Readers’ Letters − 17 January 2014

NHS must take greater control for its temporary workforce needs

Following recent coverage to expose the rise in spending on A&E locum doctors, this is just the tip of the iceberg when it comes to the cost of temporary staffing in the NHS.

‘The procurement and management of the NHS temporary workforce is not just confined to A&E − it stretches across the entire health service’

While the figures obtained by the opposition government should be placed in some context − given that not every locum will work a 12-hour shift on the same rate every single time − these figures are far from uncommon.

In fact, the annual agency spend across the NHS is widely billed at £2.5bn. What’s more, this statistic only accounts for agency staff and doesn’t factor in bank labour who are managed internally by individual trusts. If you combine the two together then the figure could easily top £5bn each year.

The procurement and management of the NHS temporary workforce is not just confined to A&E − it stretches across the entire health service, covering every grade and individual specialism, including nursing, allied health, admin and clerical and both acute and mental health medical staff.

In any situation where demand increases for a particular category of worker, staffing agencies will attempt to take advantage of the situation. The two main issues associated with this are: where charge rates are allowed to escalate; and where quality and compliance standards are compromised. The NHS should be in a position to exert greater control over these areas, as it is the health service that owns demand.

However, with trusts are under pressure to fill vacant posts and ensure staffing levels maintain government targets (eg: four hour waiting times), the desire to fill shifts often outweighs other considerations.

When you take into account that it takes six years to train as a doctor, then we have to accept that there is no overnight fix where we simply magic doctors up to soften the figures.

‘Trusts and other key stakeholders have to hold their hands up to wasteful practices’

Attracting, retaining and ensuring the appropriate number of people are being trained in key roles, is a long term issue and the healthcare sector is a marketplace that is unlikely to change its spots any time soon. The key to addressing the concerns of agency spend is by introducing more efficient and transparent ways of procuring agency staff, standardising pay rates, implementing streamlined and robust policing methods, and introducing visible and controlled assessment measures to ensure processes are compliant and flexible enough to meet everyone’s objectives.

The issue of cost and quality control regarding temporary staff is not limited to the public sector. But those that have taken greater control over temporary staffing spend have seen a reduction in overall cost and an increase in candidate quality.

It is only when trusts and other key stakeholders hold their hands up to wasteful practices, stop paying lip service to the government’s “Better Procurement, Better Value, Better Care” agenda, and admit that they cannot do everything “in-house”, will we see true and increased efficiencies across the NHS.

Andrew Preston, managing director of de Poel Clarity, a Cheshire based independent and vendor neutral expert in managing temporary workforces in the NHS and private health and care sectors