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I.T CAPITAL PROGRAMME
Integrated Electronic Rostering, Time and Attendance and Bank Staff
Management System Business Case
28th January 2010
1. EXECUTIVE SUMMARY
In 2008/09, expenditure on bank, agency and overtime was £24 million, £2.1 million higher than in
2007/08.The context is set out in the table below:
2008/09 Total Total Salary costs Salary costs Nurses Salary costs
Expenditure (5000 staff) Medical (1700 staff)
£835m £530 m (62%) £170.8m £161m
Bank & Agency £24m £11m £2m
Although reducing so far in 2009/10 compared to the increase in the last financial year, this has
been due to the extraordinary measures imposed to control expenditure on staffing and it still
remains at a high level. More efficient deployment and management of the workforce will improve
productivity and is a fundamental part of the Managing for Success Programme, critical to
achieving Foundation Trust status. This business case proposes a fully integrated Electronic
Rostering and Bank Staff Management System which will enable gains in productivity and quality to
be achieved through more efficient rostering of permanent staff thereby reducing the requirement
for Bank and Agency staff and where this remains a requirement, procuring staff with the
appropriate levels of competence more cheaply via an in-house solution and thereby not incurring
commission charges to an agency.
The implementation of a rostering system alone will achieve efficiency gains but in order to
maximise these, the system needs to link directly to managing (largely our own staff) who work on
the bank in-house. Conversely, implementing an electronic bank system alone will not achieve the
required efficiencies, as managing the demand for temporary staff is achieved through the rostering
system. Thus an integrated system is key to achieving the objective.
The Trust workforce is our greatest asset but also our highest cost therefore the efficient
deployment and management of staff is critical. This internal driver is reinforced by National Audit
Office guidance1 which promotes the usage of electronic rostering. Managing and controlling the
workforce requires a single, proven electronic solution across the whole process. Existing paper-
based are time consuming, inefficient and do not provide adequate control. Given the size and
complexity of Leeds Teaching Hospitals NHS Trust such manual, paper-based process are simply
not fit for purpose. The financial detail of the proposal is set out in Section Eleven.
The quantifiable benefits of the implementation cover the financial costs, with a pay back period
within 12-18 months. This is summarised as follows:
1
National Audit Office “Value for Money” report in 2006 on the use of temporary nursing staff, which recommended that Trusts should
“review best practice in relation to electronic rostering systems to identify cost effective products which can be integrated with Trust’s
existing finance and Human Resource systems.”
1
Year Year Year Year Year
2010/11 2011/12 2012/13 2013/14 2014/15
£ £ £ £ £
Capital Costs
Software Licence 427,700
Implementation 207,623
Internal Project Implementation Resource 295,770 126215
Sub Total Capital 931,093 126215
Total Costs 532,408 588,877 596,464 589,063 581,662
Total Savings -1,088,497 -2,873,447 -3,182,228 -3,240,968 -3,258,088
Net Savings -556,089 -2,284,570 -2,585,764 -2,651,905 -2,676,426
2. PROPOSAL SUMMARY
The procurement of an integrated Electronic Rostering and Bank Staff system will enable
managers to more effectively deploy and manage the workforce and in particular the levels of
demand for bank and agency staff, (which are seen to be excessive), thereby reducing waste,
improving productivity and driving sustainable reductions in workforce costs. The efficiencies
gained will make the system self-financing within 18 months and will also facilitate additional
efficiency gains, both financial and non-financial. These savings also rely on the establishment of
an internal clinical staff bank wholly operated and managed by the Trust and would require the
Trust to move from the current arrangement with NHS professionals (NHSP) as the primary
provider of temporary nurse and midwifery staffing for which the Trust pays a commission charge
currently in the region of £900k per annum.
3. EXISTING ARRANGEMENTS
ROSTERING OF PERMANENT STAFF
The current management and control of the workforce is through complex, fragmented paper-
based systems which offer limited control and transparency, take up valuable clinical staff time,
result in serious inefficiencies in staff deployment and temporary staffing usage and do not provide
clinical governance records. Given the size and complexity of Leeds Teaching Hospitals NHS Trust
such manual, paper-based process are not fit for purpose. Each month, across a workforce which
is in excess of 13,500 staff, senior clinicians and managers are required to develop working
schedules that accommodate and understand:
Patient demand and the alignment of staff resources.
Complex clinical rosters with as many as 150 rules for each shift/duty assignment.
The efficient use and full utilization of staff hours, compliant with the European Working
Time Directive.
The effective management of staff absences, staff working requests and staff
preferences which comply with Improving Working Lives and family friendly policies
In a recent review of rostering and workforce management practices across the Trust, a number of
risks and issues were identified. More information on the review is given in Appendix One.
