Monitor, TDA and the rush for Frameworks

The NHS is in a race against the clock.

With a deadline of the 19th of October to have ALL Nursing Agency spend going through one of only four approved frameworks - every single Trust; Acute, Community and Mental Health alike, are frantically searching for the best option.

On first glance the expansive lists available on these four frameworks are impressive, with numerous choices from agencies of various sizes. The rates are good, with set parameters and agreed routes for escalation. It seems like a great option, does it not? And this is clearly what Monitor and TDA were thinking as they put the lists together – such choice, such value – how can the NHS not be using these?

But they haven’t been, and there is a simple reason for that – desperate times cause for desperate measures.

Desperate Days.

Most NHS Trusts are relying heavily on off-framework agencies such as Thornbury. They have a niche in the market – paying the nurses a highly elevated rate that is above and beyond those available on frameworks. The nurses are aware they are a commodity and are chasing the money, which from a personal perspective makes sense but leave our hospitals in a dangerous situation. If the nurses aren’t signing up to framework agencies, how can we get the supply we need?

The lists of suppliers on the frameworks surely negate this, there are so many of them! But this is not how it seems on first glance. Working in conjunction with one of my local NHS Trusts I benchmarked their spend against all four of the suggested routes to market- they only showed a supply chain that could cover 25-35% of demand in the local area, with the rest being agencies not on these frameworks, agencies relied upon for local nurses who understand the Trust’s needs.

Treat the roots, not the leaves.

While I would never recommend to a Trust that they contravene the Public Contract Regulations, the above off framework spend has been happening throughout the country for years now, unmanaged. But Monitor and TDA are attempting to put a sticking plaster over a gaping wound here and not combating the route of the issue. There are not enough nurses in the UK.

At a recent conference one of these authorities quoted that ‘there is no nursing crisis’ – a line clearly from the top that they have been requested to spew on difficult occasions, when surrounded by NHS Trusts chomping at the bit at a despairing situation. This is clearly not the case, as all evidence suggests that the UK are suffering the worst nursing crisis in years, if ever, and the cause? Nurses salaries, nursing placements at university and the ‘upgrading’ of all nursing posts need a full degree. What are we doing to combat this?

On top of this, applications for visas for overseas nurses are being turned down by the hundreds, because they are ‘not a shortage’ and their salary does not tick all of the boxes required to get you automatic entry to the UK.

The usage of agencies, on and off framework, is a reaction to a problem that was caused years ago when bad decisions were made. It is not the fault of the Trusts, or indeed the agencies although they are clearly having a hay-day in the current market.

What can we expect?

Every Trust is likely writing their case for exemption from these rules at the moment, with numerous agencies featuring over and over again. I will be interested to see whether Monitor and TDA stick to their rigid stance on this or whether they bend and grant exception to all. It really could go either way.

So - get those letters in, call off what you can from whichever frameworks you can gamble on by the 19th and hold your breath for the next chapter in the nursing crisis! This isn’t going anywhere.