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NHS England chief exec calls on nurse managers to help tackle agency bill


NHS England’s chief executive has called for senior nurses to join the action being taken against high cost agency spending by helping to attract more temporary nurses to permanent posts.

Simon Stevens said the health service’s overreliance on temporary staffing must be addressed not only by tackling agencies, but by managers ensuring nurses have more flexible options for shifts.

“What we’ve got to now convert £3.3bn of spending on temporary staffing into as many flexible nursing jobs as we can”

Simon Stevens

He said changes to nurse rosters to fit in with people’s personal circumstances would help to bring down the NHS’s “ballooning” use of agency staff – who often take up these roles due to the more varied working patterns on offer.

Speaking at the Nursing Times’ Deputies’ Congress in London yesterday, he said: “What we’ve got to now do – and your role is going to be able to, as ward managers as directores and deputies – is to convert that £3.3bn of spending on temporary staffing into as many flexible nursing jobs as we can.”

“We’ve got to harness our collective effort on this to make the change”

Simon Stevens

He later added: “We do need more flexibility across individual trusts where people are confronted with the choice of ‘Either you sign on for 37.5 hours and we’re going to roster you this way, or you are on agency’.

“That’s the kind of stupid bifurcation where we’ve got to get some more options somewhere in between.”

However, he told the audience of deputy nurse directors that while they should be flexible with their rostering, the NHS still had to be designed to work for patients throughout the week.

He pointed to the higher mortality rates at weekend - which he acknowledged was less to do with nurse staffing and more down to the reduced availability of doctors and other staff – but said the NHS had to tackle variation in care together.

When asked by Ali Strowman, deputy director of nursing at Dartford and Gravesham Trust, how to entice well-paid agency nurse into substantive NHS posts, Mr Stevens said that in some parts of the country trusts would have to start paying the “going rate”.

Ali Strowman deputy director of nursing Dartford and Gravesham Trust

Ali Strowman

The NHS England chief said it was also important for local trusts to start working alongside one another to create a workforce strategy.

He referred to some trusts as being “at the mercy” of agencies that choose not to use the government’s pay framework for hiring staff through private companies.

“As individual employers it’s almost impossible to solve. That’s why we’ve got to harness our collective effort on this to make the change,” said Mr Stevens.

Use of agency staff has risen from £1.8bn to £3.3bn in three years, according to official figures.

Earlier this month, the health secretary announced the government would be introducing caps on hourly rates of pay for agency nurses used by the NHS.

It said the new rules would only allow NHS organisations to recruit non-permanent staff from approved agencies, and would also place a limit on total agency staffing spend for trusts in financial difficulty.


Readers' comments (12)

  • It will be interesting to see how agency costs will be controlled if the arrival of nurses from the EU is drastically reduced following the introduction of English tests (for unprepared EU nurses).

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  • I have been nursing in the NHs for over 30 years. Flexible working used to be available when I started and there was never a staffing crisis. Then The managers decided that you had to apply for a flexible working agreement-even if you had a contract stating you worked nights/term time etc. Many nurses were forced to leave and work agency because of this inflexibility. If you let people work the shifts they like/need they will be happier in their jobs, there will be less sickness and the wards will be staffed properly equating to better patient care. Hopefully, these short sighted managers will take heed of this advice

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  • Flexibility and a substantial increase in salary-Job done!

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  • When I trained in 1973, I can't remember there ever being agency or even bank staff, for that matter. I realise demands have changed, so what has gone so wrong. It would seem a problem with supply and demand. I don't know the facts and figures, but it seems obvious that there are not enough nurses being trained to fill the posts required. Having said that, more recently, posts have been left vacant in the hope to save money, and when any staff are off sick during these periods, the shifts have to be filled by someone, possibly agency staff, if staff can't be 'borrowed' from another area. I may have got this all wrong, but on the 'shop floor' this is what seems to happen.
    As for flexible working, I'm all for it, but it needs to be available to all staff. Having no children, over the years, I have felt that childless couples are the most flexible working around staff with children requiring more rigid working times. I have happily worked Christmas days, but I would like it to be realised that childless staff do have families and commitments too, siblings, parents, grandparents, aunties, uncles, cousins, and of course spouses/partners, etc.... Being able to have A/L in July and August was always a battle. At the end of the day, we are all here for giving the best care for patients.
    I hope I haven't come across as bitter, I'm not, just want a bit more fairness.

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  • This is the start of the dismantling of Agenda for Change, imagine, it's bad enough the agency staff outstripping us on pay, but now new recruits will be paid more than someone who has loyally stayed in one trust for many years

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  • So its ok to have highly paid agency IT, financial and consultants but not when it comes to nurses. Locum doctors are still generally much better paid than locum nurses.

    Ultra-highly paid agency nurse isn't the norm. Most agency staff are not as well paid as some people think. Agency staff are unlikely to have holiday pay, sick pay, employers contribution into their pensions, more difficult to maintain continual professional development, training + updates. In addition, their contracts are of variable lengths and only when there's a demand for their services. Running a business/agency also have additional costs and tax implications.

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  • As workforce management has not got things in order, paying + looking after its staff better, staff are becoming more savvy, realising their own worth and by not working 'bank' shifts (ie less pay for overtime hours) and switching over to doing agency in their free-time (out-of-contract).

    This could be partly addressed by paying substantive staff OT rates when working above contracted FT shifts. More substantive staff would reduce agency need.

    However some employers think they can get away + save money with a skeleton crew of permanent staff, then employ extra staff when things get busy. Well, where is the extra staff going to come from? All the thousands of extra staff (spread across the country) the government keeps telling us, won't make a jot of difference when you're the patient needing help/assistance and the nurses are busy helping someone else.

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  • michael stone

    '“That’s the kind of stupid bifurcation where we’ve got to get some more options somewhere in between.”'

    True - about an awful lot of things, not just this.

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  • More of listening and trying the very best to accommodate requests from nurses is a good start with fairness in doing duty rota.
    I am a childless and I have worked Christmas day for the past 3 years although more than anyone else I need to see the rest of the relatives at this time. My poor husband has to sit at home alone, with not even a Christmas dinner, we feel that we have been deprived enough.
    What is so hard about being flexible and helping staff to be happy.
    We were were not born to work we work to help us live. We must celebrate living and also have a slice of what everyone else is enjoying.
    Pay unsocial hours well for the Bank staff and for staff who will be happy to do unsocial hours for a good rate.
    The key word here is HAPPY.

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  • Getting rid of electronic rostering would be a start. Nowhere near as fair and equitable as the knowledge the rota creator had when off duty was done by hand

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