NURSING AND MIDWIFERY TEMPORARY STAFFING PROVISION
The Trusts requirements for temporary nursing and midwifery staff are currently managed through
an agreement with NHS Professionals (NHSP). The Trust has virtually eliminated the use of
secondary agencies so NHSP is a sole supplier to the Trust. Currently 67% of staff supplied by
NHSP are the Trust‟s own staff so the Trust is paying a commission of 7.7% to NHSP to supply our
own staff for bank shifts. Moving to an in-house Bank Management system would release savings
from the costs incurred currently with NHSP.
2
4. CASE FOR CHANGE
Rostering in the NHS is regarded as one of the most complex scheduling problems to solve.
Historically, the investment in supporting effective workforce planning has not been commensurate
with other aspects of service provision. In particular, and as evidenced by a review within the Trust
(see Appendix One), rostering practices are inconsistent across the Trust, with no effective Trust-
wide policy or sustainable measurement of the efficiency and compliance of rosters, rotas and off-
duty.
There is a financial and governance risk of not be able to demonstrate that the Trust is maximising
the efficient use and deployment of it‟s staffing resource and a further risk that patient safety might
be compromised by staff working excessive hours when there is no mechanism to easily identify or
manage this or by shifts not having the appropriate skill mix of staff to cover the profile of work.
NHS Trusts throughout the country all face similar challenges and technology is increasingly
supporting improvements. E-rostering is now being widely adopted by other Trusts to more
effectively manage their workforce.2
5. STRATEGIC FIT/BUSINESS PLAN FIT
The implementation of an Electronic Rostering and Bank System will support the Trust‟s plans for
Foundation Trust status and financial stability and is also consistent with the Trusts strategic goals
and the Trusts strategic direction document (June 2009). This is through enabling more efficient
management and deployment of staff and demonstrating better control of the workforce. It will also
contribute to the quality and patient safety agenda by helping to ensure that appropriate levels of
skilled and trained staff are deployed in the right areas and that support staff are equally properly
utilised.
There are significant financial savings to be made in deploying the workforce more efficiently and
the system will also enable better review of skill-mix and therefore a more informed approach to
workforce redesign. The system will also enable better activity modelling by recording total hours of
staff time deployed which can then be matched to planned activity and the effectiveness of how
this is delivered, as well as enabling baselines to be developed for services that are commissioned
in future. In addition, the system will also enable activity and demand to drive staff deployment
rather than this being overly driven by staff preferences for particular working patterns, as is often
the case at present.
6. OBJECTIVES
The overall objective is to enable gains in productivity and quality to be achieved via more efficient
rostering of permanent staff thereby reducing the requirement for Bank and Agency staff and where
this remains a requirement, procuring staff with the appropriate levels of competence more cheaply
via an in-house solution and thereby not incurring commission charges from agencies.
Specific objectives which will be measured through key performance indicators are therefore:
To provide a rostering tool to enable nursing & midwifery and medical staff duty rosters to
be developed in a more timely and efficient way
To enable all consultant job plans to be stored and shared electronically, enabling better
service planning and benchmarking across all areas
To maximise the deployment of staff up to their full contractual working hours and to the
shifts required
To reduce expenditure on bank and agency staff in nursing and medical areas
To eliminate the need to pay agency commission charges for the use of our own staff to
cover internal bank shifts
2
The Public Accounts Committee also criticised Trusts for not taking a “strategic and managed approach to controlling demand for
temporary nursing” and recommended that “…strategy should be underpinned by a clear understanding of the requisite establishment
levels needed to provide safe and effective care, which IT-based workforce management and rostering systems could help with.”
3
To record accurate baseline skill mix and establishments for all nursing areas and to
monitor the deployment of existing resource against these baselines, as a measure of
efficiency and quality
To use data from the system to inform plans for modernising the workforce
7. BENEFITS
NHS Employers list the benefits of e-rostering as helping to reduce costs, improve the quality of
patient care and improve the quality of service to staff by providing easy access to workforce
information, allowing flexible working, improving absence management, allowing more productive
use of staff, rostering staff to meet the needs of patients and reducing the amount of time spent on
administration. Comments from existing users of e-rostering systems point to sustained savings for
Trusts. The benefits from eRostering therefore accrue in four main areas - financial savings, time
savings (for roster creators, HR and Payroll), clinical governance improvements and patient care
improvements. For the purposes of this case, the benefits of implementing the integrated E-
Rostering and Bank System have been categorised into quantifiable financial benefits, scoped
financial benefits and other benefits that are assumed based on experience from elsewhere but not
fully quantified.
7.1 Quantifiable financial benefits
Savings that accrue from improved rostering directly linked to an internal nurse bank are from
efficiencies in a number of areas, mainly:
Reducing the amount of unused contracted hours (staff not working their full contracted
hours) and the amount of over hours (staff working in excess of contracted hours and time
owed is taken back)
Reducing additional duties being rostered above the stated demand.
