Spending on agency and bank nurses is soaring this year, driven by staffing cuts and increasing demands on services, an investigation by Nursing Times has revealed.
Payments for agency and bank staff are likely to be 20% higher this financial year than in 2011-12, and could pass £450m across the NHS.
The rise in spending on expensive temporary staff comes despite trusts being under pressure to cut costs, suggesting some are concerned they may have reduced their permanent workforce too much to ensure safe quality standards.
Others may have been forced to fill staffing gaps to maintain services experiencing ever increasing demand and continuing pressure from staff sickness.
The Nursing Times collected data from 100 acute trusts in England via Freedom of Information Act requests.
The investigation found small increases in agency and bank spending were widespread. But around 15 trusts had seen their spending at least double – in part because of pressure on their services, such as increased accident and emergency attendances and early outbreaks of norovirus in the autumn.
The need to fill shifts is so severe that some trusts have paid over £1,000 a shift for agency staff, the investigation found.
The biggest pay-out identified was made by scandal-hit Mid Staffordshire Foundation Trust. It had to pay nearly £1,800 for a specialist nurse to work a long A&E shift in December 2011.
But while Christmas and New Year present obvious staffing difficulties and may command premium rates, several trusts had paid more than £600 per shift in other months.
The trusts that responded to the FOI request spent a total of £238m on temporary staff during the 2011-12 financial year. They had already spent £169m on temporary staff during the first seven months of this financial year.
Based on that level of spending continuing, the trusts are predicted to have spent around £286m in total during the whole of 2012-13. However, this is a conservative estimate as it does not take into account increased use of temporary staff during the winter months.
Professor James Buchan, a nursing workforce expert based at Edinburgh’s Queen Margaret University College, said this might be the case for a minority of trusts but .
“Some trusts are freezing posts to save money and then finding they can’t cope, and have to bring in cover, and a small number of trusts may be trying to build in greater flexibility by having a proportion of the workforce they call on when management think it is warranted,” he said.
“The former reflects short-sighted and poor management; the latter approach increases risk to care, unless there are very effective systems in place to monitor workload and local staff with the right skills at short notice,” he warned.
But Helen Rudanec, managing director of the agency HCL Nursing, argued that using agencies to provide workforce flexibility could be productive for trusts. “It costs a lot of money to take someone on permanently whereas you can flex with agencies,” she said.
She confirmed that demand for her company’s services had increased month-on-month. Demand is so high that her agency brought in 112 European nurses last year, offering them an element of guaranteed income, she said. It expects to at least triple that number this year.
Royal College of Nursing head of employment relations Josie Irwin said the figures were suggestive of a looming shortage of nurses in at-least some areas of the UK.
“There is not enough supply coming through and we have this emerging shortage,” she said. “There are recruitment and retention issues – and high levels of sickness – that temporary staffing is masking.”
Academics warned that there were potentially negative effects on quality of care and patient safety from using high levels of temporary staff.
Professor Buchan said that, although the evidence base on the use of temporary staff was limited, there was likely to be a range in risk.
For example, bringing in bank staff who knew the trust, staff and patients would be at the safer end while using very short-term agency nurses – who may need orientation and supervision – was at the other.
Professor Peter Griffiths, chair of health services research at Southampton University, said evidence suggested using agency staff to cope with peaks in demand was not always cost-effective.
“The staff are relatively less effective and expensive. It might be that this is a case of savings in ward staff driving increased costs elsewhere.
“You really need to look at the total wage bill to see if there are any savings and to keep a very close eye on quality to be sure that there are no harms,” he said.
|High Spenders on Agency and Bank Staff|
Big London trusts have traditionally relied heavily on temporary nursing staff – and a small number run of bills of over £10m a year. But Nursing Time’s research showed that some of the most dramatic rises in spending this year has been among ‘normal’ DGHS. There is a strong geographical divide with the majority in the south, including a cluster in the south west which is often regarded as a low turnover area.
Among these trusts, five are likely to see spending on temporary nurses quadruple this year with one – University Hospital of North Staffordshire – facing a seven fold increase: