A snapshot survey of nurses reveals the depth of anger, frustration and even “despair” felt by those likely to be affected by a new ban on permanent NHS staff doing agency shifts, say campaigners.
Many nurses predicted they would be forced to leave the NHS and some have already quit, reveal interim findings from the online survey shared exclusively with Nursing Times.
“The most striking thing is the emotions that are being displayed”
The survey, which has attracted around 800 responses so far, was launched by neonatal nurse Bridget Catterall, who described NHS Improvement’s imminent new rule as “an insult to nurses”.
Letters have now been sent to staff by trusts confirming that the intention of the regulator is to ban NHS providers from employing any agency workers who hold substantive roles at other trusts.
The move, which comes in from 1 April, means permanent nursing staff wanting to do extra shifts will have to be employed through the trust’s staff bank instead.
Ms Catterall said she wanted to highlight the widespread opposition to the move among frontline nurses and the potentially harmful impact on patient safety, with fears it could lead to even less staff on the wards.
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“There are a lot of nurses living in hardship and they reason they are doing extra work is to supplement their income,” she told Nursing Times.
“If nurses were paid what they were worth they would not need to go to agencies, they would work in their own hospitals,” she said.
Ms Catterall, who supplements her NHS pension by doing agency and banks shifts, said she was struck by the level of anger expressed by the nurses who took part in the survey.
“The most striking thing is the emotions that are being displayed – people are angry, frustrated and then there is fear and despair,” she said.
“This has been introduced by stealth and nobody has had time to prepare – not the trusts or the nurses – they haven’t been given any incentives to join nurse banks, which can take a few weeks even if you have a substantive post – it’s like pulling the rug from under their feet,” she claimed.
“I am not against cutting agency spending but they are doing it the wrong way by punishing nurses”
Joan Pons Laplana
The vast majority of nurses who completed the survey – more than 90% – said they currently held a substantive post in the NHS.
About half said they worked extra hours for an agency and about half said they worked bank shifts, with about 18% reporting they did both bank and agency shifts.
According to Ms Catterall’s calculations, only about a quarter of nurses do not do any extra hours within nursing – although some may do extra hours in other roles.
Of those who said they did extra hours for an agency, most reported doing between 10 to 40 additional hours each month with a handful doing up to 80.
Most who said they did bank shifts did between 8 to 36 extra hours per month, but some were doing 50 to 60.
Tellingly, more than 80% said the ban on agency work would not lead to them increasing the number of hours they worked at their trust.
Some reported there were no extra hours available in their speciality, while others said rotas were not flexible enough to fit round commitments, including caring for children and elderly relatives.
“People are so angry because it has just been attack after attack – they seem to begrudge us anything”
The ban on permanent staff doing agency work was announced by NHS Improvement in February this year, as part of further efforts to clamp down on spiralling agency costs.
However, organisations like the Royal College of Nursing have complained about a lack of consultation over the plans. Its stance is that nurses should be allowed to make whatever working arrangements suit them and their families.
Many nurses used the survey to express their outrage, describing the ban as “utterly ridiculous”, “appalling” and “unfair”.
Many also talked about leaving the NHS employment altogether, including one who said: “I have handed in my notice so I can work full-time agency”.
Exclusive: Survey reveals anger and concern over agency rule
Others said they would not able to afford to keep working in the NHS and many echoed the sentiments of a respondent who wrote: “Sadly, I will have to leave my substantive post as I cannot survive on that money alone.”
One student nurse explained they had been hoping to start working in the NHS immediately after graduating and pick up some agency shifts once they had gained enough experience.
“This would enable me to afford to own my home,” said the student. “However, this change makes me consider private employment or agency employment fully.”
Medical colleagues also expressed their dismay. “I think this is an attempt to bully nurses into doing extra in-house hours because they are cheaper,” said one doctor who commented on the survey.
“If you wish to reduce the reliance on agencies, make nursing more attractive. Give them a substantial pay rise and pay for their university courses. If we want enough nurses we must be willing to pay for them,” said the doctor.
Just a handful of respondents welcomed the move, such as one who said it was an “excellent idea”, adding that “far too many nurses work agency hours and are too tired or off sick for their own shifts”.
Joan Pons Laplana
Nurse campaigner Joan Pons Laplana, who has helped promote the survey, said he was not surprised at the anger expressed by many of those who took part.
“A lot of us are struggling to make ends meet and our only option is to go to an agency to be able to survive,” he said. “The problem is that when you work for the bank they normally pay at the bottom of your band, but why should you work for a lot less money doing the same job?
He said: “If the banks would pay the top of the band, then a lot more people would be willing to do bank shifts.”
Mr Laplana said nurses were on the breadline as a result of the ongoing freeze on pay, with some forced to go to food banks.
“If you work for the bank – to be able to earn the same money you have to do extra shifts and that has an impact on our families, plus we’re more tired and when you’re tired you’re more likely to make mistakes so patients suffer too,” he said.
“I am not against cutting agency spending but they are doing it the wrong way by punishing nurses. What they need to do is give us a proper salary and if they want us to work for the bank pay us the same rates we get for the job we do on a daily basis,” he added.
Another nurse Danielle Tiplady, who has helped share the survey via social media, was among those who have thought about leaving the NHS.
“If this is the way it is going to be, and they are not going to value us with the pay, then we have to look after ourselves,” said Ms Tiplady, who is a long-standing campaigner on nurse pay and previously the student bursary.
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“If they are going to ban us from doing an extra shift here and there outside our normal job to pay the rent, and we’re not able to do it, then we shouldn’t have to live in poverty,” she said.
“It is really insulting as well – and quite dictatorial for them to tell us where we can and can’t work,” she said, adding that she thought trusts would enforce the ban for fear of financial penalties and pressure from the top.
“The most worrying thing is patient safety – because you could potentially not have any nurses to cover your agency shifts,” she said.
“People aren’t going to work bank because the pay rate isn’t very good and people will protest about this. So you could be in a situation where you have even less staff then we do now, which poses a huge risk for patient care and the sustainability of the wards,” she said.
Ms Tiplady said the move would drive people to agency nursing and damage morale. “I think that is why people are so angry because it has just been attack after attack – they seem to begrudge us anything,” she said.
“We will be providing some important guidance on the rules regarding substantive staff in the coming days”
An NHS Improvement spokeswoman said: “We recognise that the most recent agency rules bring some change to the way nurses and doctors will work, and we will be providing some important guidance on the rules regarding substantive staff in the coming days.
“However, it’s important to note that from April, nurses or doctors working for the NHS and picking up shifts via bank will be no worse off financially than agency staff,” she said. “Agency nurses will pay tax in the same way and will be subject to the price cap which offers the same take home pay.”
She added: “We are also working hard with trusts to improve the bank system and secure better rates for bank shifts.
“It’s clear that what drives nurses and doctors is their compassion for patients, and as employees, permanent staff benefit from better team working, familiarity with systems, training and appraisals – which we know helps improve care too,” she said. “We will continue to work with trusts to support their nursing staff and encourage them back into the NHS.”
Headline results from survey, as of 27 March 2017
|1. Do you currently have a substantive post within the NHS as a nurse?|
|2. Do you also work additional hours for a nurse agency?|
|3. Do you have a substantive contract with an NHS trust, and work additional hours for a ‘nurse bank’?|
|4. Do you work for both an agency (outside of your trust), and the ‘nurse bank’ within your trust?|
|5. From 1 April you will not be allowed to work for an agency at any trust in England if you already have a substantive contract with any NHS trust. Will you now increase the hours you work for your trust?|