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No sign of slow-down in NHS reliance on agency nursing staff

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An ever-increasing reliance on agency and bank nurses is costing the NHS and risks harming patient care, according to a new report by the King’s Fund.

Meanwhile, current problems recruiting permanent staff could get even worse, the influential health think-tank has warned.

Its new analysis of agency nursing data shows demand for temporary staff continues to grow.

“Increasingly reliance on temporary staff to fill permanent posts raises concerns for financial as well as quality reasons”

King’s Fund

As part of their analysis, researchers looked at agency nursing requests from acute trusts between April 2009 and January 2015.

They found that, although demand for agency and bank staff increased considerably after the Francis report on care failings at Mid Staffordshire Foundation Trust, the trend had started before then.

According to the King’s Fund report, the number of agency hours requested from NHS Professionals – the Department of Health-owned temporary staff provider – has more than doubled from 930,000 in April 2012 to more than 1,917,000 in January 2015.

“The trend does not appear to be slowing; this suggests that there are serious continuing problems with staffing levels, which trusts are solving by using temporary nursing staff in the absence of sufficient permanent workers,” said the King’s Fund report Workforce Planning in the NHS.

It added that the total number of trusts requesting temporary shift cover was increasing too, which “may indicate that these nursing staff shortages are becoming more widespread”.

“While there is a clear argument for using some agency nurse capacity to cover unplanned absences and vacancies, and to meet unexpected spikes in demand, an increasingly reliance on temporary staff to fill permanent posts raises concerns for financial as well as quality reasons,” stated the report.

It said the trend had spread to mental health services, while the increased demand for hospital nurses has been blamed for pulling nurses away from stretched community services.

King's Fund

King’s Fund senior research fellow Rachael Addicott was lead author of the report

Meanwhile, recruiting nurses could get even harder, warned the report’s authors. “As the wider UK economy continues to recover, there is a risk that the current difficulties in recruiting permanent staff will grow as the range of alternative career options open to health service staff increases,” they said.

An over-reliance on agency workers is symptomatic of shortcomings in overall workforce planning, according to the report, which combines latest research, national statistics and interviews with experts.

Its authors suggest there is a major mismatch between NHS goals and what is actually happening with staffing on the ground. They argue that a lack of consistency and co-ordination in workforce planning has contributed to current “deep recruitment difficulties” in nursing.

This includes a significant decline in numbers of community nurses, despite the drive to provide much more care in the community.

The report also highlighted “consistent declines” in mental health nursing, warning there was little evidence to suggest policies designed to make mental health a priority and put it on a par with physical health have led to more nursing staff on the ground.

“This represents another major disconnect between policy and workforce planning,” said the report.

Meanwhile, a lack of resources and staff going into primary care means general practice has “drifted into crisis”, the report added.

“The Kings Fund report is a useful addition to current thinking on planning the NHS workforce”

Danny Mortimer

One key issue is a lack of hard data. The King’s Fund team flagged up “large data gaps” in primary and community care when it came to vacancy rates and the use of bank and agency staff.

Some of the apparent reductions in nursing staff numbers – such as in mental health – may be because nurses have taken up jobs with independent and voluntary providers delivering NHS services.

However, the report concluded a lack of information on these providers makes it hard to keep track.

The report called for stronger national leadership and a much more joined-up approach to workforce planning, which should include a new national strategy covering all NHS-commissioned services.

NHS Employers described the document as a “useful addition to current thinking”, but stressed good workforce planning relied on having a clear idea of services that would be needed in future and those that actually worked.

“It’s important any future policies support the ability of local NHS organisations to deploy staff in the best way to support high quality and efficient patient care,” said chief executive Danny Mortimer.

“NHS Employers is working with organisations across the system to increase the supply of shortage groups and to support health care providers to retain and develop their existing workforce.”

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