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'Agency pay caps expose system-wide problem'


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.


Readers' comments (7)

  • michael stone

    '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.'

    I have read on NT, that there is a factor beyond the commonly-quoted 'we made a mistake and did not train enough nurses' issue: some nurses, seem to want to work as agency nurses, because it gives them more control over when they work [presumably, in fact, more control over when they WILL NOT be working].

    That factor - if it is significant - implies that the NHS needs to be 'more nurse-friendly' AS WELL as there being a need for the NHS train more nurses.

    I would be willing to bet, that most of the senior people (clinical and political) who discuss this issue, will concentrate on the 'we failed to train enough nurses' part ?

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  • I could not agree more with the comment above that the NHS needs to be more nurse friendly. This is too complex a problem to blame on just poor workforce planning. High numbers of student nurses drop out of their course, huge numbers then leave a year after qualifying. This needs to be addressed urgently, there is no point in increasing the number of training places until you find out why they won't/don't stay.
    The NHS does not even provide adequate lockers and staff rooms, nurses are fed up of being disregarded, their managers cancel frequently mandatory training. These are not the actions of an organisation that cares about their staff, the NHS imposes and dictates to nurses and then appear shocked when nurses take control back by leaving to work for an agency. In my organisation the nurse is king, we understand what a valuable resource they are and we try and do everything we can to make them feel valued and rewarded. We have 2 candidate care coordinators, their job is to ensure our nurses have help and support when ever they need it. We understand the value of an engaged and committed workforce.
    I know it is a popular statement to sweepingly say all agency nurses are in it for the money but most agency nurses hold substantive NHS posts! The system is broken and a truly honest discussion about the state of the nursing workforce is long overdue. As a ex-nurse I am disappointed at the way my former profession is represented, I see no nurse leaders I would want to follow. I hear no dynamic nurse leaders, challenging the status-quo, daring to think differently.
    I have 2 daughters who are both A * students and I have to say with a very heavy heart I would not recommend nursing to them.

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  • Let NHS give good numeration and good working condition to the nurses to boost their morale, and let us see if the situation on ground about nurse shortage would not improve. I have sworn never to work for NHS as long as they continue to use their nurses without valuing them. Nurses don't get paid break and have to work several unpaid hours ensuring they finish up at the end of their shift. NHS as an employing organisation sucks in my opinion.

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  • I'm an agency nurse and have been since 2008, when the Trust could not accommodate me taking time off to nurse my own chronically ill child !!! There was no flexible, no compassion and 100% impatience and judgement. My position is still the same with the added complication that my husband works abroad Monday to Friday. I am sick of other nurses, NHS boards and the press labelling us as money grabbing pariahs of the NHS. People forget we still pay for our NMC registration, our RCN liability, but we also have additional costs staff nurses don't have: pay for our own CPD courses which start AT £99 + VAT, if you can get one in a 100 mile radius, BLS & other mandatory training. Pension, agency booking fees, uniforms, health check documentation and the list goes on. When I was off work due to a complex ankle fracture, no sick pay, no benefits no help! This is the reality of the agency nurse. When I work I give 100%, I ignore the snide comments, I don't complain of the heavy bay, dementia/confused bay. The cold shoulders and hostile work environments. This is the reality of a normal agency nurse, just trying to make ends meet and meet our professional and personal obligations. So please but the blame where it belongs and not on "the agency nurse".

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  • Interesting comments from all above......however there are few misunderstandings here......yes there are not enough nurses trained so we have a gap & why do you think that is so......because some years ago workforce planning was done by many who do not understand it & didn't see it as a priority it was just another job to do which eventually would cost trusts money, follow on from that & the bid to keep us all in line with our budgets which in turn led to workforce planning changes as we could not increase headcount, down grading of posts or the dubious banding of new.........then you add in the Francis effect, the aging population, public expectations, pioneering changes in care ( we now treat patients who survive with ongoing care needs than ever before, 10yrs ago they would have died- the emergence of outstanding major trauma care is a prime example), the NHS is at breaking point beds are barely cold, the pre noon discharges forced in our & patient faces to help deal with the 4hr target in ED. oh & I forget many trust lost beds but have now had to increase due to many of the issues above....... Tell me why would anyone want come into & stay in nursing, midwifery, or medicine when you are faced with this everyday?
    Matrons & senior nurses who don't get a minute to breathe, take work home, work 50-60hrs a week, are harassed to just do it & ending up with making decsions that are hard for all. Most healthcare professionals just like the police, fire & ambulance service are heading for burn out in their mid30's due to the pressure. The answer is not always more staff but a different way of working & planning & no.....I don't have the answer for that. Agency staff just fill a gap & a costly one at that but tell me what else can a matron, nurse director do....sit back & watch their nursing team drown, patients fall or come to harm? That is reality of modern day costs money to deliver good care & care for staff that unfortunately is not a bottomless pit. We could start by taking at look at CCG's, NHSE, TDA la la la if we got rid of some of these people on extortion money it would free up some for training...... Would we miss them if every trust had good governance practices? some yes, many no. I rest my case

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  • I have been nursing for 3 years, came into nursing as I thought it was a graduate career, and been massively disappointed. I work agency on top of my full-time job to get by, will never afford a place of my own, and I am constantly hindered by waiting for other overworked people to sign off progress. Recently I have applied for band 6 positions who show no interest in Masters level study, so agency work is actually a way forward and out for me. Very sad as I love my job, but me and the rest of my team are sick of being constantly short-staffed, exhausted, and having to work so many nights and weekends (as its cheaper for our employer to get agency on weekdays). A few of my team are leaving the country and even the profession now, and they are brilliant nurses who care deeply, but who also feel this is no life for them.

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  • I am an agency nurse partly due to how the NHS treats it's staff. The off duty was done so far in advance and so inflexible that one could not have a social life, or holidays when wanted. I like being able to turn down shifts depending who is on duty, I worked in a hospital where I was often rostered with the poorly performing staff with the idea that one or two competent staff would lift the standards on each shift. The NHs does not treat staff well, I was told that I could not take the day of my Grandad's funeral off because grandparents are not close relatives!! I was often expected to work through my break or extra hours pay free which I did as I cared about the patients. Despite the fallacy I am not earning huge sums of money, my hourly rate is the same as at some hospitals (occasionally a little more!). I do not get sick pay. I do pay for my training. I'm on zero hours so constantly worry that I won't have money coming in from week to week, yet I would still do anything to avoid going back to the NHS full time!!

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