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NHS spending 20% more on temporary nursing staff


Spending on agency and bank nurses is soaring this year, driven by staffing cuts and increasing demands on services, an investigation by Nursing Times has revealed.

Payments for agency and bank staff are likely to be 20% higher this financial year than in 2011-12, and could pass £450m across the NHS.

The rise in spending on expensive temporary staff comes despite trusts being under pressure to cut costs, suggesting some are concerned they may have reduced their permanent workforce too much to ensure safe quality standards.

Others may have been forced to fill staffing gaps to maintain services experiencing ever increasing demand and continuing pressure from staff sickness.  

The Nursing Times collected data from 100 acute trusts in England via Freedom of Information Act requests.

The investigation found small increases in agency and bank spending were widespread. But around 15 trusts had seen their spending at least double – in part because of pressure on their services, such as increased accident and emergency attendances and early outbreaks of norovirus in the autumn.

The need to fill shifts is so severe that some trusts have paid over £1,000 a shift for agency staff, the investigation found.

The biggest pay-out identified was made by scandal-hit Mid Staffordshire Foundation Trust. It had to pay nearly £1,800 for a specialist nurse to work a long A&E shift in December 2011.

But while Christmas and New Year present obvious staffing difficulties and may command premium rates, several trusts had paid more than £600 per shift in other months.

The trusts that responded to the FOI request spent a total of £238m on temporary staff during the 2011-12 financial year. They had already spent £169m on temporary staff during the first seven months of this financial year.

Based on that level of spending continuing, the trusts are predicted to have spent around £286m in total during the whole of 2012-13. However, this is a conservative estimate as it does not take into account increased use of temporary staff during the winter months.

Professor James Buchan, a nursing workforce expert based at Edinburgh’s Queen Margaret University College, said this might be the case for a minority of trusts but .

“Some trusts are freezing posts to save money and then finding they can’t cope, and have to bring in cover, and a small number of trusts may be trying to build in greater flexibility by having a proportion of the workforce they call on when management think it is warranted,” he said.

“The former reflects short-sighted and poor management; the latter approach increases risk to care, unless there are very effective systems in place to monitor workload and local staff with the right skills at short notice,” he warned.

But Helen Rudanec, managing director of the agency HCL Nursing, argued that using agencies to provide workforce flexibility could be productive for trusts. “It costs a lot of money to take someone on permanently whereas you can flex with agencies,” she said.

She confirmed that demand for her company’s services had increased month-on-month. Demand is so high that her agency brought in 112 European nurses last year, offering them an element of guaranteed income, she said. It expects to at least triple that number this year.

Royal College of Nursing head of employment relations Josie Irwin said the figures were suggestive of a looming shortage of nurses in at-least some areas of the UK.

“There is not enough supply coming through and we have this emerging shortage,” she said. “There are recruitment and retention issues – and high levels of sickness – that temporary staffing is masking.”  

Academics warned that there were potentially negative effects on quality of care and patient safety from using high levels of temporary staff.

Professor Buchan said that, although the evidence base on the use of temporary staff was limited, there was likely to be a range in risk.

For example, bringing in bank staff who knew the trust, staff and patients would be at the safer end while using very short-term agency nurses – who may need orientation and supervision – was at the other.

Professor Peter Griffiths, chair of health services research at Southampton University, said evidence suggested using agency staff to cope with peaks in demand was not always cost-effective.

“The staff are relatively less effective and expensive. It might be that this is a case of savings in ward staff driving increased costs elsewhere.

“You really need to look at the total wage bill to see if there are any savings and to keep a very close eye on quality to be sure that there are no harms,” he said.


High Spenders on Agency and Bank Staff

Big London trusts have traditionally relied heavily on temporary nursing staff – and a small number run of bills of over £10m a year. But Nursing Time’s research showed that some of the most dramatic rises in spending this year has been among ‘normal’ DGHS. There is a strong geographical divide with the majority in the south, including a cluster in the south west which is often regarded as a low turnover area. 

