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When the Department of Health published its procurement development programme last August, it set itself the ambitious target of reducing the NHS’s non-permanent staff bill by 25 per cent by the end of 2015-16. This summer, the regulator Monitor reported that agency and contract staff spend by NHS Foundation Trusts has actually increased by 27 per cent in the last NHS financial year; from £1.1bn in 2012-13 to £1.4bn in 2013-14.
Many REC members have partnered with NHS Trusts in recent months to make cost efficiencies. But ensuring the supply of safe and cost-effective temporary staffing for the NHS is, of course, is more than just a numbers game. It’s as much about recruiting and retaining a motivated workforce with the right skills mix as rooting out cost efficiencies. This was acknowledged by Monitor’s Chief Executive David Bennett, who cited continuing difficulties in recruiting to permanent positions within the sector, “exacerbated” by increasing clinical staffing ratio requirements, following the Keogh and Francis Reports of 2013.
The importance of flexibility
Recruitment agencies have played a crucial – but unfortunately all too often denigrated – role in ensuring safe staffing levels. But REC members are also raising concerns about the sustainability of their own supply – especially considering increasing international competition for healthcare professionals. The REC/KPMG monthly Report on Jobs produced by Markit - provides the most up-to-date insights on the UK Labour market. Alarmingly, recruiters have identified both temporary and permanent nurses as key skills shortages areas every month bar one this year.
The interviews and focus groups we conducted with agency nurses as part of our recent research report ‘Flex Appeal: Why freelancers, contractors and agency workers choose to work this way’ have raised even more questions. The resounding message was that flexibility was just as important – if not more than pay to the decision of increasing numbers of full-time NHS nurses to choose agency work. Indeed, several of the nurses we interviewed explained how they had been offered permanent roles but had opted to continue to work on a temporary basis.
One said: “I have small children and I don’t really like doing nights... I was already doing [temporary work] and I was finding that I enjoyed my shifts more because I didn’t have pressure on me. And I didn’t have the politics and it was freedom, so I thought I am going to do this all the time. I can’t imagine ever going back.”
The continuing lack of flexibility for NHS substantive staff is evidently a key factor in why REC members continue to report increasing amounts of NHS substantive staff choosing temporary agency work. But many of the agency nurses we talked to also highlighted poor quality inductions, and outright discrimination when working on placement as agency nurses.
It is clear that if the NHS wants to build a sustainable workforce that includes both substantive and temporary staff that feel valued and motivated, it is going to take more than simply introducing more in-house staff banks. As even NHS Employers acknowledges, very few organisations are able to meet all their temporary staffing requirements through a staff bank, meaning that a bank is often a part of a wider solution that includes sourcing temporary staff externally.
This is why many REC members are heavily investing in both compliance and developing the talent pipeline, adding value for their clients through taking a lead on the bigger challenges around future workforce planning and management. Take REC members ID Medical, for example, which recently launched an education and medical training facility to provide training for their medical, nursing and allied health professional candidates, as well as support to medical students, in partnership with the Royal Society of Medicine.
Introducing meaningful flexibility for the NHS workforce will not only improve retention rates and productivity, but will also be crucial in realising the government’s ambitions around integration and personalisation of health and social care services. The message is slowly gathering momentum. Bringing together learning from two workshops hosted by PwC, the NHS Confederation recently released a briefing exploring how best to develop a more flexible, integrated workforce to deliver urgent and emergency care, highlighting the importance of flexible working in address the weekly and daily variation in the quality of care in 24/7 services such as A&E.
With one in four trusts predicted to end 2014/15 in deficit, we evidently cannot pause efforts to make cost efficiencies where necessary. But we also cannot allow the disconnect between workforce and service planning in the NHS to continue. NHS Employers recently distilled best practice in temporary agency staffing into ‘Five High Impact Actions’, which includes the advice “develop productive working relationships with all your agency partners in order to ensure they know how they can best meet your requirements.”
Just as many recruitment agencies have stepped up and collaborated with procurement providers and Trusts to minimise and consolidate costs, they are now ready to add value to their clients in different ways – lending their expertise to debates not only on supplying but also on shaping the future NHS workforce.