Staff management

Bank is dead, long live the bank

Where it all began

Traditional bank systems are well established today within NHS trusts. Created from a need to manage fluctuations in staffing, bank departments sprung up to relieve ward managers from the burden of administration of dealing with staff shortages. Replacing the chart on the wall of the ward detailing who is available for work, bank systems and departments have grown to support ward managers as they try to find cover and plug the gaps in the roster.

As bank departments have grown to meet demand, many now manage pools of 500 staff or more, often with a team of a dozen staff to administer the staffing requirements across the trust. From the first call made by the ward manager, the process in many cases is still manual — the administrators have then to contact staff of the right level and experience and see if they are available for the required time. Drawing upon a pool of staff that is available within the trust reduces the need to employ costly agency staff.

However, much like the typing pool of yesteryear, the bank office as it currently exists is set for a radical overhaul, resulting in considerable savings for the trusts and better work/life balance for staff while ensuring optimised coverage for patient care.

A catalyst for change

There is no doubt that the manual bank processes have worked well for many trusts. Ward managers are relieved of the time-consuming job of finding staff to cover gaps, while the costs are managed effectively. It has enabled the ward manager to concentrate on front line work of managing the ward and ensuring quality patient care.

However, while such systems have provided benefits, the costs of administrating and staffing a bank office are not trivial, and many trusts have found themselves having to make the decision whether to run the bank themselves, or outsource to an agency.

While creating a bank department has off-loaded the work, it has resulted in extended processes, disparate systems and additional costs. Indeed, the current bank systems perpetuate the symptom (the need for a bank department), rather than solve the underlying issue, that of empowering ward managers to quickly and easily find temporary staff-from within the trust

Outsourcing to an agency is little better. With costs in the region of £300 for a nurse's shift and £1000 for a doctor's shift, using agency staff is both expensive and can be far more risky to patients.

While recent stories in the press highlight the fact that medical staff brought in from outside, without knowledge of local specialisations and procedures can have disastrous results on patient care and safety, at the very least, external staff are likely to be far less productive due to the fact that they have not been orientated with the ward and lack localised knowledge.

It is clear, also, that the problem of bank staffing cannot be handled independently from rostering. The ward manager is the expert when it comes to knowing what the best staffing levels are and what skills are required and often who the best people are to fill that gap.

A financial director is certainly qualified to look at costs and a nursing director at need, but it is the ward manager that is best qualified to judge who should be in the wards.

In addition, current drivers mean that NHS trusts are required to improve efficiency, drive down costs and reduce absenteeism. Staff rosters must comply with Working Time Regulations, the New Deal legislation for junior doctors, which stipulates working hours with penalties for the trusts for non-compliance, and be more sociable, enabling staff to manage a better work–life balance, which in turn is likely to lead to lower absence rates.

A new generation of technology

There is a now a new generation of technology that addresses the root cause by meeting the needs of the ward managers, modern matrons and financial directors, while also enabling trusts to make significant savings. A single integrated solution can provide a schedule with the right staff to meet gaps, and can automatically ensure compliance and follow approval processes. The system can assign the ideal person from a ‘bank’ according to skill mix, availability, preferences, fair play and avoid breaches to working time regulations, doctors' New Deal legislation and budget.

As well as providing a roster, the system can also feed into the payroll, ensuring that the employee is fairly and appropriately paid for their hours. Built-in functionality can also accommodate different terms and conditions. With previous systems that were not integrated, the member of staff’s main role and the bank role were often managed independently of each other.

For example, a nurse normally working at Grade 6 may be employed from the ‘bank’ to carry out work required for a Grade 5. In this instance, the nurse would be paid according to the job requirements, not their personal grade. Similarly, a single system takes into account the number of working hours according to their agreed terms of employment.

A key benefit of such a system is that the built-in approval processes provide robust and rigorous controls on expenditure, satisfying financial managers, yet still empowering ward managers.

The future — ensuring the best patient care

All trusts have a charter to deliver the best patient care, while at the same time managing costs and meeting strict government legislation on clinical practice, financial administration and staff employment.
Increasingly, the adoption of technology solutions enables such organisations to work smarter, increasing efficiencies with automated processes that can reduce costs. However, there are still elements where human intervention and experience play an important role.

Empowering experienced staff with the technology and information to make decisions and carry out their tasks will deliver the best results and meet the needs of the trust. In this way, a system that can empower ward managers to deploy temporary staff efficiently ensures that both the needs of the patients and the trust are met.

And is the bank really dead? Well the bank itself certainly not, but the army of people and processes that have been built up to administer the bank we firmly believe is dead. In future the bank system may have one administrator or power user to support the system (possibly the IT service department) with ward managers using the system directly as they need it.

Nurses, doctors and other staff would be able to request shifts, book time away and generally have a significant say in their own hours, enabling them to manage their work and home lives. This approach has been proven to reduce staff absence, while maintaining and improving patient care. In short, the new generation of bank systems provide a win, win, win situation, for the trust, staff and most importantly the patients!

Nick Whiteley, Managing Director, SMART.
SMART is a leading provider of solutions for workforce management aimed at helping companies to maximise the performance, productivity and value of their people.

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