Bridgewater Community Healthcare NHS Foundation Trust (Bridgewater) is a leading provider of community health services in the north west of England, operating a network of 180 different locations.
Bridgewater provides high quality community and specialist services to almost a million people living in Bolton, Halton, Oldham St Helens, Trafford, Warrington and Wigan Borough.
The majority of services are delivered in patients’ homes or at locations close to where they live, such as clinics, health centres, GP practices, community centres and schools.
They employ 3,400 staff and have an income of £140 million which comes from their commissioners, who include Clinical Commissioning Groups (CCGs), NHS England and local authorities.
Set against a backdrop of a growing demand for 24/7 access to health and social care professionals and increasing financial challenges within the NHS, Bridgewater’s first and foremost objective is to fulfil its contractual NHS obligations and deliver high quality, safe and effective care which meets both individual and community needs.
In late 2015, with a growing need for around-the-clock, quality, appropriately qualified, staff at competitive rates – and after a particularly demanding internal audit – the senior management team at Bridgewater identified a number of challenges, regarding their temporary recruitment.
They approached de Poel health+care for a simple, compliant, cost-effective and sustainable solution that could be implemented across their various community sites, addressing the following:
1. Limited visibility of expenditure and a lack of important Management Information – resulting in poor central management control and not being able forecast effectively.
2. The requirement for visible in date compliance, employment checks that adhered to NHS employment standards and framework requirements and quality control, to ensure none of their 180 locations were left vulnerable to patient care and CQC inspection risks.
3. The logistical, commercial and legislative risks arising from dealing with multiple recruitment agencies, operating under separate terms and separate commercial arrangements.
4. The lack of transparency caused by agencies invoicing charge rates only, with charges varying agency-to-agency and location-to-location. This issue was compounded by some agencies charging differing rates for the same type of worker from the same agency at different locations.
5. The high dependency on agencies operating off the NHS Improvement-approved national/regional framework agreements – contravening the recently introduced rules, regarding the use of agency staff brought in by Monitor/TDA.
In order to ascertain a true understanding of the situation, de Poel health+care offered to carry out a ‘deep dive’ detailed analysis of Bridgewater’s current position, using their dedicated project management resource.
The de Poel health+care model works by creating a compliant, agency panel whereby all supplying agencies agree to transparent, standardised terms and conditions and rates. These are locked down in de Poel’s proprietary software system, known as e-tips®. All staff bookings are ordered through e-tips® – a simple, easy and quick way to track and manage the recruitment process.
Following the analysis, de Poel health+care presented a detailed operational and cost reduction proposal, in which they suggested an innovative, sustainable model that could be implemented across all of Bridgewater’s sites. Importantly, this could be delivered whilst Bridgewater continued to fulfil their contractual NHS obligations, and deliver the very best patient care and wellbeing.
When the contract went live in late January 2016, the implementation process took just eight weeks, with a dedicated Contract and Performance Manager appointed to visit sites, train staff on systems and understand the service requirements, supported by an out-of-hours fulfilment service.
Since going live just ten months ago, the results of the partnership have been outstanding:
• With spend now over £2.2 million, nearly 60,000 hours of quality care have been delivered, whilst achieving £203,100 in cost savings. Most crucially, this has not been at the expense of patient safety.
• Through de Poel health+care, Bridgewater now has a single agreement and single set of rates/terms and conditions. Through setting and monitoring KPIs and implementing NHS Improvement rate caps, supplying agencies now compete on quality rather than price.
• The amount of spend going “off framework” has dramatically reduced, with a relentless focus to eradicate completely. Use of de Poel health+care’s electronic ordering system, e-tips®, enables hiring managers to contact multiple framework compliant agencies in seconds, with just a few clicks of the mouse.
• Bridgewater now has access to an increased talent pool of GPs, prison nurses, physios, practitioners, pharmacists, IT engineers and admin staff – with over 40 compliant agencies on their panel.
• In a recent monthly analysis, nearly 10,000 worker hours (266 FTEs) were recorded and a fulfilment rate of 95% was achieved, with the majority of rates being compliant with the April level rate caps. This control and visibility would not have been possible without e-tips®.
• Compliance is managed via the system and meets NHS Employment Check Standards and framework requirements. In addition, it is backed up by rigorous supplier audits carried out by de Poel health+care on Bridgewater’s behalf. Workers cannot be put forward for a role on the booking system without full compliance checks.
• Prior to using the e-tips® system, Bridgewater did not have assurance that their agency workers had correct compliance checks. A recent internal audit confirmed they now have ‘significant assurance’ on the compliance of their agency workers.
