Reducing agency costs at West Hertfordshire Teaching Hospitals NHS Trust

The Situation

West Hertfordshire Teaching Hospitals NHS Trust (West Herts) is a large acute trust providing healthcare services across multiple hospital sites, serving a population of approximately 500,000 residents and employing over 5,000 staff. The Trust delivers a range of medical services, including emergency care, surgery, maternity, and outpatient services.

Prior to the pandemic, the established partnership with NHS Professionals (NHSP) had achieved a degree of control over agency spending and above benchmark bank fill rates. The challenges of the pandemic, however, meant that in the 2022/23 financial year, the Trust’s agency expenditure had grown to £4.9 million, highlighting the need for improved workforce management and cost control.

The Solution

NHSP aligned with key stakeholders within West Herts to implement a comprehensive programme aimed at reducing agency costs and improving workforce management. We embarked on a targeted programme of agency cost saving that involved the following:

• Triangulation of demand and usage against vacancies: NHSP collaborated with West Herts to align temporary staffing needs with vacancy data. The focus was placed on high agency usage areas, unfilled shifts and ensuring better workforce planning.
• Rate reductions in non-specialist areas: Rates which had escalated during post-pandemic recovery were reduced across all general nursing and non-specialist areas. This involved moving from custom rates back to the standard 2016 rate card for General Nursing, Midwifery, Theatres, A&E, and Paediatrics, bringing agency costs back in line with national benchmarks.
• Improved governance and control on shift release: The Trust enhanced its governance by implementing stricter controls over shift release, including the introduction of additional Golden Keys. The Chief Nurse personally signed off on all temporary staffing shifts, ensuring only essential shifts were released.
• Lead time reduction: Previously, shifts were visible to agencies for up to six weeks, leading to higher agency reliance. This lead time was reduced to one week by adjusting the cascade process, allowing the Trust to prioritise bank staff first and only offering shifts to agencies as a last resort.
• Elimination of personalised rates: Historically, personalised rates emerged due to ad-hoc agreements to meet specific departmental needs, resulting in inconsistent pay rates. These were removed to standardise rates throughout the Trust, facilitating cost efficiency and ensuring equitable treatment of all staff members.
• Direct agency booking reduction: NHSP and the Trust collaborated to reduce direct agency booking from 25% to 9.4%, prioritising Bank Members and reducing the need for high-cost agency staff.
• Agency shift bumping: Approximately 700 agency shifts were bumped in favour of NHSP Bank Members, resulting in a cost saving of around £50,000 for the financial year 2023/24.

The Results

The collaborative efforts between NHSP and West Herts led to a remarkable 45% reduction in agency spending, from £4.9 million in 2022/23 to £2.7 million in 2023/24. Further reductions were achieved throughout 2024/25, with agency expenditure in February 2025 dropping to £424,000 from £827,000 in February 2024. These initiatives not only controlled costs but also continued to improve workforce planning and governance.

These savings came about because of the strength of the partnership between West Herts and NHSP. Together, we focused the Trust’s priority workforce challenges - the Trust managed internal processes and actions and NHSP managed improvements in the bank supply and agency supply chain.