The NHS and its leaders are facing unprecedented levels of scrutiny on spending. After the bill for hiring temporary frontline workers soared to more than £10bn a year (The Guardian), this is no surprise.
Some unscrupulous agencies have been accused of profiteering from the severe staffing challenges across the NHS – with reports of some charging £2,000 a shift for last-minute nurses (BBC News).
To help address this issue, the Spring Budget saw the Tory government introduce restrictions on the use of the off-framework agencies. These agencies are often the ones responsible for driving up the price of temporary staff and exacerbating the financial challenges for Trust leaders.
The ban came into force this month but while this is a step in the right direction, it will only offer a sticking plaster for a symptom of the overspend, rather than address the root problem.
In the meantime, this overspend can be mitigated by a more efficient uses of existing workforce systems and technology.
The ‘bad apples’ are driving up prices
NHS Trusts face pressures like no other industry. If there is a gap in frontline services, it’s not just targets that will be missed, lives are put at risk. For any healthcare manager it’s very hard to put a price on the value of a locum doctor in a life-or-death situation.
It’s in these situations that off-framework agencies can take advantage of NHS budgets with the absence of choice and control for Trust leaders meaning the ‘bad apples’ in the agency market can hold out until the very last-minute, before swooping in to ‘save the day’ with extortionate prices for their staff.
Coupled with ongoing strike action, huge waiting lists originating from the Covid era, and inadequate workforce management systems and technology, there’s no wonder the NHS is spending more than it should on temporary staff.
A positive move that won’t solve the root problem
With overspend undeniably out of control, greater scrutiny on decision makers was inevitable. If successful, an end to off-framework agencies could help prevent the extortionate prices the industry is up against.
The frustrating truth, though, is that due to demand off-framework agencies will continue to supply locums to the NHS by piggybacking on framework agencies. Without staffing issues addressed, trusts in desperate need will find a way to circumvent the rule in the interest of patient care.
We’ve seen this happen before. With no proper enforcement, the off-framework ban is simply putting a plaster on a wound and hoping for a positive outcome, rather than addressing the core problems driving up the costs of temporary staffing in the health sector.
And with the summer months only just starting, hospitals will be facing challenging staff rotation and intense pressure, with few options but to engage with off-framework agencies.
What is the solution for the NHS?
The core problem is a shortage of skilled healthcare workers, but in the rush to fill the gaps, procurement of agency workers in many Trusts has become fragmented and inefficient. Departments often work in silos and still log shifts on paper and post it notes. And until these inefficiencies are addressed, the overspend on temporary staff will continue.
What is needed is a reset of the agency staffing model, with a complete focus on visibility and transparency. Thankfully, this is something which can be tackled now, with existing technology, as longer-term solutions for training and talent attraction are put in place.
Trusts such as Cornwall Partnership and North Cumbria have already demonstrated this. By having more information and oversight, Trust managers can put a plan in place to take back control of agency staffing spend, while the next government delivers a plan to boost new applications and support current doctor and nurses working in the sector.
So, while the ban on off-framework agencies is necessary to rein in the extortionate prices plaguing the NHS, it is not a panacea. We need to address the underlying issues of workforce shortages and procurement inefficiencies. By adopting a more transparent and efficient staffing model, and with government support in boosting healthcare workforce numbers, the NHS can move towards a more sustainable and financially responsible future.
