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Senior nurses hit out against cap on agency staff spending


Senior nurses have criticised the government’s plans to cut spending on agency nursing.

Monitor and the NHS Trust Development Authority have written to all NHS provider chief executives to give them individual ceilings for the proportion of nursing expenditure their trusts can spend with temporary staffing agencies from 1 October.

This should bring all providers’ agency spending to within 3% of their overall nursing expenditure.

Although those with highest rates of agency spend will be given longer to reach this target, nursing directors have voiced concerns over the caps.

“While all of us are committed to reducing the reliance on temporary staff, we have to ensure that the assessed needs of patients are met”

Liz Rix

“As we move into winter and the inevitable move to opening additional beds I cannot see how we can staff them without use of agency [personnel],” said a nursing director from one large trust who asked not to be named.

Liz Rix, chief nurse of University Hospitals of North Midlands Trust, said: “While all of us are committed to reducing the reliance on temporary staff, especially agency staff, we have to ensure that the assessed needs of patients are met.”

Another nursing director said the caps unfairly target nurses. She said: “Medical expenditure is far more of an issue yet no one will challenge the consultants working as permanent locums for £100-£150 per hour.”

Other parts of the health secretary’s clampdown on “rip-off agency staff ” involve a ban on trusts securing nursing staff from agencies that are not on approved “framework agreements” from 19 October, and a cap on the hourly rates trusts pay for agency nurses.

“Combined with difficulties recruiting staff from overseas, we have set the scene for a premium-cost market to continue to evolve”

Karen Dawber

This is expected to be announced by 1 December, giving Monitor more time to consult with provider organisations.

Karen Dawber, director of nursing and governance at Warrington and Halton Hospitals Foundation Trust, said she understood the
financial rationale, but said: “We have, at least for the next two years, a national shortage of nurses. Combined with difficulties recruiting staff from overseas, we have set the scene for a premium-cost market to continue to evolve. We need to encourage nursing staff working for agencies to return to the NHS.”

Janice Sigsworth, director of nursing at Imperial College Healthcare Trust, was involved in developing the guidance on the caps and said it should not affect safety.

“It should be about supporting efforts to minimise vacancies as well as ensuring sufficient day-to-day flexibility within organisations so we can still book an agency nurse if quality and safety demand it,” she said.


Readers' comments (9)

  • I absolutely agree with the director of nursing who highlights locum rates - they dwarf any spend on agency nursing. I wouldn't like to give politicians who believe in market forces any lessons in the way markets really work, but if you keep official prices low that does affect supply (nurses leaving or retiring early before their pensions are further impaired). When you add to that an inability to produce enough nurses for known demand you further impact the supply (to say nothing of barring recruitment on non-EU nurses for less than £35k salaries) and end up with a black market where prices outstrip the "official" price. If you then take control to the point that even agencies cannot create a supply you have a real problem. If this was a foodstuff, people would find alternatives - as it is nurses and other shortage occupations the prospects are much bleaker.
    It is unfortunate that politicians are willing to do anything except talk about the real issue - NHS funding - and instead try to blame the market and those who put their skills out for sale there. Karen Dawber hits the nail on the head - how would you encourage nurses to return to the NHS? I think we all know...

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  • All except Jeremy Hunt, it seems...

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  • well said - more pay, better staffing, therefore less stress at home and work... these are the issues why nurses choose agency over permanent contracts. so simple. you don't need to be a health minister to work that one out... also London weighting doesn't account for working in a very overpriced city, that's why its so hard for London hospitals to recruit.

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  • We are told bankers need top salaries and bonuses to attract talent, but when it comes to nurses, suddenly this government doesn't believe in the free market! They only care about the wealthy.

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  • 16 September 2015

    Its very obvious Politicians are liars. They do not care about the NHS, its patients, its front-line staff.

    Problem - NHS funding.

    PFI Hospital should never existed. Costing the tax payer approximately 5 million pounds to run every year.

    NHS Logistics charge 20% for every item requisitioned through them.

    Chief executive and board members fat salary, pay, bonus, pension.

    Outsource services and dodgy government contracts solicited to profit first private contractors.

    Locum- doctors, surgeons and Consultancy firm inflated fees.

    MPs 11% salary increase.

    Politicians had turned a blind eye on the problems mentioned above because it is easy to blame the Agency and agency nurses. Nurses are easy targets because of the nature itself. Its an all womens profession. Politicians will Not admitt that it is easy to blame the nursing profession because they do not want to lose votes.


    Better Pay, Terms and Conditions. Pay should be above the inflation rate every year.

    Most of the politicians friends and supporters are rich corporations, banks, companys, firms. Most of them are employed or hold a second job to this big firms. Politicians will favor their employer first because to increase public sector pay. Politicians need to collect more corporate tax. Increase in corporate tax will hurt the large profit margin of all this multinational corporations.

    Stop to the ever increasing housing rent in high cost areas. Majority of the MPs and Politicians are landlords.

    Stop the NMC from the ever increasing professional registration fee.

    NMC should move out their London office to the midlands. NMC pay an ever increasing London office rent. NMC this is Not the getting the good value for money from the registrants professional registration fee.

    Capping the agency pay rate is never the answer to the NHS deficit.

    Remember Politicians are only interested in our votes. Its Not about saving the NHS. Its about perpetuating themselves to power. Power and Influence is might. Money is the instrument to buy influence which serve their vested interest.

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  • I work on the temporary staffing bank for my local hospital I get paid exactly the same as if I was a nurse with a substansive contract its not all of nurses who have gone to work for an 'agency'

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  • Dear Anonymous | 16-Sep-2015 8:30 am - I agree not all nurses have gone to work for agencies. I am greatly indebted to nurses who work on the bank and have a great rapport with NHSP at my hospital. The caps do not cover bank as it is recognised that an excellent way to retain nurses who want added flexibility is via a bank system.

    At WHHNHS we work in partnership with NHSP to recruit and retain staff wanting to work in hospitals via the bank including nurses who are returning to work or have no acute experience.

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  • I am a hard-working specialist nurse working in an over-stretched A&E (one of the hospitals mentioned in your article above). Whilst at work I had a minor injury treated by an ENP so that i did not need to leave work. She was brilliant and I was very happy with treatment; but was shocked when she told me she was an agency ENP on a 6 month contract with the trust. Last year she was paid £80,000 by the agency! In other words the trust where i work paid that plus the premium to the agency. That is probably near a consultant salary. My gratitude to her was somewhat dampened.... Can you blame her? Something has gone dreadfully wrong

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  • cap on nurses pay, but never on bankers bonuses, now hunt wants to pay agency nurses less than the nhs rate

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