Among these trusts, five are likely to see spending on temporary nurses quadruple this year with one – University Hospital of North Staffordshire – facing a seven fold increase:

  • University Hospital of North Staffordshire Trust spent over £1m on agency nurses in 2011-12 and nearly £5m in the first seven months of this year. It said it had cut agency spend by £500,000 a month since October.   
  • Frimley Park Hospital Foundation Trust spent £152,000 on “locum” nurses in 2011-12 and £480,000 in the first seven months of 2012-13. It said spending last year was exceptionally low and it had spent this year because of high activity levels.
  • Pennine Acute Hospitals Trust spent £262,000 in 2011-12 and £869,000 in the first half of 2012-13. A spokesman said: “We have had to increase our use of agency nursing to ensure we have adequate levels of nursing staff. This has mainly been across our medical and surgery divisions due to… higher than normal levels of staff sickness and to cover vacancies.”   
  • Cambridge University Hospitals Foundation Trust spent £186,000 on agency nurses in 2011-12 and £402,000 in just six months during 2012-13. Increasing demand for its services was behind the increase, it said. It has begun a new recruitment strategy.
  • Sheffield Teaching Hospitals Trust spent £105,000 on agency nurses in 2011/12 and £257,000 in seven months this year – annualised to £441,000.  The trust said it was expanding community services and had used agency staff for this while it recruited permanent nurses.



Readers' comments (9)

  • It's very enterprising of those who can earn money by taking advantage of the short-termism, lack of common sense, and politically correct managers who hang on to their jobs by reducing staffing numbers, grades and pay to save a bit of money each financial year. None of this is patient centred, of course, which is unfortunate. I am aware of colleagues who have reduced their regular staff hours in order to earn more by doing a few agency shifts, and I commend them for their acumen.

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  • this is all down to incomptent nhs managers

    oh I know how to save some money...erm lets cut staff on the wards...yep that should save some and make me look good

    oh dear not enough staff on the ward to cope with the ill paitents..I know get some bank and agency staff in

    oh doh its going to cost us god did these fools ever do simple maths at school, my 8 year old could do better!!!

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  • I know nurses who have left their jobs. Some had nice (if you can call it that) redundancy package and then got better paid jobs doing the same thing with less stress, concerns or worries. Few others with business sense are now agency staff and are inundated with work, also their training, travel and subsistence are deductible from their earnings. Easy when they're excellent nurses with valuable experience.
    Also some trusts don't have bank admin staff, so costs them even more for agency staff. Who's going to look for patients records when a hospital is very busy?
    As nurses are covering due to staff shortages, more are getting tired + ill, meaning even less available for bank work.
    Yeah really makes sense to pay over treble for every staff missing, and longer term costs are even higher.

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  • I had to laugh with I read 'agency staff can be flexed'.
    I am aware some trusts employ teams of permanent roaming (bank) nurses to temporarily fill gaps around the trust, though tricky when wards have outbreaks of Nora or C Diff, these staff and agency staff can't risk becoming infected too.

    Also seemed to be forgotten, added to the cost of agency or bank staff, is the sick pay for missing staff then any rehab costs. Also with increased risks to patients as well as other staff, is possibly litigation costs from substandard care and staff accidents.

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  • Unfortunately agency nurses are often not allowed to do IV's or many of the skilled RN jobs, so the RN that is employed on a permanent basis ends up doing their work as well for a lot less money. The NHS needs to wake up and look after their nurses, because sooner rather than later a lot of the experienced ones will be gone.

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  • At the Trust where I work the Temporary in House Staffing Office can simply not recruit Band 5 staff. This is mainly due to the way it pays staff a month after they work. A process adopted two years ago.
    Therefore we are now relying on Agency Nurses daily to cover sickness absence, specialing, escort duty etc. We are then held to ransom by Agencies who state that their employees will only work full shifts, not half shifts.

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  • The ward I work on has lost two nurses with over 10 years experience and three nurses with more than 3 years experience, so both young and mature in the space of two months. We are now waiting for the the places to be filled by nurses from Spain in a couple of months. In the meanwhile we work short or if we are lucky we get agency. When the agency work wih us we end up doing some of their work as there are things they need help with.
    It is not good times.

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  • My trust seems to be using a lot of agency at the moment as they are having trouble recruiting band 5 nurses. It's an expensive option for sure, especially some agency staff can't do a lot of the things required, and the regular staff end up doing them.

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  • My Trust has a recruitment freeze and our wards were slightly understaffed just as this came about. Most shifts run short. So regular staff keep going off sick and we're left with bank to fill in the gaps. Last few shifts I've been the only permanent member of staff which is pushing me to breaking point. Doesn't help that our service users don't like bank staff members and will only come to/talk to permanent staff. Incident levels are rising and then more staff go off sick. We then use more bank staff and it just goes round and around in circles.

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