• e-tips® has also provided Bridgewater with much-needed visibility and control of their temporary staffing spend, enabling them to forecast efficiently with access to real-time Management Information.
• The system has reduced thousands of invoices to a single, consolidated, weekly invoice. This has saved a considerable amount in terms of administration and resource – allowing Bridgewater to refocus their time and energy elsewhere.
• So far, by implementing the de Poel health+care model, the Trust has saved around 8% from the previous cost in real cashable savings, whilst ensuring the very best temporary staff are working with patients. In addition, there have been savings related to back-office processing and temporary staff ordering.
de Poel health+care is working with Bridgewater to introduce an online staff bank management service. This will help to not only build their bank of workers, but manage their availability and bookings through e-tips®, which has recently been updated to reflect NHS requirements. This will aim to increase bank usage and effectively reduce the use of agency staff. Phase one of this project will be rolled out with community and district nursing.
de Poel health+care and Bridgewater are also currently scoping and planning a locum ‘direct engagement’ model, designed to reduce unnecessary expenditure on VAT.
Testimonial from key sponsor
Mark Duffy, Senior Procurement Partner at Bridgewater Community Healthcare NHS Foundation Trust comments:
“I would highly recommend the de Poel health+care approach to any NHS Trust or healthcare operation with a high dependency on temporary staff, wishing to gain greater control, transparency and quality whilst ensuring best overall value.
“Before our partnership began, major issues we faced surrounded the lack of Management Information available in a timely manner, and managing a large number of temporary recruitment agencies all working to differing Service Level Agreements. Through de Poel health+care, we now work with a select number of agencies that have signed up to our standard terms, meaning we can continue to deliver consistent levels of high quality care at all times, across all our 180 locations. The cost savings generated since late January have also been impressive.
“Our dedicated Contract and Performance Manager, Carmen Farrow, works closely with our operational teams, providing continuous support and expertise in those areas experiencing challenges, related to supply or quality.”
Ramsay Health Care is one of the largest private healthcare organisations in the UK, operating a network of 31 hospitals and 4 neurological units. Ramsay Health Care delivers both private treatment and care under contract to the NHS.
In order to support their operations and deliver their contractual NHS obligations, Ramsay requires instant access to high quality, appropriately qualified temporary staff at competitive rates.
In 2013, with a growing need for temporary staff, the senior management team at Ramsay Health Care identified a number of challenges:
1. Poor visibility of expenditure and a lack of meaningful management information
2. The need for more robust candidate quality checks and quality control to ensure the organisation was not left vulnerable to patient care and CQC inspection risks
3. The logistical, commercial and legislative risks arising from partnerships with 100 recruitment agencies, all operating under separate terms
4. The lack of transparency caused by agencies invoicing charge rates only, with charges varying agency-to-agency and location-to-location. This issue was compounded by some agencies charging differing rates for the same type of worker from the same agency.
Working with de Poel health+care offered answers to all of these issues. Ramsay Health Care now has one agreement with de Poel health+care and a single set of rates/terms and conditions, with a reduced agency panel.
de Poel health+care’s leading management information and invoicing system, e-tips®, also provided the much-needed visibility in terms of usage, activity and cost of the temporary labour force. The consolidated, weekly invoice has saved a considerable amount in terms of processing time and resource.
Agencies understand the quality of staff needed, whilst compliance is managed via the system backed up by rigorous supplier audits carried out by de Poel health+care, on Ramsay Health Care’s behalf.
As a result of the partnership with de Poel health+care, Ramsay Health Care has seen a 6% reduction in relative agency expenditure.
Additionally, compliance is tracking at 98%; an increase of 50%.
Matthew Watts, Category Buyer for Indirects of Ramsay Health Care, said:
“Although this is largely an internal problem to fix, our de Poel health+care account manager, David Neville, is working tirelessly with us to resolve this situation.
I would highly recommend the de Poel health+care approach to any Healthcare operation with a high dependency on temporary staff, wishing to gain greater control, transparency and quality whilst ensuring best overall value.
Our dedicated de Poel health+care Account Manager, David, works very closely with the operational teams, providing continuous support in those areas experiencing challenges, related to supply or quality.”
Ramsay Health Care now has a dedicated line for booking temporary resource at one site, with plans to roll this out across all of their sites by the end of 2015.
This enables them to have one point of contact, rather than liaising with up to 20 agencies, resulting in time and efficiency savings of around half an hour a day, as well as annual savings of around £120,000 compared to the previous supplier’s cost.
