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With difficult economic times come tough choices, and in the current climate every penny must be accounted for. The challenge for the NHS is clear; find £20 billion of efficiency savings whilst reforming delivery against the backdrop of an ageing population. No easy task. In order to help drive this change the NHS must understand the benefits of diversifying its workforce.
To navigate these choppy economic waters, NHS managers should recognise the critical role that locum or interim staff play in providing the NHS with a highly trained, cost effective workforce that can step in at a moment’s notice to ensure that staff absence doesn’t lead to a drop in standards.
Meeting the challenge
In order to meet the ‘Nicholson challenge’ NHS managers are having to look carefully at their budgets, redesigning services to ensure that standards of patient care are improved in a cost effective manner. As a result, many managers are looking to slash their spend on agency and locum staff, viewing them as an excess cost that can easily be stripped away. This is a false economy. Not only do agency staff actually prove cheaper than hiring a permanent or in house worker, but they provide essential cover for staff shortages and sickness.
Let’s look at the evidence. Hiring locum staff is cheaper than hiring for a full time position as they are only paid for the period in which they work. This means that they directly respond to spikes in clinical demand and, pound for pound, often prove more efficient than hiring full time members of staff. Variations in clinical demand are a core concern for any health manager at this time of year as throughout winter hospitals see, particularly amongst the elderly, a rise in admissions due to injury or sickness. By having a team of expert locum doctors, nurses and healthcare workers on standby to cover these eventualities, this ensures that patient care is not compromised by understaffing.
We can see across the NHS the dangers of an understaffed workforce; in midwifery for instance staff are warning that patient care, particularly out of hours, will drop due to a lack of available staff. Similarly, the recent CQC report identified that many of the hospitals with poor clinical standards suffered problems with understaffing. It is also worrying to see some trusts turn to unqualified healthcare workers to plug the gap, with an estimated 150,000 workers responsible for tasks they are not qualified to perform.
The first priority in staffing decisions should always be clinical, and use of locum staff, often highly specialised and experienced professionals, ensures that understaffing does not have an impact on patient care.
Value for money
Whilst patient care must always be the priority, in the current economic climate it is important to assess which option provides best value for money. Locum doctors, hired through a specialist REC-approved recruitment agency, are not only cheaper than a full time appointment but actually prove cheaper than hiring from an in house bank. To see this we need to look no further than the NHS current in house provider, NHS Professionals.
It is estimated that NHS Professionals has proved significantly more expensive than using agencies, largely due to the high set-up and running costs. Furthermore, in house banks don’t have access to the wide pool of candidates agencies have built up and the years of experience they have accrued in placing locums and advising clients on their workforce needs.
When faced with periods of change, like the current moves towards GP-led commissioning, it is crucial that the NHS has back up plans to deal with every eventuality. By accessing a highly skilled and effective locum workforce; you can cover your workforce needs.
A locum workforce is not a substitute for permanent staff, but is a crucial component in ensuring that patient care does not suffer as a result of understaffing. The next few years will test the NHS and will force managers to be innovative and adopt new models of delivery.
It is important that as well as ensuring that they have best value for money, managers must ensure that they have a workforce that can not only serve the patient but also help drive clinical and structural change. In order to achieve this managers must not view locum staff as a disposable cost with which to balance the books, but recognise that not only are they experienced professionals who help drive up standards of patient care, but prove great value for money as well.
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