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Spending on agency nurses and midwives in Wales has dipped after years of increase

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Spending on agency nursing and midwifery staff finally dipped slightly last year in Wales, following cost increases since 2014, according to a new report.

In 2017-18, agency spending on nursing and midwifery fell by £2.4m in comparison with 2016-17, said the report by the Auditor General for Wales.

“We know that nurses leave the NHS and turn to agency work because it offers better working terms and more flexible working conditions”

Helen Whyley

However, it warned that it was still much higher than the £29m spent on agency nurses and midwives in 2013-14.

The report highlighted how expenditure on agency nursing staff had gone from up to £46m in 2015-16, then peaked at £54m in 2016-17, before the dip to £52m last year.

The figures for nursing and midwifery reflect the overall trend in spending on agency staff in the Welsh NHS, with its peak also in 2016-17.

The report explained that after a period of stability, agency spending grew “significantly” after 2013-14, peaking at £164m in 2016-17. It noted that agency expenditure for 2017-18 marked a 171% rise over seven years.

The report – titled Expenditure on agency staff by NHS Wales – also identifies that the nurse and midwife staff group made up 38% of the proportion of agency expenditure for 2017-18.

On average, the report explained how health boards had spent nearly half their total agency expenditure on medical and dental staff since 2014-15 and a further third on nurses and midwives.

“More has to be done to retain the nurses who work in the NHS”

Helen Whyley

The Welsh Auditor claimed that the rise in spend was down to escalating hourly rates of pay charged by agencies, an increased demand in services and difficulties in recruiting and retaining staff.

In terms of recruitment and retention, the report also noted that the NHS workforce increased in size by 7.5% between September 2010 and September 2017, with nursing, midwifery and health visiting staff increasing by 4.7%.

It highlighted that, so far for 2018-19, 80% of agency spend was “providing cover for vacant positions and the NHS is seeking to reduce both the demand for agency staff and the price it pays for them”.

Temporary staff in the NHS generally cost more than equivalent employees on substantive contacts, noted the report. It added that those provided by agencies tended to be the “most expensive source of temporary staff”, when compared to bank workers.

The report said future projects designed to manage agency and other temporary staffing spending would need “strong leadership and the capacity to drive change in a timely manner, to deal consistently with difficult decisions.

Auditor general Adrian Crompton said: “This report is packed with useful statistics and insights on the current picture of NHS agency expenditure in Wales.

“I hope it will be used by a wide range of people and professionals in Wales, along with the data tool we have produced, to help NHS Wales continue to bring down and control these costs at a time of significant financial pressure,” he added.

Royal College of Nursing Wales/RCN Wales

Helen Whyley

Helen Whyley

Responding to the Wales Audit Office’s report, the Royal College of Nursing said more needed to be done to retain permanent staff.

Helen Whyley, interim director of RCN Wales, said: “Retention of staff is just as important as recruitment. More has to be done to retain the nurses who work in the NHS.

“We know that nurses leave the NHS and turn to agency work because it offers better working terms and more flexible working conditions,” she said.

Ms Whyley suggested that “employee-friendly” policies would “encourage” more nurses to stay in the NHS.

She also highlighted that the RCN had been “disappointed” that student nurse education commissioning places for 2019-20 were not increased in Wales, warning this created a “standstill” for growing the nursing workforce.

Ms Whyley added: “Moving forward, we welcome an opportunity to work in partnership with the Welsh government on this important issue.”

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