From September, de Poel health+care will also be working with Ramsay Health Care to roll-out a similar system across its supply of permanent staff, helping it benefit from the holistic range of services offered by de Poel health+care.
The work of around 50-60 recruitment managers’ time will be freed up as this will all soon be transferred to a single manager at Ramsay Health Care and a dedicated recruitment partner at de Poel health+care, meaning significant cost savings in terms of reduced time and also the associated recruitment marketing and advertising costs.
Founded in 1982, Care UK has grown to be one of the leading providers of health and social care services in the UK. They offer a wide range of services from mental health to care services, from hospital to care homes and pride themselves on providing a high quality service centred around the specific needs of each individual they work with.
Care UK work to understand people’s personalities and background to create a plan of care which fits in around their lifestyles, hopes and aspirations.
Care UK identified the importance of having a consistent level of quality care throughout their business and the services they provide however, realised that by using multiple agencies across the UK, coupled with a lack of accessible Management Information, that managing the quality of care needed addressing.
After identifying and understanding the risk, in 2010, Care UK partnered with de Poel health+care, global workforce solutions specialist, to manage the temporary workforce across their business.
In the first three years Care UK began working with de Poel health+care, the level of quality that they received, in terms of their supplier base, was far greater than it had been. By standardising pricing on the temporary labour supply base the focus was taken away from price and instead the focus for agencies shifted towards quality. The differentiators now are quality driven, the kind of care that Care UK now gets is much more important to their agencies.
Standardising price has also provided Care UK with a level of cost savings on their temporary labour agency spend across the business. Consequently, it’s a much more equitable level of pay that Care UK is now paying towards agencies and ultimately to the temporary staff themselves.
Since 2010, de Poel health+care has reduced Care UK’s agency supplier base by half. All of these agencies are now on the same terms and conditions, and are also regularly audited by the de Poel health+care audit team. Combining these two elements ensure Care UK continue to receive first-class candidates from their agencies and in turn, provide this first-class care to their service users.
The visibility and control information has changed enormously for Care UK since 2010. Through de Poel’s web-based electronic timesheet and invoice processing system, e-tips®, Care UK now have real-time Management Information available to all operational teams across the business. Whereas previously it might have taken up to six weeks to obtain detailed spend data they are now able to extract spend data whenever they want.
There have also been a number of additional benefits for Care UK. They are now processing about 99.5% less in terms of the volume of invoices; receiving one invoice per week instead of 100 that they were previously experiencing. For their accounts payable team, this has resulted in a significant reduction in processing administration, allowing resource to be re-distributed within the business.
Care UK has also benefitted from a dedicated Account Management team, who understand the needs and requirements of Care UK as a business, as well as their service users. Being quite a unique business, offering a broad range of services, it was integral that the Account Management team could empathise with the Care UK operators and understand the daily pressures; something the Account Management team successfully continue to achieve.
As de Poel health+care continue to provide added value for Care UK, their dedicated account management team are now working to grow and develop the organisation’s bank management solutions.
By sourcing qualified and suitably trained temporary staff for duties as bank staff, de Poel health+care will be able to add a higher level of cost control and transparency for Care UK.
Furthermore de Poel health+care are working to introduce temporary direct hire solutions, implementing self employed medical professionals through a direct engagement model – VAT mitigation and introducing mandated spend – enforcing contractual rights.
Christoph Marr, Group Procurement Director, said:
“The major issues we were facing before working with de Poel health+care was the lack of management information available in a timely manner and working with a large number of temporary recruitment agencies. Since working with de Poel health+care we now work with a select number of agencies that have signed up to Care UK standard terms. Our primary reason for entering into the project with de Poel health+care wasn’t just to save costs, it was to ensure first class and consistent high quality of care across all our locations. Since working with de Poel health+care, pricing has been standardised across all our panel agencies which means our agencies now compete on quality of staff not on price. In addition, through the de Poel e-tips® system we have reduced the number of invoices we process by 99%.
I am delighted to be working with de Poel health+care. Saving money and increasing visibility of our spend in this area is of course important to Care UK, but our primary concern is to uphold the quality of care we provide and our ability to offer tailor-made service solutions to our customers.
Using the de Poel health+care solution allows Care UK to strike the right balance. Their expertise in the agency marketplace, coupled with their appreciation of the specific needs of the care industry, has given us confidence in their ability to deliver exactly what they said they would.
The introduction of their electronic timesheet invoice and processing system, e-tips®, has streamlined our administration processes and provided us with real-time Management Information of our temporary agency labour.”