Reducing the number of unregistered shifts being filled by registered staff and balancing the
unfilled shifts across Early, Late and Night shifts.
Improving leave management to ensure against too many or too few staff being given
leave.
automating the planning of bank and agency staff, providing a faster, quicker process for
booking bank staff
reducing and then eliminating commission charges to NHSP
objective requesting of temporary staff via a demand-based electronic rostering system
A recent pilot across four typical nursing & midwifery areas in the Trust identified the potential
savings that could be achieved from more efficient rostering, so reducing the need for bank staff.
The projected savings based on this are as set out below, (based on 120 nursing & midwifery
areas undertaking rostering, an average of 0.50 wte staff saving per roster area at a cost of
£25,000 per annum (including Employer‟s on costs) and an 18 month rollout programme.):3
In addition, the implementation of an integrated E-Rostering and Bank Management system and
the consequent move to an in-house clinical staff bank would provide savings year on year on the
commission paid to NHSP as the Trust moves to a model of internal bank with no secondary
supplier. These are also set out in the following table:
3
Year 1 and Year 2 savings reflect the rollout timetable during which 10 wards per month will transfer on to the live system. These
figures are consistent with other Trusts using an E-Rostering system, for example County Durham and Darlington NHS Foundation Trust
(6,500 staff in total) identified staff cost savings in nursing of £1.2m over 08/09 financial year which they attribute wholly to more effective
rostering via an electronic system.
In addition, the Mid Yorkshire Hospitals NHS Trust has implemented E-Rostering and over a 3 month period, identified an average
reduction of 8.75% in the number of unfilled shifts on their planned rosters. If the same ratio is applied to the 08/09 Nurse Bank
expenditure of £11.4m in the Trust, an equivalent reduction in the number of unfilled shifts at Leeds Teaching Hospitals would realise an
annual saving of £997,500.
4
AREA 2010/11 YEAR 2 YEAR 3 YEAR 4 YEAR 5
EFFICIENT NURSING & MIDWIFERY ROSTERING
(£317,708) (£1,312,500) (£1,500,000) (£1,500,000) (£1,500,000)
SAVING
SAVINGS ON COMMISSION PAID TO
(£420,789) (£675,947) (£797,228) (£855,968) (£873, 000
EXTERNAL BANK PROVIDER
In addition to nursing staff, the use of the system for job planning and/or rostering of medical staff
will provide greater flexibility and the ability to match job plans (capacity) to demand across all
specialites, better management of leave and absence so work can be planned in advance more
efficiently and significantly reduce the time spent by consultants in managing and planning work
rosters.
Within the Trust, some Consultants use about1 PA each per week to produce and trouble shoot
rotas. The autorostering functionality within an E-Rostering system will reduce Consultant level
input in this area, releasing the equivalent of at least £110,000 per annum in Consultant clinical
time back to direct patient care.
Based on savings made at other Trusts using an E-Rostering system to manage junior doctors,
savings in the region of £355,000 across General Medicine and £190,000 across General Surgery
are achievable through banding compliance and more efficient banding management for junior
doctors. Minimum expected annual savings in this area across the medical workforce therefore
equate to in excess of £600,000 per annum.
If as expected, through more efficient rota management and locum usage, there is an 8.75%
reduction in temporary staffing, when applied to the 08/09 medical agency expenditure of £2m, this
would potentially realise an annual saving of £175,000. Total potential savings delivered via the
system in terms of the medical staff workforce therefore equate to £885,000 per annum, with an
initial saving in the first year of around £350,000.4
AREA YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5
Medical Staffing (£350,000) (£885.000) (£885,000) (£885,000) (£885,000)
Savings will accrue from the point of implementation onwards, i.e. as soon as nursing and medical
rosters/rotas are transferred live on to the rostering system. A summary of the potential savings at
full implementation as described above is therefore as follows:
Area £m 2010/11 £m Year 2 £m Year 3 £m Year 4 £m Year 5
N&M Staff Group (£317,708) (£1,312,500) (£1,500,000) (£1,500,000) (£1,500,000)
Medical Staff Group (£350,000) (£885.000) (£885.000) (£885.000) (£885,000)
Savings on commission
paid to external bank (£420,789) (£675,947) (£797,228) (£855,968) (£873, 000
provider
Total £1.09m £2.9m £3.18m £3.24m £3.25m
This saving projection is conservative when compared to 08/09 nursing expenditure alone:
NURSING COST AREA FY08-09
SUBSTANTIVE STAFF COSTS £159.639m
BANK STAFF COSTS £11.4m
7.2 Scoped financial benefits
Savings can also be realised by removing manual processes from clinical teams (a conservative
estimate for this is 3.5 days per ward per month). Additionally, removing manual processes within
4
Assumes 18 month roll-out programme
5
the payroll function is estimated at 1.67 days per month per 10 Wards. Time savings are also
achieved through the use of „autoroster‟ (the automatic transfer of timesheet data to ESR) and the
reduction in support calls to payroll due to improved accuracy. The Roster Assessment pilot in the
Trust also identified some anomalies between actual worked, rostered duty and the enhancements
paid. There will therefore be some expected savings delivered via the system in terms of more
efficient and accurate payments.
