NHS trusts will ‘undoubtedly’ struggle to employ the doctors and nurses they need as the service clamps down on the cost of temporary staff from next month, NHS England chief executive Simon Stevens has told HSJ.

  • Stevens: converting temporary staff into permanent is the NHS’s “biggest operational financial risk”
  • Guidance to ensure patient safety while reducing reliance temporary staff market due within days
  • The health service would be “going hell for leather” on the efficiency programme, Stevens says

Stressing that guidance would be developed within days to make sure patient safety was not endangered, he nevertheless acknowledged the NHS would face “volatility” while the temporary staffing market is reset.

In an exclusive interview, Mr Stevens also described the challenge of converting temporary staff into permanent roles as the NHS’s “single biggest operational financial risk”.

The NHS England chief executive said: “There will undoubtedly be occasions where it will be hard in the first several weeks or few months for a hospital to fill a marginal spot while this works its way through the system. We just have to be open about that.”

Monitor and the NHS Trust Development Authority will consult “over the next several days” to make sure safeguards are in place to protect patient safety while the reliance on agency staff is reduced, he said.

HSJ asked if patient access to certain services, such as planned operations, will be restricted while trusts cope with an initial drop in agency staff. Mr Stevens said this was “obviously one of the considerations that Monitor and the TDA will be taking into account”.

He added that the speed at which reduction in spending can occur will have to “factor in” possible staff shortages in certain services.

Simon Stevens

Converting temp staff into permanent roles is the NHS’s ‘single biggest operational financial risk’, Simon Stevens said

Mr Stevens said “hundreds of millions of pounds” spent on agency staff would have to be taken out this financial year. He added it would be a “huge job” to convert temporary staff shifts into “well paying” permanent nursing jobs. It is “our single biggest operational financial risk in 2015-16”, he said.

Temporary staffing issues are a “far bigger pressure” in London and the South East than in other parts of the country, Mr Stevens said.

He continued: “It’s going to have to look different in different parts of the country… We’ve got to be sensitive to the local availability of staff, and at the same time ensure that trusts are offering sufficiently flexible and attractive employment opportunities for permanent staff.”

A “complete strategy” for the NHS workforce is needed, he said. “We’ve got to continue to expand the supply of nurse training out of our own programmes, we’ve got to look at the career ladders that exist in nursing between care assistants and graduate nurses. We’ve got to make sure we’re getting full value from the money that’s being spent with universities on nurse training.”

He said the health service would be “going hell for leather” on the efficiency programme “which will need to deliver about the same quantum of efficiency over this Parliament as the health service delivered over the last Parliament, but obviously through somewhat different means”.

The efficiency drive is not being done “simply out of necessity” but out of a “sense of obligation”, Mr Stevens said. “We can see we are leaving money on the table in terms of how we’re currently spending our funds.”

At the NHS Confederation conference the national leadership bodies will be “kicking off a process” to work with frontline leaders over the next four months to “practically map out what those efficiency opportunities look like in each part of the country”. He said the local efficiencies would “go alongside” those made through “national action”.

The NHS England chief executive said there are questions about efficiency that “we can’t duck anymore”. He cited examples of inefficient procurement practices.

One example has been uncovered in a national project by Tim Briggs, president of the British Orthopaedic Association, who has been visiting hospitals to look at efficiency in planned care.

“What Tim was telling me was even something as tangible as buying hip replacements – the joints, the prosthetics – for one hospital it cost £1,000, at another hospital it cost £1,800; each hospital thinks they’re getting the best deal [when] they’re clearly not,” Mr Stevens said.

Another example he gave was a large teaching hospital in the north that has 700 sales representatives “associated with that hospital” and an average of 65 sales representatives on the hospital site at one time selling products.

He said: “We’ve known this but we haven’t acted on it. So my message for us all is that now we have got to get going on some of these things that have been talked about that have eluded our grasp.”

HSJ asked Mr Stevens if there should be an increase in funding this year, as some commentators have suggested. He said extra funding had been secured in 2014-15, as well as changes to the better care fund which “affects the purchasing power” of the NHS and extra funding secured in the autumn statement.

He added: “I see nothing to suggest that the NHS should expect more in-year funding in 2015-16 than the total funding envelope that we’ve got. So our collective task is now to seek to manage within the 2015-16 totals. People should not expect a new cheque will be written next month.” 

Stevens interview: Dealing with agency staff is NHS’s ‘biggest operational risk’