You are being asked to reduce agency spend. Last time trusts did that at scale, sickness absence rose in the six months that followed.
When NHS trusts cut agency spend across FY 2020-21 to FY 2022-23, each £100 less agency spend was associated with about £2.70 of pay-bill-equivalent sickness absence across the six months that followed. That is a valuation of lost time at pay-bill rates, not cash, and we have not established that one caused the other. That is not a prediction about your organisation. It is what comparable trusts recorded the last time this decision was made across the sector, and it is the kind of thing that is very hard to put in a board paper without an independent source.
The position you are in
You are accountable for retention, absence and agency dependence. You have limited control over the establishment, the pay framework, the estate or the demand.
You are asked for assurance at every board meeting, from data that describes what already happened. When you say a target is unrealistic, you are heard as defending your function. When you agree to it, you own it.
What is missing is rarely more data. It is an independent comparison that lets you say “this is what happened to organisations like ours when they did this,” and have it land as evidence rather than as resistance.
Four things we can tell you that internal reporting cannot
1. Whether your agency reduction is likely to hold
Trusts that get out of the heaviest agency quartile are still out two years later 77.8% of the time, against 91.1% for trusts that were never in it. Most escapes hold. Relapse is 13.3 percentage points more likely than in trusts that were never there, averaged across three historical windows. If a target is going in the plan, that relapse rate belongs in the plan too.
2. How far your reported intention to leave sits from your actual leaving
Across English NHS trusts, around 22% of staff report an intention to leave. Around 10% actually go the following year. The gap sat at a median of 11.5 percentage points across 203 NHS trusts, and a trust's position relative to its peers largely held between 2021 and 2023: rank correlation 0.62, falling to 0.49 and 0.37 across single years. A wide gap is not a warning about the future. It is a property of the organisation, not of any individual. The two rates come from different measurements on different bases, and this analysis does not link a survey answer to a leaving date. The gap is a trust-level measurement and nothing below that level was observed.
Those are national figures. Your own gap is measurable from published data and ranges across trusts from under 5 to over 15 percentage points, which is why the national number is not much use on its own.
3. Whether your distress has stopped being visible
Eighteen trusts, 6.4% of the 282 trusts scored, show persistent multi-year distress in staff survey and workforce measures without corresponding regulatory escalation. Distress that lasts long enough stops triggering the alarm. If nothing has escalated, that is not the same as nothing being wrong.
Scored against all English NHS trusts. Ambulance services are over-represented because sickness absence and intention to leave run higher across that sector; on a within-sector comparison they are not unusual.
The Normalised Fragility watch list contains 18 trusts, 6.4% of the 282 English NHS trusts with enough years of data to be scored, including 7 of 10 English ambulance services. These are scored against all English NHS trusts. Ambulance services are over-represented on this measure because sickness absence and intention to leave run higher across that sector as a whole; on a within-sector comparison they are not unusual. Their agency use is in fact well below the national median.
4. Which of your pressures is actually the binding one
These three measures are close to independent of each other: mean absolute correlation 0.114, with the strongest pair at 0.217. You can be severe on one and unremarkable on the other two. No single mechanism is dominant for more than 26% of organisations, however we count it: 21.6% of trust-years on the panel we developed the measure from, 24.6% on a group of trusts held back before the analysis started and looked at only once it had finished, and 25.6% counted one row per organisation, which was a later check on the unit rather than a gate fixed in advance. There is no typical failing trust, which is exactly why a national programme designed for the average lands so badly in so many organisations.
What we cannot tell you from outside
We cannot see your tenure distribution, your staff age profile by organisation, your pay band detail, your vacancy figures, or your survey results broken down by staff group. NHS public data does not publish any of them. Fifteen of our seventy-nine tests could not be scored on public data for exactly that reason, and six of those are blocked outright. If your question needs those, it needs your data, and the honest answer is that a public-data review will not settle it. We would rather tell you that on a call than part-way into an engagement.
A test you can run this week, without us
Take your last staff survey. Find the percentage who said they were looking for another job. Then take your actual leaver rate for the following twelve months. The difference is your departure lag. The median across 203 NHS trusts is 11.5 percentage points. If yours is materially wider, you have a retention problem that your turnover figures are not showing you, and you can establish that before you speak to anyone.
What this changes in a board conversation
| Instead of | You can say |
|---|---|
| “Turnover is up and we are working on it” | “Our departure lag, the gap between the staff who say they intend to leave and the staff who actually go, sits at X percentage points against a peer median of 11.5, and it has been stable for three years, which makes it a structural feature rather than a bad quarter.” |
| “The agency target is challenging” | “Comparable trusts held their exit from heavy agency dependence 77.8% of the time. Here is the sequencing that has to precede the target if we want to be in that group.” |
| “We have no formal escalation, so we are managing” | “Eighteen trusts show sustained distress with no escalation. Absence of escalation is not evidence of absence of risk, and here is our position on the same measure.” |
| “We need more workforce data” | “We need one independent comparison, and it exists in data we already publish.” |
What we are not
We are not a recruiter. We are not a bank or agency provider. We do not sell rostering, e-rostering or workforce-management software, and we have no reseller relationship with anyone who does. We have no NHS contracts and no supplier relationships, so nothing in our commercial model depends on what we conclude about your organisation.
We do not forecast. Of seventy-nine pre-specified tests, every result is recorded, including the fifty that failed, and the register is available under NDA. One of our four original measures, Capability Collapse by Cluster, failed its gates and is named on this website as a documented failure.
We are also not neutral about one thing. If your data says the structure does not need to change, we will tell you that, and there will not be a programme to sell you.
Who you would be working with
The Labour Prefect was founded by Prince Opara, who holds CIPD Level 5 and an MSc in Leadership and Human Resource Management, and works as a Healthcare Assistant in a UK healthcare setting.
That combination is deliberate and it is unusual. The models describe rotas he has worked. When a finding does not match what the frontline experience says, that gets treated as a problem with the model.
What is the workforce decision you are least confident about right now?
You do not have to book anything to find out. Reply with one sentence describing the workforce decision in front of you. If published NHS data can speak to it, I will tell you what it shows. If it cannot, I will tell you that instead, and neither answer costs you anything.