7.3 Other benefits which can be assumed but are not fully quantified
Electronic rostering has been proven to have a positive impact across the NHS by helping to
reduce staff sickness and turnover. Staff satisfaction levels can also be improved via the production
of fairer off duties. The system will help the Trust achieve and maintain performance against key
initiatives including New Deal, Working Time Directive and Improving Working Lives. Improvements
to patient care can be achieved through more effective skill mix utilisation of substantive staff.
The system will enable medical staff leave to be more visible and transparent to other services, to
assist with more effective utilisation of the Trust‟s resources. Benefits can also be realised from
having an overview of all doctor rotas (cross site and cross speciality) and from having a central
store for all medical staff working patterns (Job plans, junior doctor rotations, on-calls).
In addition, having a single, accurate repository for the entire staff deployment record (thereby
removing paper based records held at ward level) is a key Clinical governance benefit and may
lead to decreased insurance premiums if Governance auditing can be evidenced.
Implementation of an internal clinical bank in conjunction with electronic rostering will not only
improve the quality and effectiveness of rostering by enhancing the ability of managers to deploy
staffing resource effectively across speciality and directorate areas, it will also enable the Trust to
support improved clinical outcomes, patient experience and staff well being. In addition, the
integrated Bank system operates in tandem with the rostering system thus ensuring legislative and
Trust policy compliance across both employment situations. Other benefits of the establishment of
an internal clinical staff bank include:
Increased local control to improve the quality of bank only staff recruited and consistency in
training and education of staff to improve patient experience and clinical outcomes.
Improve the Trusts ability to plan for and respond to seasonal variations in workload
Enabling ward sisters to have full visibility on levels of Bank shifts worked by their individual
staff anywhere in the Trust.
Giving staff the facility to register for Bank work via the rostering systems Employee On-
Line functionality
8. IMPACT WITHIN INFORMATICS DIRECTORATE
The system will require implementation across user PCs and some additional local servers will be
required. The Business Case provides for implementation support from the company as an initial
start up with an annual charge for on-going system maintenance and support. There will be
however a need for a helpdesk/system administration support facility which could be shared with
other such provisions (e.g ESR system administration).
9. IMPACT ON OTHER ACTIVITIES/ DIVISIONS/DIRECTORATES
The system will need to be rolled out to all Directorates and specialties and therefore there will be a
project implementation resource requirement but staff will be required within each area to provide
leadership and support for the implementation and the project itself. The Business Case provides
for implementation support from the company to “Train the Trainers” and after this initial period it is
expected that the Trust will be self-sufficient in training and implementation support.
10. SCHEME DESCRIPTION
6
This is a web-based IT solution that will be deployed in every ward area and to cover all medical
staff, providing electronic rostering with an “employee on-line” facility which enables staff to access
their roster and personal details via the web.
11. FINANCIAL IMPLICATIONS (DETAILING VAT AND NON-
RECOVERABLE VAT) AND OTHER RESOURCES
INFORMATION TECHNOLOGY COSTS
The costs for the software, implementation and annual support are shown below, based on
software licences for the Trust‟s nursing and medical workforce These costs have been negotiated
by The Yorkshire and The Humber Commercial Procurement Collaborative under a regional e-
Rostering system procurement framework that allows Trusts to contract direct with their chosen
supplier (without the need for further tendering) under OGC Catalist contracting terms and
conditions:
Software licence for Nursing and Midwifery £236,000 Capital (one off cost
Software licence for Medical Staff £76,500 Capital (one off cost) Capital Charges
Year 1 £120,386
Software licence for Bank system £51,500 Capital (one off cost)
Year 2 £121,532
Implementation Services (Nursing and Midwifery) £83,000 Capital (one-off cost) Year 3 £117,747
Implementation Services Medical £62,500 Capital (one-off cost) Year 4 £113,962
Year 5 £110,177
Implementation Services Bank £31,200 Capital (one-off cost) Year 6 £4,207
Trust Implementation Resources £421,983 Revenue total over 18 months
Hardware Costs £20,000 Revenue - per annum N/A
Support & Maintenance for Rostering (Nursing and £55,500 Revenue - per annum N/A
Medical)
Support & Maintenance for Bank £9,090 Revenue - per annum N/A
SYSTEM IMPLEMENTATION – PROJECT INTERNAL REVENUE COSTS
In addition to the implementation support provided by Allocate Software, the Trust will need to
provide project implementation resources for 18 months at a total cost of £422k (maximum). This
cost can be either capital or revenue and the costing options are set out in the Cost-Benefit
analysis below.
