Use of agency nurses by the NHS has jumped by 50% in a year and is quickly rising, Nursing Times has learnt, calling into question widespread cuts being made to posts in order to save money.
The number of acute and community shifts filled by agency staff in England rose from around 14,000 during January to March 2011 to roughly 21,000 during the same three months in 2012, suggests a report seen by Nursing Times.
The document also reveals burgeoning demand across the NHS for temporary shift work. Requests for both bank and agency shifts during January to March 2012 were up 18% to 155,000, compared to the same period 12 months before.
The report was compiled by NHS Professionals, which provides much of the health service with bank staff. It was based on data from 70 trusts across England and covers nursing bands 2 to 6.
Worst affected was the North where temporary shift demand was up 24% in January to March 2012 compared to the same three months in 2011. The South of England saw demand jump 12% and in London demand rose by 13%.
The findings appears to contradict many trusts’ claims they are looking to reduce spend on agency staff due to the higher associated cost, and increased risks to quality and safety created by reductions in continuity of care.
The report said: “After reducing for two consecutive years, shift demand has increased steadily from summer 2011, and greatly accelerated from January through to March 2012.
“Much of the additional demand seen in the last six months was unforeseen, with many trusts actually forecasting reduced shift demand. This raises the question of the root cause of the unexpected increase in demand for additional staff and how long it might be sustained.”
NHS Professionals suggested a number of potential causes, including underestimation of referral numbers and delayed discharge of patients as well as recruitment freezes and post cuts.
Peter Griffiths, chair of health services research at Southampton University, said the increases were surprising. It could either mean demand was outstripping supply, or that trusts were cutting back on workforce and relying on temporary staff to fill shifts, he said.
“Agency staff are a very expensive option,” he said. “It is difficult to see how this is good value for money. You are employing someone who is less effective and costing more.”
Professor Griffiths warned that increasing agency use might lead to bank staff moving to agencies, because the rates of pay were often better. This would exacerbate the problem, as trusts would be forced to turn to use agencies due to falling bank capacity.
However, the report was seized on by unions as evidence that austerity measures were leaving parts of the NHS understaffed.
Royal College of Nursing chief executive and general secretary Peter Carter told Nursing Times: “You can’t take out hundreds of nursing posts and expect life to just carry on. It’s a false economy.
“The agency mark-up will be phenomenal. This is an ill-conceived way of trying to go about saving money.”
Unison head of health Christina McAnea echoed this view, saying the increase in temporary staff use showed the impact government cuts were having.
She said: “This huge dependence on agency staff is a clear indication that staffing levels are inadequate, and scuppers the hard work that has been done over the last 10 years to reduce agency spend across the NHS.
“The enormous staffing pressures facing nurses in hospitals needs to be addressed urgently, and plugging the gaps with agency staff is not a viable or cost effective solution to the problem.”
She added: “It will cost hospital trusts far more in the long run – financially and in terms of the valuable experience permanent staff develop over time.”
Philippa Slinger, chief executive of Heatherwood and Wexham Park Hospitals Trust, successfully reduced agency spend from £1.5m in September to £800,000 at present, by employing 300 permanent staff.
She said the report revealed a “surprising” trend given the current economic climate. “Every chief executive knows agency costs a lot of money and can compromise your quality,” she said.
NHS Professionals refused to release to Nursing Times the precise numbers behind the percentages highlighted in its report.
In a statement it said the trend was “disappointing”. “This increase in demand is representative of trusts struggling to maintain the right staffing levels to meet real changes in their needs,” it added.
However, a Department of Health spokesman claimed the report did not “reflect the national picture” and said the DH was confident the NHS would hit its £300m savings target for agency spend by the end of 2013-14.
He said: “We are reducing our spending on agency staff by re-negotiating contracts nationally to get the best possible staff at the best possible price, and hope all NHS organisations will use the new contracts. Since most agency staff are used to cover sickness absence, we are working with hospitals to improve staff health and wellbeing.
“Local healthcare organisations are best placed to decide how many doctors, nurses and other health professionals they need to care for their patients,” he added. “Where there are changes to the size and shape of the workforce senior doctors and nurses must be involved at all stages and the quality of patients’ care must be maintained or improved.”