Wards rely on agency staff as trusts strive to save cash

24 August 2010 | By Charlotte Santry

Trusts are undermining safety and efforts to cut costs by placing too much reliance on agency nurses, according to a report shared with Nursing Times.

Workforce experts have labelled the trend a “knee jerk” reaction to budget pressures and claim it is intensifying problems created by vacancy freezes and summer absences.

Late release of shifts is often due not to operational necessity but finances. This is counterproductive to trusts’ aims in terms of both costs and patient safety

The report, by the health service’s in-house temporary staff bank NHS Professionals, is based on data from 80 trusts, including acute, teaching, foundation and mental health trusts.

It reveals that acute trusts used 15 per cent more agency workers during April to June 2010, compared with the same period last year. The total number of shifts rose from 7,575 to 8,695.

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The report also shows the trend appears to be increasing month on month, with agency shifts in acute trusts rising from 2,602 in April to 2,953 in May and then 3,140 in June.

The report claims the rise is due to trusts waiting too long to decide whether or not to pay for bank workers - in the hope of plugging shortages internally to save money. As a result they are left with no option but to rely on external agencies, the report says.

It states: “Operational experience shows that late release [of shifts] is often due not to operational necessity but financial expediency. Most shift vacancies are visible in advance but not released due to financial pressures.

“This practice is clearly counterproductive to the trusts’ aims in terms of both cost reduction and patient safety.”

NHS Professionals chief executive officer Neil Lloyd told Nursing Times that the use of bank nurses was likely to be safer. He said: “In our experience, bank workers are more likely to have experience of working within the same ward, improving continuity of care.”

He added that acute trusts were failing to budget for temporary staff, meaning “shifts are more likely to be filled by expensive agency staff instead of an experienced bank worker”.

NHS Professionals expects the proportion of shifts released at short notice to continue to grow amid sustained financial pressures.

Unison head of health Karen Jennings said nurses were having to “pick up the pieces” when wards lacked staff with the right skills and expertise because of bad planning.

“This isn’t a safe or considered way to organise cover where there are shortages of staff,” she said.

“Trusts need to think more strategically about how they manage vacancies and holidays. We’re in the holiday period, but they have time to plan that, and should be planning ahead.”

James Buchan, professor of social science and healthcare at Queen Margaret University College, Edinburgh, said decisions not to fill vacant posts or employ bank staff were putting pressure on nurses to work additional hours.

He said: “It may be a short term, knee jerk solution to financial problems but it’s only storing up problems in the long term.”

However, there was insufficient evidence to show that bank workers were safer than agency staff, he said.

A spokeswoman from agency HCL Locums said it “wholly rejected” NHS Professionals’ claims. “Quality and continuity of patient care is paramount, and we are committed to continuing to work with the NHS to provide a service that is not only reliable but cost effective too,” she said.

However, the report suggests that agency demand has fallen in London and the mental health sector. Agency shifts in mental health trusts were 6,874 in June 2009, but 5,113 in June 2010.

In the capital, agency fill in April to June was almost half that during the same period last year. In 2009, agency fill for acute sector trusts in London during April, May and June was 11,149 compared with 5,965 for the same period in 2010.

The report states: “A sustained reduction in usage of expensive agencies across London trusts suggests that they continue to gain control over their agency requirements while other areas have allowed a slight increase.”

While spending on agency staff in acute trusts overall is growing, the number of permanent vacancies is plummeting.