TRUST PROJECT RESOURCE (FOR NURSE ROSTERING AND BANK AND
ROSTERING FOR MEDICAL STAFF):
Overall Project Manager Band 8a 1 wte 18 months £78,113
Nursing Rostering project Band 6 1 wte reducing after 18 months £45,636
lead 12 months to 0.6 wte
Medical Rostering project Band 6 1 wte 12 months £34,924
lead
Project implementers Band 6/5 5.0 wte 18 months £245,502
Admin support Band 3 0.6 wte 18 months £17,808
TOTAL £421,983
Project Team support (on an as and when basis) to include IT, HR, Payroll and Staff Side Leads.
Medical Staffing Co-ordinators / Medical HR representatives available as required for the duration of the project. (not costed as
additional resource requirement).
SYSTEM SUPPORT – RECURRENT INTERNAL REVENUE COSTS
There will in addition be revenue costs associated with the rostering system management and on-
going training for nursing and medical staff around the use of the system. It is proposed to house
this with the existing ESR system administration and this will incur the following estimated
additional staffing costs:
7
1 wte Band 6 £34,924
1 wte Band 3 £20,006
TOTAL £54,930
TOTAL COST-BENEFIT ANALYSIS
The total cost benefit is summarised as follows:
Year Year Year Year Year
2010/11 2011/12 2012/13 2013/14 2014/15
£ £ £ £ £
Capital Costs
Software Licence 427,700
Implementation 207,623
Internal Project Implementation Resource 295,770 126,215
Sub Total Capital 931,093 126,215
Revenue Costs
Support & Maintenance 64,590 64,590 64,590 64,590 64,590
Bank Operational Costs - Pay 110,662 147,550 147,550 147,550 147,550
Bank Operational Costs - Non Pay 22,329 18,769 18,769 18,769 18,769
Inhouse Pay costs 57,665 68,319 79,256 79,256 79,256
Capital Charges 202,232 234,719 231,369 223,968 216,567
Internal System Support Running Costs 54,930 54,930 54,930 54,930 54,930
Hardware Cost 20,000
Total Costs 532,408 588,877 596,464 589,063 581,662
Savings
Nurse Rostering -317,708 -1,312,500 -1,500,000 -1,500,000 -1,500,000
Nurse Bank - commission -420,789 -675,947 -797,228 -855,968 -873,088
Medical Staffing -350,000 -885,000 -885,000 -885,000 -885,000
Total Savings -1,088,497 -2,873,447 -3,182,228 -3,240,968 -3,258,088
Net Savings -556,089 -2,284,570 -2,585,764 -2,651,905 -2,676,426
Note :
The above capital costs and capital charges include VAT at 17.5%. Any potential VAT recovery needs to be discussed with the
Trust's VAT Advisor.
12. OPTIONS CONSIDERED
ROSTERING OPTIONS
From the internal review undertaken in the Trust there are a number of areas that urgently need to
be addressed. Bank, agency and overtime expenditure in particular remains high although
decreasing in this financial year. The Trust is therefore presented with two options to improve the
deployment of staff:
Option 1 - Attempt to improve using manual systems. This is not realistic as this cannot
provide real-time information on staff useage, will take a significant resource to match the
efficiency and timeliness of an electronic system and will still result in staff rosters that will
be inefficient.
8
Option 2 - Improve the existing workforce processes, policy and management with
technology as an enabling, operational tool at local level, providing Key Performance
Indicator based decision-
making support.
The Trust assessed the availability of technological solutions through:
A procurement process which in 2009, was through the Yorkshire & Humber Commercial
Procurement Collaborative, a regional procurement framework exercise, during which
suppliers of eRostering systems were analysed.
An analysis of existing implementations by suppliers in the region and nationally.
Extensive demonstrations covering all aspects of the solutions.
Recent contract awards in the region.
Identification and testing of those systems with the ability to fully „manage‟ our medical
workforce, at both Consultant and junior doctor levels
In 2007, the Trust reviewed a number of available providers in the market at that time. Four main
suppliers were identified and invited to submit information and provide a demonstration of their
systems as a precursor to a procurement process. These were:
Company and Product Decision Reasons
SmartWorkforce Rejected Cost and limited benefit and a limited user base and no robust functionality
solutions for rostering medical staff.
Rosterpro supplied by HMT solutions Rejected Limited functionality and major concerns around service and reliability, as
well as also no functionality for medical staff.