When de Poel health+care partnered with Scope in October 2011, the objective was to implement a framework which would support their operation to give clear visibility over their entire supply chain. The national charity wanted to ensure their management team would have access to key information as well as reassurance regarding compliance. Managing Director of de Poel health+care, Andrew Preston, spoke to Richard Hawkes, Chief Executive of Scope, about how the de Poel health+care service is benefitting his organisation.
Why did Scope look to implement a managed service provider like de Poel health+care?
Scope is a national disability charity that exists to make this country a better place for disabled people and families with disabled children, running a whole range of services throughout the country.
When we look at the number of people we employ and how we recruit people, especially temporary staff, it’s absolutely crucial that we’re doing things as effectively as we can.
How has de Poel health+care helped Scope to have more visibility and control of their temporary staff?
Since we’ve been working with de Poel health+care it’s been so much more effective in that we’ve saved a lot of money, our processes and systems are better, the visibility of Management Information is a lot better and compliance issues overall are much stronger. Specifically our management team, through using the e-tips® system, get much faster information about individuals that we’re employing to make sure that we’re compliant in every area and we know information about those individuals in our area of work. When you’re providing social care to people you’ve got to be absolutely sure that you’re compliant.
Furthermore, by working with de Poel health+care we’re saving a lot of money. I think we’ve saved almost £200,000 since we’ve been working with de Poel health+care which has enabled us to use that money elsewhere in the best interests of disabled people. This enabled us to support more families with disabled children.
How has working with de Poel health+care helped Scope to streamline administration?
There was a time in the past where we had something like more than 8,000 invoices a year in regards to temporary labour. Since we’ve been working with de Poel health+care, that’s reduced down to one consolidated invoice a week. So, in an average year that used to be more than 8,000 and it’s now 52 – which obviously saves us a lot of administrative time, staff time and that’s another area of saving we’re then able to invest in the business overall – at the better interests of disabled people. The recruitment system itself is much more streamlined, managers can get better information and it’s reduced the administration from thousands to 52 invoices a year.
How do you find working with the de Poel health+care team?
One of the benefits of working with an organisation like de Poel health+care is that we’ve been able to take advantage of the huge areas of expertise and experience that the Account Mangers at de Poel health+care have. Rather than us simply buying an effective system we’ve also benefited enormously from consultancy services and advice from de Poel health+care colleagues, who have really helped us in understanding things like; what good looks like in recruitment practices or the way that people are managing systems and processes. My understanding from a large amount of my colleagues is that it feels much more like a partnership arrangement where we’ve benefited enormously, not only with the better system – but also from the great advice and the consultancy from the staff at de Poel health+care.
How has de Poel health+care helped provide clear Management Information?
We’re a disability charity and it’s really important that our managers are able to focus on the things that are important for the organisation, which is mostly about providing great services for disabled people. When it comes to Management Information, we’ve got to make sure that the information we need is easy and simple for our managers to access. The e-tips® system is great in that respect; very simple and at the push of a button a manager is able to get great information about individuals, time management and about the number of hours that people have been working.
The functionality of e-tips® really helps our managers understand their costs even more effectively, but more importantly it helps them plan more effectively as well. We know who we’ve been using to provide temporary staff and who we want to be using again in the future. It’s really simple, it really helps our managers and it really helps us as an organisation.
What has the agency panel done for Scope as an organisation?
The agency panel has really made a big difference to our managers. In the past they’ve had to worry about a whole range of issues to do with cost or legal aspects. Now through de Poel health+care they don’t need to worry about that because they have the confidence that using the agency panel, de Poel health+care is managing those issues. For us, this means our managers know that the different agencies are competing with each other on the service they’re giving, so our managers can make choices based on what’s best for Scope, without having to worry about issues like cost and legal compliance, because de Poel health+care is managing that through the agency panel.
How do de Poel health+care go above and beyond other managed service providers?
Perhaps one of the most successful parts of the partnership with de Poel health+care is that it really feels like a partnership; it doesn’t feel like a transactional relationship. We feel like we’re benefiting from consultancy advice, better systems and processes that are making us more effective as an organisation, allowing us to use our resources really effectively. Beyond that, what’s been great are the relationships we’ve established with individuals at de Poel health+care, as well as the company overall.
To support Scope, people at de Poel health+care have been taking part in fundraising activities for us, gaining sponsorship to do a range of different events. That not only helps raise the profile of Scope, but also promotes the issues that are important for us. We’re benefiting enormously overall, way beyond what you’d expect from a working relationship like this. It really feels like a partnership and we’re working together to make things much better for disabled people in this country.