Readers' comments (28)

Anonymous | 24-Aug-2010 8:54 am
Survey finds 'NHS managers cannot manage or plan ahead'...... not exactly a shock then. So many managers are where they are because they are nice people who never disagree with anyone senior to them - but have no qualifications other than this.
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Phil Dup | 24-Aug-2010 9:05 am
NHS Professionals are a total joke ! They constantly mess up on wages / paperwork and pay joke wages.
I will not work extra shifts anymore as although I have worked at my Trust for 12 years and am on Band 5 top scale if I do extras within the very same Dept my payrate DROPS by about £2 an hour (more if its a night / bank holiday).
When NHSP first formed all their advertising basically stated one would be paid at the same grade you were normally on plus a little extra. This was to try and counteract the money spent on private agencies who charged the NHS a lot more.
Now they have done the usual NHS Management trick of changing the contracts around to take the p*** out of the workers in effect the NHS is now paying overtime rates LESS than normal hourly rates - absobloodylutely disgraceful dishonourable stuff.
I've resigned from NHSP now and if I need to do extra shifts I'll do them with a private agency. If more people vote with their wallet and do this then basically NHSP have cut their own throats.
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Helen Tarbet | 24-Aug-2010 12:32 pm
At the heart of the matter is ensuring high quality and continuity of patient care at a time when a third of the current nursing workforce is due to retire in the next decade, with not enough school leavers replacing them. Not only has NHSP admitted in this report that it is unable to fill vacant shifts at short notice, but since its inception NHSP has succeeded in losing nearly £100m of taxpayers' money, posting a £10.3m loss last year. The Health Service makes use of independent agencies because they provide a fast, efficient service supplying skilled and compliant professionals, often at very short notice, and more cheaply than NHSP. That's why more Trusts and nurses are choosing private agencies over NHSP.
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Anonymous | 24-Aug-2010 1:27 pm
NHSP wages are a joke.If I work a late shift I take home £74.A mere pittance for taking charge of a 20 bedded post operative ward
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Delphine sutherland | 24-Aug-2010 2:26 pm
I find it hard to believe that NHSP nurses are more expensive than agencies. I have done both at different points in my life and have most certainly been paid far more from agencies than NHSP - their wages are a joke which i why i would never go back to them. I would far rather join an agency as the money is better and the service is better too. If NHSP got their act together and if trusts realised that if they pay a decent rate to bank staff they would not need to use agency in the first place. Why should we do bank shifts for doing exactly the same job we are doing now and getting paid a lower rate!! Anyone who does is an idiot in my book and i suggest they join an agency, it pays better.
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Anonymous | 24-Aug-2010 6:17 pm
NHSP should be taken apart in favour of every hospital having its own bank.

I'm sure that'd save the NHS s*** loads of money instead of cutting frontline staff...
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Roger Hodgson | 24-Aug-2010 9:49 pm
We are entering the same subject again........poor staffing levels and budgets. The answer ihas been highlighted time and again...Management staffing levels are too high!!

The budgets should be directed to hands on front line staff. This is after all where the patients are. You know patients, the people for whom the system was designed and built for.

Come on Cameron...sort it out for God's sake. The NHS is a caring organisation for the sick and infirm not a shelter for overpaid talentless accountants and IT operators.
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mike | 24-Aug-2010 10:12 pm
What an absolute bunch of morons the management and executive idiots in the trusts are!

To save money they freeze recruitment and do not hire enough permanent staff in the first place, leading to staff burnout and shortages.

To fill the inevitable shortages they hire agency/bank staff, which costs them MORE and helps noone! They don't give a crap about patient safety, it is all about the money at the end of the day. What an absolute piss take.

