Caps on the hourly rates of pay for agency nurses have brought down costs for NHS trusts, but many employers are still failing to recruit workers onto their bank or into permanent roles due to the lower earnings on offer, the NHS’s provider of bank staff has said.
The NHS Professionals organisation said employers were often using the savings made from the new rules to re-invest in extra agency shifts – when instead they should be increasing pay for bank shifts.
”A lot of trusts have embraced the caps… but they need to make their bank more attractive to bring staff across”
Data from a sample of 48 trusts that NHS Professionals works with - that was shared exclusively with Nursing Times - has shown in some cases the number of hours worked by agency nurses and midwives at NHS trusts has in fact grown significantly since before the new rules were brought in at the end of November 2015.
The most recently available data shows that in January 2017 a total of 18 NHS trusts had each used at least 40% more agency hours than in the same month two years previously. One organisation had a 1439% increase - from 200 hours in January 2015 to 3,077 hours in 2017.
The organisation with the worst performance - in terms of the highest number of hours used - saw an increase from 13,730 agency nurse and midwife hours in January 2015, to 28,785 hours in January 2017.
More generally across the whole sample of trusts, NHS Professionals said that the money spent on agency nurses and midwives has been decreasing at a faster pace than the total number of hours used, since the rules were introduced by the government in 2015.
By October 2016, the group of NHS trusts were still using 1% more agency hours than at the same point in 2014 – 866,000 hours compared to 815,000 hours.
“While agency spend has been coming down for a while, hours have still not really been reducing to the level they were at before the cap”
But spending had just reached a tipping point and was 6% less than two years before, having reduced from £26 million to £24 million.
In January 2017, the total amount of money spent on agency nurses and midwives had continued to fall – to £21 million, which was 14% less than two years previously, when it was £24.5 million.
However, the number of hours worked by agency staff had reduced at a slower pace - to 850,000 hours, representing only a 4% reduction compared with the same point in 2015.
When the hourly caps were brought in they were set at 100% more than the rate paid to permanently employed nurses, from November 2015 to the end of January 2016.
They were later reduced further and since April 2016 agency rates have been limited to 55% above an equivalent wage for a permanently employed nurse.
NHS Professionals regional director Jay Patel said NHS trusts needed to do more to meet one of the key goals of the caps – which was to bring more agency staff onto the bank or into permanent roles in the NHS.
“While agency spend has been coming down for a while, hours have still not really been reducing to the level they were at before the cap was brought in until very recently,” she told Nursing Times.
“What we’ve seen nationally is that a lot of trusts have embraced the caps and have started to work within them and driven down the costs but they need to make their bank more attractive to bring staff across,” she said.
She noted that in recent years agency working had begun to be seen as the “norm” for NHS nurses and midwives who needed to earn extra money.
“Trusts across England managed to reduce agency staff spending by £700million last year alone”
NHS Improvement spokeswoman
The increase in spending on agency staff by trusts had been largely driven by NHS nurses refusing to work additional shifts at pay rates that come under the NHS’s Agenda for Change system, she said.
“It’s a not shortage of nurses that has caused the increase in agency spending, it is the shortage of people willing to work at Agenda for Change pay rates during their additional hours,” she said.
“Because agency working has become something of a ‘norm’, it is possible to attract some of those agency workers back by increasing bank rates,” added Ms Patel.
She noted that in cases where employers had improved pay for bank shifts this had not caused NHS employees to migrate to other trusts for additional agency shifts – but had instead meant they remained at the trust for extra work.
”We’re working with trusts to support improvements to banks and looking at options like shared banks”
NHS Improvement spokeswoman
Regulator NHS Improvement, which is responsible for enforcing the caps, said agency spending across England had reduced but that it wanted to see reliance on these shifts reduced further.
“Trusts across England managed to reduce agency staff spending by £700million last year alone, and their efforts to improve workforce planning and rota management continue to have a positive impact,” said an NHS Improvement spokeswoman.
“We’re working with trusts to support improvements to banks and looking at options like shared banks. We’re also helping trusts with modern solutions like e-rostering which will help manage shifts in a more efficient way,” she said.
“A big part of the solution is keeping staff in NHS employment, which is why we launched our new national retention programme last week.
“Our programme contains a raft of measures, tools and support to help trusts understand why staff are leaving their organisation and how to keep them on,” she added.