The Challenge

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

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 it’s spending on temporary staff needed to be scrutinised and reviewed in line with the following key parameters:

  • Patient safety
  • Efficiency
  • Reduction of risk
  • Continuity of care
  • Reassurance on compliance
  • 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 tender.

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

There was some resistance to moving to a single outsourcing model from medical staff who had been receiving enhanced rates with other agencies. This lead to fears about possible disruptions in service and deterioration in the quality 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 the 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.