· 2 min read · Features

Controlling agency spend in the NHS


The NHS spent £3.3 billion on agency staff during 2014/15. That’s £793 million up from the£2.5 billion spent in 2013/14.

We mustn’t forget that use of agency staff is a legitimate tool  staff get sick and replacements are needed at short notice. But it’s clear that the NHS provider sector has a problem with escalating agency spend. And this was a key contributor to the sector ending 2014/15 with a £822 million deficit. 

So what’s pushing agency spend up? The rise in agency spend has been fastest for nurses. After the Mid-Staffordshire care scandal and the Francis report, there was rightly a renewed focus on care quality, and having sufficient staff to deliver that care. Yet many Trusts found themselves in a no-win situation. On one hand, the regulatory and political climate meant that they were compelled to recruit staff to comply with new safe staffing guidance. But on the other hand the extra nurses were simply not available to employ on a permanent basis. 

Trusts had little choice but to make greater use of bank and agency staff to fill gaps at a considerable premium, with one case  at the extreme end  of an agency nurse costing £1,875 for a 12-hour shift on New Year’s Day. 

It’s not that Trusts haven’t pursued other options. Many are recruiting nurses from overseas – also at considerable cost – particularly from Spain, Portugal and the Philippines. To add to the challenge, insufficient extra funding was given to Trusts to cover the cost of the extra staff they were expected to take on. 

Since the general election, the government has announced new controls including maximum hourly rates for nurses and doctors. This intervention has divided opinion. Some question how it will work in practice. Others are glad something is being done. But focusing only on demand for agency staff is not the full answer. 

So what more needs to be done? 

First, the immediate shortage of nurses and other workers must be addressed. Health Education England (HEE), which leadNHS workforce planning, has promised an additional 13,000 nurses by 2019HEE has also attempted to encourage nurses who have left the profession to return to practice. 

It’s important that HEE listens to and involves Trusts in deciding how many nurses and other roles to commission and allows flexibility for region-specific workforce challenges to be addressed. 

Second, the government and national NHS bodies need to adopt a joined-up approach on the NHS workforce that avoids a misalignment between central directives and staff availability and funding. It’s encouraging that a new national Workforce Advisory Board has been established to ensure that future workforce decisions are aligned with plans for the NHS to deliver care in new ways. 

Recent announcements on safe staffing also appear to offer opportunity for a more holistic approach to recruitment and care quality. However, there are concerns that government efforts to control immigration may undermine Trusts’ work to recruit and retain nurses from outside Europe. This must be avoided. 

Finally, national NHS bodies and Trusts must ensure the NHS is an attractive place to work on a permanent basis. Staff need to be fairly rewardedAnd just as importantly the NHS needs to be a place where flexible working is offered wherever possible, and staff health and wellbeing are priorities.

Paul Myatt is chief policy advisor for workforce at NHS Providers