temporary staff needed to be scrutinised and reviewed in line
with the following key parameters:

  • Patient safety
  • Reduction of risk
  • Reassurance on compliance
  • Efficiency
  • Continuity of care
  • Widening the talent pool

On review the Trust identified an annual agency spend in the region of £7-10million and over 50 agencies, many
of which were non-framework (not on the government standardised tariff scheme) and therefore pricing was
unregulated and out of control. Even more worrying was the poor levels of candidate clinical compliance by
some of these suppliers which could directly impact patient safety. The review determined that temporary staff
recruitment would be better managed by a single outsourced provider who could deliver considerable
potential recurring savings and efficiencies whilst ensuring compliance and decided to put the service out to

Beyond the obvious cost benefits, the Trust acknowledged that by using a large number of staffing agencies in
managing resources it was not operating to maximum effect and was creating opportunities for medical staff to
hold the Trust to ransom on pay rates. The Trust wanted reassurance that it was getting the best possible price
from the minimum number of agencies.

Outsourcing to one provider has allowed the Trust to focus on its core business of delivering first-class patient care, realise considerable financial benefits and improve productivity and quality. Our partnership approach is crucial to what we offer – we strive to be a valued partner, not just a supplier, enabling the delivery of outstanding healthcare by providing innovative and measurable solutions.

The Solution

The single service was put out to competitive tender with several objectives:
• Realise substantial benefits in terms of compliance, risk transfer, productivity and quality
• Guarantee continuity of service and continuity of care
• Provide a positive solution for NHS employees who would be impacted by the change
• Reduce spiralling pay rates and identify cost saving initiatives
• Streamline the number of agencies
• Ensure continuity of care

In the competitive tender HCL, one of the UK’s largest suppliers of staff to the healthcare sector emerged
as the only realistic partner due to its proven track record and a long experience working with a large
number of hospitals in the country to enable innovative and measurable outsourcing and staffing solutions
aimed at supporting the NHS. The company was selected by the Trust to help it achieve its targets in terms
of cost savings, quality of candidates and enhanced compliance.

One of the biggest challenges was engaging staff at the Trust, as there were over 15 different contacts who
needed to be kept up to date and consulted with. HCL worked in partnership with the Trust and placed a
permanent member of staff on site for the first two months to ensure any problems or issues were dealt
with promptly. It also created an opportunity for doctors to be checked on site quickly and efficiently to
ensure compliance.

While there was concern regarding the use of a single, standardised agency about resistance of some staff
to accept a standardised pay rate, and the knock-on impact on fill rates, HCL worked hard to engage
medical staff as well as make Trust staff aware of alternative, high quality candidates which they had not
employed previously. The company even provided new, compliant and quality candidates on a ‘free of
charge’ trial basis to allay fears and overcome resistance in an attempt to widen horizons.

The Outcomes

HCL conducted a cost saving analysis, benchmarking itself against the historical spend. In a 12 month
period the HCL model has saved the Trust £2 Million compared to the spend reports from previous years.

 An annual saving of £2million        Clinical governance metrics met


 Shift fill rate                                        Quality compliance agreements established


 Over 74,000 locum hours supplied     Unrivalled out of hours service was provided


The service has immediately and positively impacted cost, quality and productivity. All staff are provided fully compliant, are of high quality, efficient, flexible and all risk management has been completely transferred to HCL.

HCL has even seen the return of the old cohort of temporary medics who now accept that the Trust is
serious about making these changes, permanently.