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NHS finance directors divided over agency staff measures

  • 3 Comments

More than one in five NHS finance directors fear new controls on agency spending will hamper effort to recruit enough nurses to provide safe care, reveals a new survey by the King’s Fund.

Twenty seven out of 97 finance directors who took part in the survey felt the measures, announced by health secretary Jeremy Hunt in June, would affect their ability to ensure safe staffing.

Thirty said the measures would not affect safe staffing, but the remaining 40 said they did not know.

Mr Hunt said he was bringing in tighter controls to prevent staffing agencies “ripping off the NHS”.

“Trusts remain focused on improving the quality of care and are planning to recruit more nurses”

John Appleby

The measures include setting a maximum hourly rate for hiring workers, like nurses, and capping the total amount trusts can spend on agency staff.

However, the body that represents staffing agencies has claimed agencies are being used as a “convenient scapegoat” for the NHS’s staffing woes, as previously reported by Nursing Times.

The views of trust finance directors were canvassed as part of the King’s Fund’s latest quarterly monitoring report looking at how the NHS is performing.

The idea of controls on agency spending garnered a mixed response, a selection of comments from contributors revealed.

“We need a workforce solution to ensure that we can recruit sufficient nurses and doctors,” said one finance director from an acute trust. “The increase in temporary staffing is not just down to a lack of controls.”

Meanwhile, a finance director from a mental health trust described the policy as a “publicity stunt” that would harm staff welfare.

“It will put additional pressures on safe staffing and on existing staff to work bank hours, leading to higher stress levels and sickness,” said the director, adding that it was “not well thought through”.

Others said the proposals showed a lack of understanding of how the service worked and the reasons behind staffing shortages.

“I do wonder whether the government understands that the shortage of nurses compared to the number working for agencies may reflect two years of no pay awarded to the NHS, followed by a very poor pay settlement the last two years,” said a finance director at a community trust.

However, some felt the policy could help. “If it works properly, it should reduce the attractiveness to nurses of working for agencies, thus, there will be more available for substantive recruitment,” said another director from the community sector.

The majority – 59 out of 97 – said they did not think the stricter controls on agency spending would significantly reduce the total amount they forked out for agency staff.

Just 11 directors felt the plans would indeed lead to a substantial reduction in agency spending.

However, the survey also found three quarters of trusts were planning to recruit more permanent nurses in the next six months.

The King’s Fund said this suggested trusts were prioritising quality, despite mounting financial pressures.

“Rising costs, cuts in the payments they receive for treating patients and increasing demand makes 2015-16 the most challenging year for NHS providers this century,” said the think-tank’s chief economist John Appleby.

King's Fund chief economist on health policy John Appleby

King’s Fund chief economist on health policy John Appleby

“The majority expect to be in deficit by the end of the year,” he said. “Despite this, trusts remain focused on improving the quality of care and are planning to recruit more nurses.”

The survey found a third of trusts planned to reduce their overall number of permanent staff, but the results suggested this will mostly affect non-clinical staff, as more than half these trusts said they still intended to recruit more nurses.

For the fourth quarter in a row, staff morale topped the list of concerns raised by finance directors.

Professor Appleby said measures like capping agency fees and limiting staff pay increase would not be enough to cut costs and boost productivity in the NHS.

“The most promising opportunities like in changing clinical practice to deliver better outcome at lower cost,” he added.

“This is something that can only be achieved by engaging NHS staff in a new mission to deliver better value,” he said.

  • 3 Comments

Readers' comments (3)

  • The temporary work force within the healthcare setting is a key component for delivering care to patients in our communities, fact.

    Let's not lose sight of this.

    The NHS Temporary Staffing Conference held in Peterborough earlier this year certainly praised the efforts of staff banks and recruitment companies, they're not the enemy, far from it.

    Let's put the NHS in perspective, it's the 5th largest employer in the world and therefore it's never an easy job to manage it, staff it and cope with a variety of staff shortages.

    Buying healthcare staff from foreign countries costs money, buying temporary staffing costs money but like all industries recruitment companies are a life line in difficult circumstances, project work and other instances.