Optimize supplied by Powertech Rejected Only live in one Trust at that time and therefore deemed to pose a risk
around implementation and support.
MAPS Healthroster Allocate Software Approved Best rostering capability, largest (growing) client base in the NHS plus tried
plc) and tested implementation methodology. Evidence of NHS customers
satisfaction with the product.
It was therefore decided to undertake further evaluation of the MAPS system however this would
have cost in the region of £30,000 and was not progressed at that time. In early 2009, e-Rostering
was revisited and MAPS Healthroster (now called Allocate Software), having been identified as the
preferred supplier previously, were invited back to provide an update on their system. Their service
had changed in the intervening period and they were able to undertake an evaluation of their
system in the Trust at no charge and with no obligation.
At the same time, the Yorkshire & The Humber Regional Commercial Procurement Collaborative
undertook an exercise to produce a regional procurement framework consisting of a number of
suppliers of Time & Attendance and Rostering Systems. Both E-rostering and Bank Management
Systems are under this umbrella contract and if procured through this route, our liabilities have
been met and there is no need to advertise.
The Trust therefore was able to use Allocate Software as a preferred supplier with no need for a
further procurement process and their evaluation process was undertaken, looking at the difference
between the Trust‟s actual rosters and ones produced through e-Rostering, to quantify the possible
benefits to the Trust (Appendix One).
BANK OPTIONS
Five options for improved efficiency and effectiveness in the delivery of temporary nurse
and midwifery staffing within the Trust were considered. These are;
Option 1 Continue with NHSP as sole supplier of temporary nursing and midwifery staffing in the Trust.
Option 2 Internal clinical staff bank using Allocate Softwares Trinity bank system with no secondary supplier
Internal clinical staff bank using Allocate Softwares Trinity bank system with NHSP as secondary supplier
Option 3
internal clinical staff bank using Allocate Softwares Trintiy bank system with an alternative secondary supplier
Option 4
Option 5 Alternative provider as sole provider
9
NHSP HOSTING ARRANGEMENT (ROSTERING AND BANK)
As of 18th December 2009 NHS Professionals have since proposed an outsourced management of
the nursing bank and incorporating eRostering, covering the same staff groups as the proposed
licence offer from Allocate software but also including all annual maintenance. NHSP Fees
include:-
Fixed Charge subject to indexation - Qtly in advance £144,126
Flexible Worker shift charge - Monthly in arrears 2.2%
Agency Shift Transaction Charge - Monthly in arrears £4.25
Rostered Shift Charges - Monthly in arrears (would be in range of 1,250,001 - 1,500,000 shifts at
£0.10 per shift).
These costs are based on the assumption of a contract length of up to four years. The following
table shows the relative cost of the NHSP proposal versus the Trust purchasing via Capital.
Cost/(Benefit)
Trust to purchase along
For NHSP Proposal with option 3 if LTH purchases
£ £ via Capital
Year 1 1,135,008 1,501,121 366,113
Year 2 965,890 557,516 -408,374
Year 3 975,137 299,829 -408,374
Year 4 989,626 296 220 -693,405
Costs in Year 5 will include Capital charges and Maintenance costs if purchased in house via the
Trusts Capital allocation, (total £190K), however NHSP‟s information only states that the contract is
for 4 years so there still could be a possibility of the Fixed Charge (circa £580K) plus other variable
usage charges per year. The NHSP option includes the Trusts Capital charges for the
implementation of the system as these will run for 5 years (total £36K).
13. PREFERRED OPTIONS
Rostering
Following the assessment of existing processes within the Trust, Option 2 - Improve the existing
workforce processes, policy and management with technology as an enabling, operational tool at
local level, providing Key Performance Indicator based decision-making support is recommended.
An integrated electronic rostering and bank management system is the only means of providing
easy access to information across all levels of management in the Trust about the deployment of
staff. This will enable local input and will also automatically aggregate information so that local
decision-making can be performance managed.
Following review, the Trust confirmed that the preferred supplier of such a system is Allocate
Software plc. They have been selected because the company is now the UK‟s leading provider of
NHS E-Rostering systems, with 99 trust-wide E-rostering NHS customers, 63 of which are acute
Trusts, significantly more than any other supplier. They are the only supplier that has proven
implementations covering doctors and their projects have also been identified by the National Audit
Office and NHS Employers as examples of best practice. They are available for supply from pre-
tendered national and regional framework contracts. Demonstrations of the MAPS Healthroster
system have been well received by Consultant Anaesthetists as well as senior Nursing,
10
Operational, Service, HR and Payroll leads. Their track record with doctors, as well as the above,
was a key reason for their selection.
In addition, integral to the E-Rostering system provided by Allocate Software (MAPS Healthroster),
is a proven Bank Staff Management System (BSMS) that provides end-to-end management of the
whole staffing process. Over 20 NHS Trusts from the Supplier‟s E-Rostering client base have
implemented the integrated bank system alongside the rostering system, with the creation of an in-
house centralised Bank office.
