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Dr Zofia Bajorek

The high costs of temporary agency staff in the NHS

Authors: Dr Zofia Bajorek Researcher

16 June 2015

The use of temporary agency staff in the NHS is not a new story, but in the last few weeks it has featured in the headlines yet again with Simon Stevens admitting that hospitals are over spending on agency staff and agencies who rip-off NHS Trusts must be targeted.  The latest figures suggest that the NHS spent £1.8 billion on agency and contract staff in 2014, twice what had been planned.  In some ways it is understandable why this provoked an element of outrage – the NHS is attempting to make £22 billion in ‘efficiency savings’ and ministers have failed to rule out cuts to doctors, nurses and other staff, yet at the same time, agency and locum staff are often drafted in at expensive costs to fill staff gaps.  The other concern often raised in relation to agency staff use is their risk to patient care.  This leads to a number of questions: If agency staff are so costly and at an increased perceived patient safety risk, why does the NHS rely on them so much?  What would happen if the NHS does not use temporary staff at all?

The NHS has a duty to provide high quality care for all, and yet there is a large body of literature suggesting that staff vacancies and inadequate staff to patient ratios can negatively affect patient safety and service quality.  Hospitals with good working environments, improved staffing and suitable staff to patient ratios had improved patient satisfaction ratings and nurse outcomes.  Patients in hospitals with higher ratios of patients to nurses (increasing staff workloads) were less likely to rate the hospital highly for patient care.

The NHS then has an unwelcome conundrum: if there are risks (and high costs) in both using agency staff and not using them, what can the NHS do to manage this problem.  It is clear that greater consistency and co-ordination of the use of temporary staff is needed not solely for minimising costs, but for patient safety efficiency and care.  However, if the focus becomes solely on costs rather than a wider look at workforce planning and productivity then workforce wellbeing and the quality of patient care are still at risk of being compromised.