    The media sells papers and raises income from creating out of context statements, the shock factor, creating a frenzy for the public to draw non-factual opinions.

    An agency Doctor may be charged at an hourly rate but unlike substantive staff there's no other costs associated to employing the Doctor.

    Substantive staff are paid a salary, Employers NI, pension contributions, sick pay, lots of annual leave, continued professional development, occupational health, compliance and other costs in addition to an annual salary.

    Temporary staffing frameworks already cap costs, the NHS simply need to take a commercial approach to who they buy their temporary staff from, insist on framework suppliers only.

    This has begun and if the appetite from Directors of Nursing, Procurement Managers and Staff Bank Managers continues the common goal can be achieved.

    Thornbury shouldn't be allowed to exhibit at the Royal College of Nursing annual conference let alone supply Nurses at £62.00 plus per hour, Mayday shouldn't be used, Ambition 24, Day Webster, VIP Nursing, New Cross, Plan B and many other unregulated recruitment agencies should be banned from the supply chain unless all else fails. All of these companies are non-framework suppliers of agency staff and aren't regulated.

    Framework agencies are audited, price capped and insured to supply staff. Therefore, allow them freedom to work with the NHS, listen to their ideas and take note of a Sussex NHS Trust who've embraced Jeremy Hunt's directive, worked with a few framework suppliers and are pioneering to stop non-framework agencies supplying, they've introduced framework Nurses and will save multiple millions as a result.

    Good luck to the NHS and framework agencies; in partnership you can achieve a reduction in agency spend and work in sustainable harmony.

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  • To suggest that only using framework agencies is being commercially minded is misguided. The fact that the framework agencies are unable to fill the shortages demonstrates that the agreements are not fit for purpose. Most framework agencies sub contract from non framework agencies as they do not have resources on their own. While I agree that costs need to be regulated, limiting the supply chain seems counter intuitive. In order to be commercially minded refuse to pay extortionate rates and negotiate better rates. That is being commercially minded.

    The issue here is temporary agency staffing. The simple answer is to employ more substantive staff to redress the balance. As an example, what if an agency are able to provide 100s of nurses to a Trust at a highly competitive cost and also only provide permanent staff? If they are off framework they could not be used even if that agency is solving a problem at a lower cost than a framework agency.

    Just using agencies as scapegoats for some staff members within the NHS's lack of commercial acumen simply moves the light away from their poor negotiation skills and onto the "boogeyman" that agencies are becoming through such misguided thinking.

    Not all agencies are out to rip off the NHS and there are some that are willing and able to provide a competitive, compliant quality service and assist in the recovery of the health economy by using their global databases to provide permanent staff.

    If you have a job to do why limit the number of tools you have to do it? The key is in selection not reduction.

    Unsuitable or offensive? Report this comment

  • To suggest that only using framework agencies is being commercially minded is misguided. The fact that the framework agencies are unable to fill the shortages demonstrates that the agreements are not fit for purpose. Most framework agencies sub contract from non framework agencies as they do not have resources on their own. While I agree that costs need to be regulated, limiting the supply chain seems counter intuitive. In order to be commercially minded refuse to pay extortionate rates and negotiate better rates. That is being commercially minded.

    The issue here is temporary agency staffing. The simple answer is to employ more substantive staff to redress the balance. As an example, what if an agency are able to provide 100s of nurses to a Trust at a highly competitive cost and also only provide permanent staff? If they are off framework they could not be used even if that agency is solving a problem at a lower cost than a framework agency.

    Just using agencies as scapegoats for some staff members within the NHS's lack of commercial acumen simply moves the light away from their poor negotiation skills and onto the "boogeyman" that agencies are becoming through such misguided thinking.

    Not all agencies are out to rip off the NHS and there are some that are willing and able to provide a competitive, compliant quality service and assist in the recovery of the health economy by using their global databases to provide permanent staff.

    If you have a job to do why limit the number of tools you have to do it? The key is in selection not reduction.

    Unsuitable or offensive? Report this comment

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