Can you get more shortsighted?
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Anonymous | 25-Aug-2010 8:27 am
Those who are getting shifts filled with agency are the lucky ones. I work in a hospital in Scotland, which shall remain nameless. Our lead nurse has stated that if the nurse bank cant fill the shift, it remains UNFILLED. The ward then has to run short staffed. Not only do the staff complain all day about it, patient care suffers!!
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Anonymous | 25-Aug-2010 10:57 am
Mike - the management aren't as stupid as you want to think! On this occasion they are financially smart but still business (patient care stupid). Agency staff appear more expensive when looked at on a shift by shift basis. Over the long term they are cheaper as there are no training and other 'on' costs. Used only when needed it is a cheaper option.
However, in terms of patient care and safety it can become very expensive (litigation) but they are too stupid to appreciate that.
Short term ability with no long term vision is the criteria for NHS managers much to the detriment of the patients.
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tinkerbell | 25-Aug-2010 1:46 pm
I am heartily fed up and worn old (& out) with all the lip service & bullshit I hear about patient safety, continuity of care, patient dignity, individualised care, etc., it just don't mean a thing in reality. It's all talk. Our wards are permanently staffed with agency, mostly they try to do a good job, some are clueless and an extra liability on the ward. We have a large number of permanent HCW posts waiting to be filled that have been left on hold for ages. Now we are being asked to cut back on agency staff because the costs are too high (doublespeak for run short) 'so long as it doesn't affect patient safety' (but of course we all know it will). Well then recruit the staff we need. SOMEBODY! Puhleese! All the governments say they will restructure the NHS, get rid of top heavy management, and then do nothing. It's not rocket science but most managers in the NHS couldn't organise a piss up in a brewery. It all comes down to money and the patients are just pawns in a game. David Cameron, Nick Clegg, Gordon Brown, all clueless or couldn't give a flying ****. Come and talk to the frontline staff, we'll tell you what needs to be done and how to get it sorted and then go away and DO IT you timewasters. Stop relying on managers to tell you what needs to be done because they're mostly all protecting their own arses, they are hardly likely to say their jobs aren't needed are they? Over & out!
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Anonymous | 25-Aug-2010 3:28 pm
I cannot believe Neil Llyod thinks that agency workers are less experienced than bank staff, and yet he is running an agency. This just goes to show why NHSP nurses are always rubbish, their Chief exec thinks so. This school of thought is unjustifiable as there are nurses on long term contracts on the wards and are as good and knowledgeable about the wards as permanent staff. neil should be more poisitive about his staff as they are his bread and butter.
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Steve Williams | 25-Aug-2010 4:52 pm
@ mike.

I love you big guy but please stop taking the lead singer of Herman's Hermits name in vain!

http://encyclopediadramatica.com/Noone

I know it was well before your time but Peter is actually quite a nice chap!
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Sandra Joyce Powell | 25-Aug-2010 6:28 pm
Tell me something new ,this is history in the making. False economy at its most perverse.