This business case is therefore recommending the implementation of an integrated E-Rostering
and Bank Solution in conjunction with establishing an in-house Bank Management service which
will require the current NHSP service to be decommissioned.
Bank System
The preferred option for delivery is the establishment of an internal clinical bank with NHSP as
secondary provider in the first instance. This is necessary as the Trust will still require temporary
staff who are not currently employed by the Trust. This will move through a phased approach to
eventually an internal bank with no secondary suppliers by 2013-14 as the Trust will improve
deployment and recruit more substantive staff in place of bank staff. This option realises the
greatest savings for the Trust and enables full integration with E-rostering.
14. RISKS
Issue Risk and Cost Rating How managed Responsibilities
Bank System Contractual position with NHSP Low The adoption of a phased
might delay or prevent a move approach to delivery mitigates the
to an in-house bank.There may risk of a dispute with NHSP
be political consequences of regarding disengagement from the
disengagement with NHSP due existing service level agreement.
to the potential impact upon the
regional health economy. This
might prevent the move to an in-
house bank and will impact
benefits significantly if required
to continue with existing use of
NHSP.
Delayed Rostering system is procured Medium Adequate resources to be Senior Management
implementation but not fully implemented - committed to implementation and Team
maximum benefit of the system robust project management
not fully realised. This would arrangements and infrastructure Director of Nursing
reduce or even negate the are in place within a short time
benefits identified earlier. scale to enable delivery of the HR Director
Implementing proposed IT project
platform is a significant change
management project and IT Ensure that the use of the system
implementation project. becomes mandatory.
Lack of Rostering system procured but Medium Adequate resources to be Senior Management
Engagement not fully implemented because committed to implementation and Team
of failure to engage medical robust project management
staff and/or nursing staff so that arrangements. Director of Nursing
the maximum benefit of the
system is not fully realised. This Ensure that the use of the system Medical Directorate
would reduce or even negate becomes mandatory
the benefits identified earlier.
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Issue Risk and Cost Rating How managed Responsibilities
Difficulties in The Trusts may not be able to Medium The adoption of a phased Director of Nursing
recruiting more recruit the additional staff approach to delivery through
staff to Bank required to ensure no breaches utilising option 3 in the first
of WTD and reliance on NHSP instance mitigates the risk of the
as a secondary provider within Trust being able to recruit
the project roll out timescale. sufficient bank only staff or
increase the number of Trust staff
NHSP staff might fail to migrate working bank shifts in the early
over to the internal bank. stages of implementation.
Equal Pay claim The Trust might be subject to Medium The Trust will employ staff on a HR Director
equal pay for equal work claims separate bank contract (like many
as the „method‟ of clinical staff other Trusts in the NHS) with
working additional hours differs terms and conditions that reflect
to other staff groups. The cost the rate of pay and are then not
would be that bank shifts would overtime hours.
have to be paid at overtime rate
for full-time staff.
15. TIMETABLE
The implementation of both Rostering and the Bank System will be delivered in parallel over an 18
month period. The implementation will follow Allocate Software‟s tried and tested methodology
which is designed to maximise the speed and efficiency of the initial implementation but also
ensure the stability of the system thereafter. It is proposed that the internal clinical staff bank
becomes operational on 1st April 2010 with a phased implementation over all nursing areas by the
end of March 2011. Reliance on the secondary supplier will be phased out over a four year period.
Implementation of the preferred model will be led and managed through the Nursing Directorate
working in close partnership with Human Resources. A project manager will be appointed and as
far as is possible and practicable, implementation will run alongside the implementation of the e-
rostering system; however where necessary to achieve full implementation by March 2011 the
bank module will be implemented on a stand alone basis.
16. RESPONSIBILITY (FOR PROJECT AND PROJECT DOCUMENTATION
(IE TENDER SPECIFICATION, POST-PROJECT EVALUATION)
The Director of HR will be responsible in conjunction with the Director of Informatics for the
establishment of the Project and initial documentation. Implementation and post-project evaluation
will be undertaken in conjunction with the Director of Nursing and the Medical Director.
17. POST PROJECT EVALUATION
Post-project evaluation will be undertaken in conjunction with the Director of Nursing and
the Medical Director.
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APPENDIX ONE
REPORT ON EVALUATION PILOT IN THE TRUST
The e-rostering pilot across four typical nursing areas in the Trust identified efficiencies from
improved rostering of an average of 0.75 wte per unit per annum. Applied to all nursing units in the
Trust, these efficiencies equate to around £1.5m in reduced bank and temporary staff usage. The
nurse workforce roster assessment was undertaken across four representative areas and the table
below summarises the efficiencies gained in the respective service areas from improved rostering
via the MAPS Healthroster system.
ROSTER EFFICIENCY SAVINGS
Chapel Allerton Orthopaedic Centre (CHOC 0.1
Ward 29, LGI (acute medical with elderly beds
0.4
Ward 25, SJUH (acute receiving unit for over 80s)
1.6
Ward 89, SJUH (haematology and bone marrow transplant 0.9
Average 0.75
The key objective of the assessment was to identify the value that could be realised from the
introduction of electronic rostering, demonstrated by using the MAPS Healthroster solution.
During the review, savings were primarily focussed and objectively measured in three key areas
across the process:
Establishment variance between the service area‟s demand and budget allocation that can
drive excessive expenditure.
Actual improvements in the rostering effectiveness via the use of the MAPS Healthroster
system
Temporary staff use in addition to that predicted via the unfilled duties on the generated
roster that could show excessive utilisation of temporary staff.
A presentation of the main findings was made to the Trust‟s Executive Team on 22nd July 2009, as
follows:
1. Clinical Governance Records
There are inconsistencies across the Trust‟s various paper based documentation resulting
in an inaccurate record of care. Staffing changes and temporary staffing records are not
consistently maintained across all processes and the Trust is therefore at risk of having
inaccurate Clinical Governance records.
2. Payroll Inconsistencies
The Trust‟s current paper processes indicate that in a typical month a number of staff may
be paid incorrectly. A comparison (covering 120 staff) based on the Trust‟s „final record‟, i.e
the final paper-based roster, identified at least one inconsistency in 33% of cases against
the enhancements paid through payroll.
3. Budgets and Staffing
There is a lack of clarity regarding activity levels, rostering demand and staffing budgets.
The foundations on which rosters are being built are not clearly understood across all
stakeholders, resulting in ineffective use of staff. There are significant inconsistencies
between the Finance and Nursing view of establishments.. All areas involved in the
exercise were identified as having budgets in place which are RN and particularly HCA
poor, the result being that RNs are often fulfilling HCA duties.
4. Non-Clinical Work, Absence and Downtime
Leave management across the Trust could be significantly improved. Whilst there is a clear
focus on sickness absence, this accounts for a small element of the budgeted 20% down
time and sufficient focus is not given to other types of absence, e.g. annual leave, study and
training leave. In the worst cases across the areas under review, 46% of registered and
47% of unregistered nurses were unavailable due, in the main, to „manageable‟ absence.
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5. Subjective Temporary Staffing Requests
The inefficiencies in staff scheduling driven by items 3 and 4 above mean that clinical
services directorates are unable to maximise the use of their existing substantive staff,
resulting in temporary staffing usage which is not controlled and objectively driven.
6. Staff Preferences
High levels of staff preferences, in some cases, are the dominant driver for staff scheduling
rather than service delivery. This can exacerbate staff deployment complexity and again
has significant impact on temporary staffing usage. Whilst from the Trust‟s perspective a
ward or team may appear to have the right levels and mix of staff to meet Service delivery
requirements, where staff are not flexibly available, the over-rostering of staff on certain
shifts will lead to shortfalls elsewhere, resulting in further temporary staffing usage.
7. Overlap Times
The early / late shift times overlap in all areas reviewed, at a minimum of 3 hours and 10
minutes, is well above the national average.
8. Unfilled Shifts
High levels of unfilled shifts existed in all areas reviewed, the result of budget and staffing
demand mis-alignment, poor management of staff „downtime‟ and high levels of staff
preferences.
9. Lost Contracted Hours
Despite all of the above, and particularly the high levels of unfilled shifts, in the worst case
under review, 2.5% of available contracted hours were lost / not utilised.
Roster Assessment: Budget and Roster Demand alignment
The table below summarises the extent to which „perceived‟ service area staffing demand differs
from that which has been set in the budgets. The following is clear:
In all cases the RN and HCA budgets do not match the staffing levels against which the
ward managers are rostering. This can lead to negative outcomes, both financially and in
terms of quality of patient care.
In all cases and despite the above, RNs are fulfilling HCA shifts. Notwithstanding the
obvious cost implication, this can lead to motivational/morale issues with the additional
potential impact on sickness absence levels
WARD BUDGET DISCREPANCY
Demand (+20%) Budget – Demand
Budget (WTE)
(WTE) Variance (WTE)
RN HCA RN HCA RN HCA
CHOC 42.5 13.9 53.5 14.7 (11.0) (0.8)
WARD 29 19.4 8.7 21.0 15.0 (1.6) (6.3)
WARD 25 21.7 11.1 23.7 14.5 (2.0) (3.4)
WARD 89 25.0 3.8 26.2 5.0 (1.2) (1.2)
TOTAL
(15.8) (11.7)
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