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Show me the money – why agency work is essential for some nurses to survive

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Decisions about the running of the NHS are often made by those at the top without really considering their impact on the day-to-day functioning of the service. A goal is set, an objective is defined and suddenly it becomes the rule. Then NHS organisations – and the people working in them – have to live with the consequences.

That’s exactly what happened when the service regulator NHS Improvement announced new rules preventing staff from working agency shifts for other trusts if they have a substantive post in the health service, which were due to come into force on 1 April. Unsurprisingly the announcement attracted a plethora of angry comments on the Nursing Times website, and sharp responses from the unions, furious at the lack of consultation about a decision with frightening implications for many of their members.

At yesterday’s Nursing Times Careers Live event in Bristol, I met some nurses who work agency shifts around their full-time NHS jobs simply to make ends meet. These aren’t people clocking up extra hours to pay for a fancy car or luxury holiday. For them, the money earned from agency shifts makes the difference between being able to afford their rent or mortgage and being at risk of falling behind. It really is that important to them.

A ban on nurses supplementing their shrinking income looked like another attack”

This reckless decision would literally force nurses into hardship all over the country. So I’m thankful that the outcry has forced the regulator into a last-minute U turn – although it is currently described as a ‘pause’.

Having suffered years of frozen pay or below-inflation rises, a ban on nurses supplementing their shrinking income looked like another attack on an underpaid, undervalued and under-resourced profession.

Let’s not forget, we’re talking here about nurses already working in the NHS, not those who have left to take up agency work full time. So the move wouldn’t have done anything to reduce the nursing shortage, but would simply punish those whose extra shifts help NHS providers to plug gaps caused by that shortage.

“Nursing has borne the brunt of £700m savings already made on agency staff”

NHS Improvement has acknowledged that nursing has borne the brunt of £700m savings already made on agency staff, and that more needs to be done to curb spending on locum doctors. Of course the relative size of the two professions means nursing is always top of the list for budget holders looking to save money, but firmer action on agency spend on medics could not only yield some significant savings, but would also go some way to making the system fair.

At present the medical locum market looks like it’s run by the National Lottery, with just 20 doctors costing the NHS £7.5m a year, while over 300 locums have been working at the same trust for over two years but pocketing inflated agency rates.

“Some nurses feel they’d earn more working in a supermarket”

And while these medical colleagues drain the NHS, judging by some of the comments on our website some nurses feel they’d earn more working in a supermarket. No offence to the hardworking retail staff out there, but what does it say about our society when we place a greater value on stacking shelves than we do saving lives?

If the regulator wants a strategy to cut agency spending and address the nursing shortage I have a radical suggestion. It might consider putting away the stick it’s using to beat NHS nurses, finding some carrots that will attract full-time agency nurses back into NHS posts, and cracking down on the ludicrous sums being charged by agencies supplying medics.


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