The best thing hospitals can do is go back to night and day staff and stop internal rotation, Also employ its own bank staff stat. Research show that night duty followed by day duty is damaging to a nurses health and do not ask me to quote line page and author.
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Anonymous | 25-Aug-2010 9:47 pm
Here is yet again another report on a matter which, 'has just been recognised'. This is something which has been happening for ages and some bright spark has suddenly realised it and has commissioned a report to tell us all about it. Thanks. Now tell me something I don't know, like what are you going to do about it?
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Anonymous | 25-Aug-2010 11:23 pm
I have been an HCA for some years for NHSP who were very odd at times I felt and some staff seemed to not let wards know when you were going to be off due to sickness occasionally. This happened in my case and I once got into trouble as a result when they thought I had let them down at the hospital. I had a letter one week praising me for my great work and another letter soon after saying I was rejected by them and it was for the reason I explained, so since then Ihave not done anything for them for over three years. I went on to do some great work for an Agency and was praised by them as well and they wanted to put me into a nursing home to give a good first impression on a trial week as aiming at winning a contract permanently, that was how well observed I was in my work. Taking off the paper hat now, as that is nort why I am writing, but wanted to explain I have been there seen it and done a lot in the Agency Nursing world. I then went on to become a Student Nurse and by now had an Adult teaching City and Guiilds Cert and had spent some time in an NHS Practice Developement to enhance my ability to pass on Mandatory skills, non clinical at that time. such as Policies, Confidentiality, Information Govenance, and Patient Dignity and Basic Care skills. As a Student I attended an area recently and was placed solely with a HCA who told me she was a permanant Bank HCA. She then told me she had been instructed to train me on the Spirometry Machine and running of the clinic pre-Consultant checks. There was no fully trained Nurse in sight. She told me a Sister who was meant to be my mentor had said she must train me and report on how good I was operating this machine and then to my horrror she told me she may get dragged out later on and then I would be managing this clinic alone. I imediately told her I needed to leave the room. I found the appropriate person to explain, but not the Sister who had apparently passed on this task to an HCA and was told not to worry it would be dealt with. So our hospitals it seems are confidently run by Sister instructing HCA's to train Student Nurses now, is that not totally bizzare ? we are not even being mentored sufficiently. This HCA in my dreadful experience was not even a trained HCA Trainer in any shape or form and could have said just about anything, plus I would have been answerable for illegally running a Spirometry clinic unqualified. Also I wondered if the HCA had really got a high enough qualification to be left alone to run this practice. It requires some skills of in depth care and assessment even in the pre-Consultant stage of the clinic in the observational stages of having a Spirometry test under taken. This I feel is an unbelievable mix up going on in Nursing Practice and shows a lack of concern.
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Marc Horton | 26-Aug-2010 0:25 am
Now what's new here? This has always been the case.I have not worked in the UK for 13 years but having been a Charge Nurse in London we ALWAYS relied on Agency Nurses as the old hospital "Bank Nurses" left the bank to join agencies as the pay rate was higher.Its an on going case of juggling the money around so it looks better on paper for reporting back to the Health Board. Skilled manpower costs money.
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gordon keightley | 26-Aug-2010 10:03 am
As the Director of a Nursing Agency I am so irritated by the mis-informed idea that Agency staff who are all either Registered Nurses who have received extensive training or HCAs who are trained by our own staff to work in any clinical environment are always assumed to be inferior to Bank Staff in Nursing Times articles. This is simply not true. There are good and less good nurses supplied from both Agencies and bank providers. Banks are used as they are perceived as less expensive but once administration expenses are added such as booking staff,payroll etc (which are included in the agency fee) there is little to choose from. Agency owners are naturally very keen to supply staff of a high quality standard to ensure repeat business and many NHS wards and temporary staff organisers prefer our staff to bank due to the effectiveness of using our staff over bank nurses.
Ultimately cost matters but as I have said when you include on costs its a less absolute picture.
Banks only exist to allow the NHS to re-employ its own staff on less favourable term and conditions than the overtime rates previously applied. No other reason,not quality or continuity which they already had but cost reductions drive Nursing banks.
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dino-nurse | 26-Aug-2010 6:22 pm
Well said Gordon. Working in a specialist area (ICU) if we are short-staffed the hospital bank can rarely accomodate us- although the hospital is happy to take nurses out of the ICU to prop up the wards. Currently we have an agency ban (again) so unit staff are being run ragged. When the ban is lifted I will go back to getting agency staff through a specialist agency because they have the skills to do the job. Good agencies ensure that staff are kept up-to-date and pay them appropriately. In my younger days when I could burn the candle at both ends, I couls make a weeks wages by doing 2 agency shifts for an ICU agency in London. Agencies reward staff, the NHS bank merely abuses them. Blinkered employers sontinue to freeze posts and save money on paper regardless of the real cost to the patients.
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Anonymous | 27-Aug-2010 0:13 am
I can only comment on the generally poor staff provided on 'agency' to cover the few available shifts in my area.

I can recall very genuine staff attending for work with shiny shoes but unable to monitor blood pressures. They were sincerely sorry, but I sent them home with Trust apologies for wasting their time.

I have very recently experienced the provision of an agancy nurse to cover my acute gastro unit - she had only Nursing Home experience & hadn't worked in an acute hospital since her training.

I manage a unit with an excellant staff retention rate - my own staff tend to cover any out-standing shifts due to sickness or vacancy on NHSP.

I am unable to comprehend that there are units run entirely on agency or NHSP staff. I would love a considered opinion on this matter; do you think this is partly due to poor rota management? Are all the regular staff on early shifts? Could it be poor annual leave profiling or appalling sickness rates?

Please do not berate me for not understanding the current situation - I have worked in the NHS as a ward manager for over 7 years...I am therefore qualified to question how a unit could be woefully understaffed.

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