As you get older it feels as though things come around increasingly quickly.
Birthdays, the Olympics, the need for new glasses, new TV programmes about baking. The writer John Mortimer once remarked that when you get past 50, it feels as though you have breakfast every 30 minutes. I think I know that feeling - particularly when it comes to health policy or, rather, government initiatives.
Last week the government introduced measures to cut NHS agency staff costs. It’s a good idea and I’m surprised nobody has thought of it before. Oh wait, what’s that? They have? I don’t remember if it was the 1980s, the 1990s, the 2000s or all of those decades but I definitively remember we all decided agency costs were a bit excessive and we came up with NHS Professionals to help with that. Is that not working then?
Apparently the cost of agency and contract staff across the NHS in England last year was £3.3bn. That is a lot of money, and it leaves with us a few questions. While I’m all for running up the hill with my torch and pitchfork in agreement with the BBC headline “Sanctions target ‘rip-off’ NHS temps”, I can’t help but notice that £600m of the spending last year went not on nurses or doctors but on management consultants.
I’ve never fully understood the whole management consultancy thing. Do we buy them in because there are not enough managers to do all the managing and we need more when there is a rush on. Or do we buy them in because the managing that needs doing is a bit too hard for the existing managers and we need to get some advice?
And when we notice in horror (thanks again BBC) that one agency nurse cost £2,200 for a 12-hour shift (including agency fees), are we equally outraged by the day costs of said management consultants? Or is it that some high costs more acceptable than others?
Not that this addresses the key question of expenditure on agency nursing and why it has remained a recurrent issue for the last 30 years. There are lots of reasons why we use too many agency nurses; financial uncertainty can make recruitment difficult, as can a lack of suitable nurses. And lots of nurses just prefer the flexibility that comes with working as an agency nurse. (Anyone else remember Improving Working Lives? Around 2000? No? Maybe I imagined it.) But a key issue is the fact that we have constructed a culture in which agencies thrive.
We have encouraged a market economy in the NHS; profit-making agencies will inevitably emerge from that. We don’t just facilitate it, we actively encourage it. We can’t on the one hand say “a free and unregulated marketplace is the best model for the health service” then, on the other, be cross with agencies - or management consultants for that matter - for simply coming to market.
We have also made issues such as recruitment and education dependent on the economic cycle. Can we afford an extra staff nurse? Or extra student places? Or to develop that really successful service? Not this year, no, because of the cuts. But maybe next year we can. Meanwhile the needs remain and so we’ll plaster over the disinvestments and hope for the best.
I am all for cutting agency costs, not simply because of economics but because I think many services benefit from more control over staffing. However, throwing politics at the problem every 10 years doesn’t seem to be the answer. Understanding the implications of existing politics and the exchanges of power on the other hand - that might help.
Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe