Our exclusive investigation into how the introduction of caps has affected spending on agency staff (read the story here) reveals that trying to make hospitals spend less on staffing will only work if they are actually able to do it.
We have discovered that acute trusts in England have overridden government-enforced caps on hourly rates of pay for agency nurses more than 60,000 times since they were introduced late last year.
That figure alone tells the story, and should be used to inform the future NHS workforce strategy. This is not one or two trust chief nurses playing fast and loose with their payroll budget – it is a system-wide issue. There are not enough permanent staff working in the NHS, and so nurses in charge of rosters have to decide between safely staffing wards and breaching caps.
When they were introduced, the message from NHS England, the Trust Development Authority and Monitor was clear: you can breach the caps if safety would be compromised. But the subtext was also clear: we hope that this will be in very rare circumstances. Well, 60,000 instances of a breach in just over three months does not feel that rare to me.
I worry that this will be used as a means to tighten the belt further. Will these results be used to penalise organisations that are evidently already under huge pressure because they don’t have enough nurses to safely staff their wards? It is all very well giving trusts a target to meet, but if they can’t recruit enough permanent staff, then they can’t simply leave the gaps unfilled.
Nursing directors don’t want to spend money on agency staff – they would far rather recruit permanent staff and use bank staff to fill the gaps, only using agencies on rare occasions. The only reason they are spending so much on temporary staff is that they have no choice. And the only reason they have no choice is because not enough nurses have been trained to meet the demand.
Training-placement numbers may have been determined by the previous coalition government but this government was part of that coalition and, in trying to enforce a cap, it is trying to have its cake and eat it. When in coalition, it didn’t fund the training of enough nurses and it is now trying to prevent chief nurses from spending money on the only thing that would resolve the issue.
What nursing needs is a sensible workforce strategy that provides safe staffing, not unrealistic targets that punish rather than help nursing.