Much has been made of the withdrawal of crucial funding to nursing students in the UK, with a lack of funding and bursaries thought to be responsible for dwindling numbers of new applicants to nursing courses. Although there have been hushed rumours that the government may be looking to reintroduce nursing bursaries, there still remains a great lack of nurses available to care for patients. With a lack of caregivers comes stress on healthcare professionals and those already short staffed and managing with inadequate staff numbers. But what to do? In these circumstances, care homes, hospitals and community care centres often turn to short term solutions to cover demand. Nursing agencies serve as a great tool to quickly fill a vacancy and cover short staffing. But how much of public health expenditure does this account for?
In August of last year, an internal NHS report stated that upwards of £450 million could be saved by employing staff already registered with the NHS or using bank nurses. However, agencies are often used due to the rapid filling of job vacancies, something which is vital to continue the provision of high quality care. It has been reported that employing agency healthcare workers such as doctors, pharmacists and nurses may cost 20% above the normal NHS salary for the same workers, quickly driving up costs and placing questions on the sustainability of such a tactic to fulfil vacancies. The solution, by comparison, could be to use the bank workers who are available for flexible working.
Bank workers are often those already employed within NHS trusts or those who have flexible working commitments and may have waived the working time initiative to work extra hours. In using these workers, the NHS would invest back in to its workers and system, allowing the conservation of budget which is dissolved when using agency workers. Yet, amongst other reports of late around the sense of stress and pressure felt by nurses and bank staff, how sustainable even is this tactic? Ian Dalton, Chief Executive of the NHS Improvement initiative, had this to say in an internal interview of 2018, “Temporary agency workers play an important role in ensuring staffing numbers remain at a level that provides the best possible care for patients and gives them the opportunity to work flexibly. But an over-reliance on high cost private agencies when there are other options available is not good for patients or for the NHS’s finances”.
In times of high pressure, questions must be raised about the workplace culture and how sustainably this is being managed amongst workers and colleagues. If the organisation often rewards workers for their efforts and they feel empowered, there will often naturally be the willingness of employees to devote extra time and take on surplus hours. However, in an organisation such as the NHS where resources, incentives and rewards are restricted due to funding, it may be difficult to motivate those already employed to put in hours beyond their mandate. Interestingly, the NHS has managed to restrict agency spending so far by upwards of £1 billion on agency staff since 2015 when new restrictions were put in place. It does seem things may be heading in the right direction though, with the 2018 year being the first where spending on bank staff has surpassed that of agency spending.
The NHS placed targets on it’s trusts to reduce agency costs by 17% in the previous period, with a new initiative to take a ‘bank-first’ approach. Yet, for those vacancies which are felt dearly – particularly in high turnover and high risk teams, it is imperative to provide immediate staffing to continue the provision of high quality care. However, the use of agency staff on a continued basis has led to a depletion of resources available to be fed back into services and development. Taking a more long-term perspective on provision requires careful planning, something which is quickly disruptive in high stress situations where the provision of care is the crucial factor.
Ideally, positions and vacancies would be filled following the ‘bank-first’ initiative, and only then relying on agency staff on an ‘ad-hoc’ basis. It appears that using the agency sourced staff has been a convenient and quick solution to the lack of nurses in certain disciplines. Furthermore, if the NHS is to continue in any capacity, it must continue to make big strides (such as capping agency spending) to allow formore ‘front line’ recruitment of staffing numbers. One does have to ponder in this time of uncertainty – if funding to nursing courses and bursaries is reintroduced, how long will it take before the service sees a reduction in vacancies, gaps and short staffing? Until then, it appears bank staff and agency serve a crucial role in continuing a well-oiled healthcare machine.