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Published: 19/09/2002, Volume II2, No. 5823 Page 14 15

Which is the fair rate for a nurse:£8,400 for an agency nurse over a bank holiday, or the basic NHS nurse's rate? Alison Moore wonders what happened to market forces You're a manager in a busy acute hospital, needing specialist nursing cover for a bank holiday weekend. A local nursing agency says it can provide the nurses to staff these shifts at short notice. You breathe a sigh of relief in terms of patient care, but what is the cost of this cover?

The answer is one that will turn your finance director red - as much as£8,400, half the annual salary of many nurses. Even worse, this bank holiday rate can be payable on days such as Mothers' Day and over the Glastonbury music festival.

These rates are charged by national staffing agency Thornbury Nursing Services for the period from 2pm Friday until 8am Tuesday. The cost is based on an hourly rate to the trust of£93.45, plus travel expenses and national insurance contributions if applicable. The nurse will be paid£55.30 an hour - still a sizeable sum, but nearly£40 an hour less than the trust is paying.

Thornbury recruitment training manager Angela Thompson says the cost of the technology and qualified staff needed to run the organisation explains the agency's mark-up. She also says many nurses are reluctant to work on occasions like Mothers' Day and extra pay is needed to attract staff.

Avon, Gloucestershire and Wiltshire strategic health authority chief executive Mark Outhwaite says the cost of agency staff 'is one of the biggest single causes of financial instability for trusts in my area'. The bill across the SHA's area was£40m last year, which is dwarfed by the£150m London is spending on temporary staff each year.

Some trust managers feel agencies have been pushing up prices recently, taking advantage of nursing shortages. Royal United Hospital Bath trust finance director Stephen Cass expects the bill for agency staffing to increase in Bath from£5-6m last year to£7-8m this year.

'Judging from my previous trust [Worthing and Southlands Hospitals trust], rates have moved up, and I think it is the same position here, ' he says. 'It is a burden for us.'

So, what's being done to try and sort this out, given the huge costs involved.

The main way the NHS is tackling this massive bill is through NHS Professionals, effectively an in-house agency which also runs trusts' 'banks' of staff willing to work extra shifts.

The Department of Health says 35,322 staff are on NHS Professionals books, which is working with 40 acute trusts and 10 primary care trusts.

The intention is that the service should cover the country by April 2003, but the DoH says there is 'a considerable way to go' to meet this target.

However, HSJ sources say the DoH accepts the organisation has had enormous problems setting up and it is some way from solving them.

Federation of Independent Nursing Agencies communications director Charles Walker says NHS Professionals is having some impact in some areas - but adds it is difficult to say whether it is actually saving money, given the cost of its infrastructure.

The huge start-up problems with NHS Professionals have led to some trusts seeking a more local solution. North Bristol trust human resources director Keith Johnston says some nurses left the trust's bank to work for agencies earlier this year, as a result of difficulties with NHS Professionals, which was administered for the trust by the West Yorkshire Metropolitan Ambulance Service trust.

These difficulties included nurses not being paid and errors in payments.

Now North Bristol, which has a£10m annual bill for bank and agency staff, is working with other local trusts to re-establish NHS Professionals in the area and give it a more local feel. In the short term, the bank is being run by the trust itself and has seen the number of staff registered with it soar.

Elsewhere, the NHS is inviting nursing agencies to tender to supply staff for groups of hospitals. A scheme along these lines for some specialist nurses across all London trusts has already been set up, and is thought to have saved the NHS around£250,000 per year. Early next year, it will be extended to cover all trust nurses in the capital.

Trusts in the South West are also inviting agencies to tender to be included on an approved list, and a similar scheme is being set up in the North West.

But whatever system is used, the level of pay will always be the main problem.

Agencies cost more than twice as much as NHS rates, says Mr Johnston, but they also pay their nurses more. Trusts need to find a pay rate for NHS Professional staff that is attractive but still undercuts the cost of an agency nurse.