Feature / Right time, right place

01 July 2013

Login to access this content

E-rostering may have moved into the mainstream, but trusts have yet to harness all of its potential benefits. Seamus Ward reports

Around five years ago, e-rostering became an NHS buzzword. Acute trusts in particular seized on it and now most trusts have a computer-based rostering system. But with most systems now maturing, what benefits have they delivered?

Reducing the complex task of creating nursing shifts six or eight weeks in advance to a few button-pushes – it previously involved hours poring over reams of paper – has been a boon for ward managers. But trusts have also reported financial savings.

Basildon and Thurrock NHS Trust began implementing the Smart rostering and time and attendance system four years ago. The first phase involved putting all nursing staff on the system, while phase two, completed in April, focused on the remaining non-medical staff. Overall, 3,700 staff are covered by the roster.

Financial controller, Ian Child, says: ‘We are in the process of realising the benefits of phase two. In phase one, most benefits were around nurse management, allowing us to save on agency usage. Other things were credited with leading to the drop in agency usage, but we know rostering had an impact. For example, the rules on our system ensure that weekend shifts – the most expensive shifts – are filled with our staff first, rather than agency staff.’

The trusts saw a number of gains, including compliance with contracted hours. If a nurse works three 12-hour shifts a week, 1.5 hours of their 37.5-hour working week remains. In a paper-based system, these hours could be lost, but with the e-roster they accrue and can be allocated as an additional shift. 

County Durham and Darlington NHS Foundation Trust has seen big benefits since it began implementing Allocate’s Healthroster in 2007. Ged Whitfield, its clinical standards lead for e-rostering, says that not only has e-rostering saved ward managers’ time, but also costs. The roster is linked with the trust’s electronic staff record (ESR), leading to greater payroll accuracy and, through better use of staff available time, a reduction in bank costs.

The trust’s finance department analysed the impact of e-rostering on the overall cost of the roster in 14 wards that had used the system for at least a year. ‘It

found the roster had reduced the cost by £328,000 across the 14 wards. This was through reducing bank, overtime and additional hours worked,’ says Mr Whitfield. 

‘When extrapolated over the 44 wards where e-rostering had been implemented, this could have saved £766,000. This was a significant saving and only looked at a relatively small number of wards. We now have 120 rosters.’

It is important to establish a template for each roster, Mr Whitfield adds. This ensures there is no over-resourcing on some shifts, which will lead to under-resourcing on others and a reliance on bank staff. The trust also worked with ward managers to think about how they managed time when staff are unavailable, due to annual leave or study leave, to avoid dips and spikes in availability.

The trust’s roster was integrated into its ESR for time and attendance and sickness absence in 2008 – a vital step, says Mr Whitfield. It has meant payroll staff no longer have to manually input more than 3,000 timesheets each month (for both substantive and bank staff). As a result, it has led to a reduction of two whole-time equivalents in the payroll team. 

‘The ESR link was important in making sure the rosters were accurate and reducing errors,’ he says. ‘Timesheets are no longer based on someone’s interpretation of agenda for change rules on pay; the electronic system sticks to the rules and there is no variation.’

NHS ESR programme director Paul Spooner adds: ‘The ESR solution enables interfaces with third-party systems, including, but not limited to, occupational health, time attendance and rostering, expenses and active directory.’

Using such interfaces, NHS organisations using ESR have delivered major efficiencies – both cash and non-cash releasing, by removing data duplication; enhancing data accuracy, quality and integrity; and improving operating processes such as paperless administration.

‘There is an extensive list of system suppliers that utilise the ESR interfaces, ensuring that ESR remains the master source for all employee data,’ says Mr Spooner. 

But further benefits could be gained. ‘With the systems in place, the trusts are now moving on to realising the benefits they offer,’ says Paul Scandrett, head of healthcare at Allocate, which has 154 NHS clients. ‘This goes beyond interfacing with the ESR to ensure staff are paid properly. The challenge now is to use the data produced to address the transformation agenda, such as delivering the seven-day NHS.

