Spending on agency nurses fell by 20% in the latest financial year as trusts used more bank staff instead to cover vacancies, according to the NHS’s latest annual review.
The report by regulator NHS Improvement said spending on agency staff across all NHS roles fell by £93m in the year ending 31 March 2018.
“Despite epic challenges, NHS staff up and down the country displayed incredible resilience”
The reduction has “partly been caused by moving agency workers and shifts into bank and substantive roles, which represent greater value for money than the equivalent posts,” the report said.
It hailed the reduction as “a huge achievement in view of the record levels of demand and the extreme pressure on the acute sector”.
NHS spending on bank staff was £976m higher than planned, although no figures have been made available for what proportion of this went on temporary nurses.
The report said: “This reflects the increasing use of bank staff by trusts to manage workload in the face of increased demands, high levels of vacancies, sickness/absence and staff turnover.”
The rise has also been affected by “missed cost improvement programme (CIP) targets on pay and by volume shifts between agency and bank, both of which were not factored into trust plans”, said NHS Improvement.
“The number of nurses missing from England’s NHS remains stubbornly high”
In all, at the end of March, trusts employed over 314,000 whole time equivalent registered nursing staff, according to the report – titled Performance of the NHS provider sector for the year ended 31 March 2018.
At the same time there are over 35,794 WTE nursing vacancies of which approximately 95% are being filled using a combination of bank (65%) and agency staff (35%).
This vacancy position has remained relatively static since the third quarter of the 2017-18 financial year, NHS Improvement said.
London at 14.1% was the region with the highest rate of nursing vacancies, while the highest vacancy rate broken down by region and sector and was ambulance nursing in the North at 19.7%.
The annual review reported an overspend on pay of £976m, largely for doctors and nurses in acute trusts, as part of an overall NHS pay bill of £52bn. Nursing pay costs were £20.54bn, which was £515m more than planned – a 2.6% overspend.
NHS Improvement praised staff for their “incredible resilience” during the worst winter in a decade, and said the NHS had outperformed recent productivity in the UK economy.
Ian Dalton, chief executive of NHS Improvement, said: “Despite epic challenges, NHS staff up and down the country displayed incredible resilience and saw more patients than ever before within four hours.
“More than two thirds of providers ended the year on budget or better than planned,” he said. “Given rising demand and record vacancies, this is an important achievement.”
Janet Davies, chief executive and general secretary of the Royal College of Nursing, said: “These figures reveal both sides of the same coin – a cash-starved NHS forced to run without enough staff to treat people safely. For as long as hospitals remain £1bn in the red, patients will pay a heavy price.
“The number of nurses missing from England’s NHS remains stubbornly high – hospitals cannot afford to recruit and inadequate numbers are being trained too,” she said.
Ms Davies noted that promised extra funding for the NHS ”must be both substantial and genuinely new money”, regardless of whether it was announced in time for the NHS anniversary this summer or in the government’s autumn budget.
“It would not be enough just to wipe these deficits – health and care budgets must be boosted to reflect genuine demand,” she said. “Anything less exposes patients to unacceptable risks and leaves care increasingly unsafe.”
Over 270,000 more patients were seen within four hours at A&Es in 2017-18 compared to the previous year. However, because of the higher overall numbers coming to A&E, the proportion being seen in four hours fell slightly from 89.1% to 88.4%. The national target is 95%.
“Frontline staff are working harder than ever in the face of a relentless rise in demand for care”
The report showed that NHS trusts had a deficit of £960m at the end of 2017-18, double what trusts expected at the start of the year. Aside from acute hospitals all other providers showed an underspend in 2017-18, the report said.
But health think tank the Nuffield Trust warned the deficit was worse than it appeared. “We must remember that the reported figures published today are very much window dressing,” said its senior policy analyst Sally Gainsbury.
“Our analysis suggests that the true, underlying figure is much, much worse as the NHS has had to patch up its finances with a series of one-off savings and emergency extra cash,” she said.
NHS Providers chief executive Chris Hopson added: “NHS trusts and frontline staff are working harder than ever in the face of a relentless rise in demand for care, severe workforce pressures and a continued funding squeeze.”