Reducing Registered Bank and Agency Spend
Summary
In January 2023, United Lincolnshire Teaching Hospitals NHS Trust began a focused programme to reduce reliance on temporary staffing. The work combined international recruitment, tighter rostering, and a phased reduction of agency rates to NHS England caps. By May 2025, the Trust had removed all nursing agency use, significantly reduced bank spend, and aligned payments back to Agenda for Change. These changes have supported safer care delivered by Trust staff, improved staff experience, and delivered substantial financial savings.
The Challenge
The Trust faced considerable workforce and financial pressures. More than 300 registered nurse posts were vacant in 2023, while quarterly bank and agency costs stood at over £7 million. Agency rates were far higher than national caps, with additional “critical” rates applied in some areas. Since 2017, Bank Band 5 nurses had been paid at a Band 6 mid-point incentive rate, further inflating costs. This reliance on temporary staffing created risks to continuity of care and placed additional strain on substantive staff, who faced high levels of overtime and last-minute cover requirements.
The Solution
A coordinated programme was introduced to regain control and improve staffing stability:
- Agency rates were reduced month by month until all suppliers aligned to NHS England caps
- Over 300 substantive nurse vacancies were filled through international recruitment, reaching an over-established position by April 2025
- 31 agency nurses transferred into the staff bank, strengthening the pool of familiar staff
- Roster clinics were introduced to challenge overtime, headroom use and unavailability
- A new approval process required senior sign-off for all bank requests, with shifts released no earlier than 28 days in advance
- The Band 5 bank incentive rate was removed in May 2025
- Standby shifts were introduced to provide daily resilience and time for mandatory training
- Centralised control was extended to AHP, HCS and APS&T staffing, ensuring consistent processes across the workforce
Results & Next Steps
The impact has been substantial, both financially and operationally:
- Agency spend reduced from £2.28m (Jan 2023) to zero (Jun 2025)
- Registered bank spend reduced from £708,941 (Apr 2025) to £432,273 (Jul 2025)
- Monthly registered requests fell from 7,086 (Apr 2023) to 1,171 (Jul 2025)
- Bank fill rates reached 85%, with 93% of shifts filled by bank rather than agency
- Substantive nurse vacancies were filled by April 2025
- Staff survey results showed:
- +4% increase in staff feeling there are enough colleagues to do their job properly
- +5% increase in staff recommending the Trust as a place to work
- Improvements in staff reporting realistic time pressures and reduced exhaustion
The Trust’s approach has been adopted by Lincolnshire Community Health Services NHS Trust, with other organisations requesting to learn from the model. The next steps focus on sustaining control, embedding roster efficiencies, and maintaining long-term resilience.
