29th PAC Report 2006-07
Improving the use of temporary nursing staff in NHS acute and foundation trusts
Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:
“By calling on temporary nursing staff, hospitals can respond flexibly to short-term peaks in demand and staff vacancies and absences. What is worrying is that, in practice, both the use of temporary nurses by the NHS and spending on them are still running at very high levels. And it has taken the current financial situation in the NHS to get managers in trusts to face up to this problem.
“In the five years up to 2005, the number of permanent nurses working in the NHS in England increased by some 20 per cent. But spending on temporary nurses, far from falling, actually rose over the same period by nearly 40 per cent, to over one billion pounds in 2004-05. This was despite the attempts by the Department of Health to reduce reliance on temporary cover.
“Most trusts are failing to plan for and manage their demand for temporary nursing staff. Too many do not have the management information they need to employ temporary staff cost-effectively. And too many are relying on temporary nurses to mask their inability to manage their permanent staff properly.
“This is not simply a point about wasting money. The use of temporary nurses might be compromising patient safety. At least 39 per cent of temporary staff are not receiving supposedly mandatory basic life support training. Indeed, it is sobering to learn that at least 30 per cent of permanent nurses are in exactly the same position. Strategic Health Authorities and trusts must address this nurse training issue head-on. Trusts must also put reliable systems in place to stop temporary staff working an unsafe level of hours.”
Mr Leigh was speaking as the Committee published its 29th Report of this Session which examined the cost and extent of use of temporary nurses in the NHS; whether the NHS has taken a planned approach to controlling and managing the supply and demand of temporary nurses; and the safety and quality issues associated with the use of temporary nurses. The Committee took evidence from the Department of Health (the Department) and NHS Employers.
Temporary nurses are employed across the NHS to meet fluctuations in activity levels and to cover vacancies and short-term staff absences. NHS acute and foundation trusts obtain temporary nurses from their own nursing bank, from private nursing agencies or from NHS Professionals (an NHS run temporary staffing service). Properly managed, temporary nurses play an important role in helping hospitals achieve flexibility. Excessive use can be costly, particularly when trusts are heavily reliant on agency nurses. High use of temporary nurses can also have a negative impact on patient care and satisfaction.
In 2001, the Department of Health stated that anticipated growth in the NHS workforce under the NHS Plan would significantly reduce its demand for temporary staff. Between 2000 and 2005 the NHS nursing workforce increased by 55,000, more than double the NHS Plan’s target of an additional 20,000 nurses by 2004. Despite this increase in the nursing workforce, however, the Department estimates that total expenditure on temporary nursing rose from £795 million in 1999-2000 to £1,098 million in 2004-05. As a proportion of total expenditure on nursing, the use of temporary nursing has remained at around 9%.
In summary, the Committee’s main conclusions are:
Despite a significant increase in the number of nurses employed by the NHS the amount spent on temporary nursing staff continued to increase until 2002-03. Whilst it has started to decrease over the last two years, the number of shifts filled and the amount spent is still higher than in 2000-01.
There is poor information on the drivers of demand for or use of temporary nurses across the NHS and an absence of a planned approach to controlling their use. Since 2001, the Department has introduced a number of initiatives to improve the quality and cost of temporary staff, but it is only as a result of financial deficits that the NHS has taken more co-ordinated action to reduce reliance on temporary cover.
There are safety implications for patients when trusts employ temporary nursing staff that have not received mandatory training or may have worked an unsafe number of hours.
Notes for Editors
1. Contact details for requests for further comment from Mr Edward Leigh are provided below. ISDN facilities are available for broadcasting purposes.
2. The full text of the Committee’s Conclusions and Recommendations is attached to this press notice.
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