Cutting the “staggering” level of spending on agency workers and improving the way staff from black and minority ethnic backgrounds are treated have been earmarked as key priorities for nursing in the NHS, its chief executive has told Nursing Times.
Tackling spending on agency nurses
In a major interview with Nursing Times, Simon Stevens said directors of nursing would be asked to help tackle both issues over the coming months.
“My view is that one of the single most important things that the NHS has got to get right over the next year is dealing with the ballooning use of agency nursing staff and other staff across the country,” he said.
“Instead of spending all this money on temporary staff, we’ve got to convert that into permanent posts with good working conditions and career progression”
He highlighted research from the Royal College of Nursing, published earlier this month, which estimated that trusts were spending £980m on agency nursing staff this year and that this would be enough to fill 28,000 permanent posts.
He also quoted figures from the regulator Monitor that showed, in the first six months of this year, hospital trusts were expecting to spend £389m on temporary and agency staff and instead they spent £830m, which he described as “staggering”.
Mr Stevens acknowledged that the spiralling agency spending was partially down to the current focus on increasing ward nurse staffing levels in response to the Francis inquiry into Mid Staffordshire Foundation Trust, which he said was “quite rightly” happening.
But he called on trusts to invest the vast amount of money being spent on temporary staff into recruiting permanent posts.
“My sense is that the single biggest source of dissatisfaction for frontline nurses, in terms of being able to do the caring job that they came into nursing to do, is having the right number of colleagues at work and on the shift,” he said.
“Instead of spending all this money on temporary staff, we’ve got to convert that into permanent posts with good working conditions and career progression,” said Mr Stevens. “This is one of the central issues that hospital managers and nursing directors have got to get to grips with over the next year.”
He said that bringing down agency spend was necessary to improve quality of care, the quality of working conditions for staff and the financial sustainability of the NHS.
Equality for all NHS staff
Mr Stevens also told Nursing Times that a “spotlight” needed to be shone on the experiences of BME staff in the health service and how it could be improved. He said BME staff reported bullying and racial discrimination at about twice the rate of white staff, and were less likely to hold senior management roles.
Last April, a hard-hitting report claimed the NHS had left itself open to accusations of institutional racism after failing to ensure ethnic minorities are represented in senior roles, such as nursing director posts.
Titled the Snowy White Peaks of the NHS, the report called for urgent action to tackle “widespread, deep-rooted, systematic and largely unchanging discrimination”.
“My ask to directors of nursing across the health service is that they take a serious look at the workforce race equality standard”
For the first time from April, the NHS England chief executive said a “workforce race equality standard” would be introduced across the service, with the agreement of unions.
This would “track” how staff responded to being asked whether they had been subject to bullying and harassment, discrimination, or been taken seriously when they had raised an issue.
“Over the course of the next 12, 24, 36 months, we want to see measurable progress on this question,” he said, with a narrowing of the gap between what staff from BME backgrounds said versus staff from white backgrounds.
“My ask to directors of nursing across the health service is that they take a serious look at the workforce race equality standard… and work with their all their staff, including their BME staff, to set out a plan of action for improvement over the course of the next year, two and three,” has said.
Asked about other priorities had for nursing, Mr Stevens said NHS England wanted to make a “big improvement” on speeding up access to mental healthcare over the next financial year, starting in April, as well as making a “final push” on ending reliance on institutional long-stay care homes for people with learning disabilities.
Nursing and the NHS five-year plan
He also reiterated the importance of the “nursing contribution” to developing the new care models proposed in the NHS five-year plan for England – the Five-Year Forward View.
The plan, which was published in October, set out a shake-up of service structures with ideas for a series of new care models aimed at dissolving the boundaries between primary, community and acute care.
“What we basically need is a triple integration”
One option – called the Multispecialty Community Provider – will see clinical leadership in primary and community care expanded to include more nurses, therapists and other professionals. Another example aims to modernise maternity provision, with more birth outside of hospital, by making it easier for midwives to set up their own NHS-funded midwifery services.
Mr Stevens told Nursing Times that the change was needed to “overcome many of the organisational, funding and workforce fragmentations that have existed in the health service since the year dot”.
He noted that nurses working primary care, community care, mental health and hospitals were all part of different NHS “funding streams”
“We’re now interested in people coming to us and saying ‘here’s how we wish to tear up those distinctions and empower different groups to come together to do things quite differently’ in a way that is not just rearranging the deckchairs and actually produces some tangible benefit for patients,” he said.
“What we basically need is a triple integration,” he said. “First better integration between primary and specialist services, second better integration between physical and mental health services and third better integration between health and social care services.”
Mr Stevens said that NHS England had received 261 responses to a call for ideas on new models of care, and that he was “convinced that lurking in the pile” would be some “really interesting” ideas for community nursing, primary care and the future of the health service.
Hospitals to provide own social care
He went on to discuss in detail the need to tackle delayed discharge and the wider problems of care standards in care homes.
Mr Stevens told Nursing Times that “over the next several years” he thought some hospital trusts would begin to “employ their own home care services and on the back of that create new career ladders for people coming as care assistants”.
“One of the issues in domiciliary care has been we’ve got too many people on minimum wage contracts being asked to use their own car to drive to drive to different appointments, not being paid travel time and so on – that’s not a sustainable model,” he said.
“I hear from some directors of nursing at some trusts that they are beginning to think should they start actually providing some of those services for social care.”
Paying the NHS workforce
Mr Stevens reiterated views he made in October about the importance of pay in recruiting and retaining the NHS workforce.
Recent pay freezes “will not be indefinitely repeatable” in the future, he told BBC Radio 4’s Today programme, noting that staff would leave the profession if the NHS fails to provide them with competitive pay rates in future.
He told Nursing Times he was “very pleased” that a new pay offer had been made by the government for 2015-16, which was currently being considered by unions, in the wake of a series of strikes last autumn.
“I’ve been up front about saying that the health service is going to have to pay the going rate, if we’re going to be able to recruit and retain the staff that we need,” he said.
“As we look out over the five years that is going to mean that we’re going to have to pay close attention to what is going on the rest of the economy, because the health service doesn’t exist in isolation,” he added.
Whistleblowing and raising concerns
Noting the publication last week of the Freedom to Speak Up report on whistleblowing in the NHS, Mr Stevens was asked to assess current NHS culture around raising concerns and whether progress had made since the findings of the Mid Staffordshire public inquiry were published in 2013.
Highlighting that he had met a group of whistleblowers during his first week in role as NHS England chief executive, saying: “I think we’ve come quite a long way, but clearly in a number of places we’ve still got a lot of work to do.”
Fact file: Simon Stevens
Simon Stevens became chief executive of NHS England on 1 April 2014, succeeding Sir David Nicholson. His appointment was announced in October 2013.
His first major move was to publish the Five Year Forward View in October 2014, a five-year plan for the NHS strongly focused on developing new models of care in the community.
During the late 90s, Mr Stevens was a policy advisor to Labour health secretaries Frank Dobson and Alan Milburn and, from 2001-4, was health policy adviser to Tony Blair.
He subsequently spent time abroad, holding various senior positions at US healthcare giant UnitedHealth.