‘This calendar year, there has been an enormous level of interest and focus on delivering safe levels of nursing care, driven by the NHS chief nurse before Christmas and more recently by the second Francis report,’ adds Mr Scandrett . ‘It’s an incredibly complex question, but e-rostering has a role to play in the answer. This will focus minds further on the use of the systems in an operational way, not just in paying people with ESR.’

Finance and HR managers and suppliers agree that rostering for medical staff is the next step, though many point out the difficulty raised by consultants working in programmed activities rather than hours. They add that it is anachronous that doctors are rostered on a paper-based system, while all other rosters are created electronically. 

‘Changing how the medical workforce is managed is not an easy task,’ says Mr Scandrett.  ‘It’s necessary for trusts to think differently, so that consultants, as well as the organisation, see the benefits. We are doing this by better management of the actual clinical activity, meaning that the medic schedules are created based on patient needs. This also helps organisations to have visibility of the contracted versus delivered activity.’

E-rostering has become an integral part of the health service for many staff and it has brought many benefits. The challenge now is to use the data it produces to make services leaner, safer and better quality. 

Locum benefits

NHS spending on locum doctors has risen by 8% since 2011, with the overall bill topping £2bn in the past three years. It is no surprise that trusts are trying to minimise spending here.

More than 60 trusts have signed up to Staff flow, a joint initiative between Liaison and PricewaterhouseCoopers. Under Staff flow, trusts use a recruitment agency to find candidates for locum positions and a third party to provide administrative and payroll support. Liaison claims the system is on track to make an annualised saving of £30m for the NHS from VAT, reduced agency commissions and internal process improvements.

The idea is to bring contracting with locums back in-house. Liaison managing director Andrew Armitage says traditionally, trusts fill demand for locums through agencies. A phone call would be made to an agency, which would then look through its database, find a doctor and supply them to the trust. At the end of the assignment, the doctor would hand in a timesheet to the agency, which would raise an invoice to the trust for the supply of the doctor.

But Mr Armitage says Staff flow gives trusts greater transparency over rates paid and more control. ‘The agency finds the relevant people, provides a selection of CVs, and their involvement stops there. The trust will select a doctor and contract directly with them.’

Basildon and Thurrock NHS Trust is using Staff flow. Financial controller Ian Child says the system minimises ambiguity, reducing the potential for disputes. It is much easier for users to book a locum. There are significant controls – all his department has to do is send payment to Liaison to pay the contracts that have been signed and approved as worked.

Savings include a cut in the cost of processing agency invoices. In the past, the trust would have dealt with about 200 invoices a month, he says – some for doctors who worked a single shift, others for more regular work. ‘According to national statistics, these cost £30 each to process, so we are almost saving £6,000 a month in processing costs. This is a saving that’s not being realised but it is going back to add value in other areas,’ he adds. ‘And because the transactions are being recorded in a timely way, our financial reporting for all our divisions is up to date, so we are recognising costs in the right period, making it easier to control spending.’

Savings have been made by setting a fixed pay scale and other technical changes. In the past, some locums were paid at different rates for similar contracts. The trust had begun to set fixed rates for locums and Staff flow has helped the trust take further control of this spending.

‘We saved 8% with fixed all-inclusive rates for medical staff with 10 agencies, and since then a further 14% by going over to Staff flow – on average our hourly cost average rates are 22% lower than two years ago. This is not because every doctor is getting less – though some are being paid less because they have come into line with the pay of everybody else.’

NHS Professionals chief executive Stephen Dangerfield (left) is urging trusts to undertake a strategic and operational review of locum management to meet QIPP (quality, innovation, prevention and productivity) targets, reduce spend and avoid putting patients at risk. 

It also has a new Agency procurement programme. ‘This works to identify staffing agencies that suit a trust’s unique temporary workforce demand patterns. NHS Professionals works with the trust to establish a small group of preferred agency suppliers who are compliant with NHS Employment Check Standards and have agreed negotiated rates of supply,’ he says.