Health Business

The use of temporary staff to fill the gaps caused by staff shortages and to cover out-of-hours shifts such as weekends and evenings has long been commonplace for the health sector. However, the cost to the NHS of using temporary workers has risen over recent years.         

Approximately £0.6 billion was spent on agency staffing costs alone in 1998/1999 and this rose to a peak of £1.4 billion in 2003/2004. This figure represents 4.2 per cent of the total NHS pay bill. Inevitably, the NHS is now under pressure to reduce this expenditure. That said, it must be recognised that temporary workers are a vital resource to the NHS and care must be taken not let this pressure work against the provision of a quality healthcare service.
    
The locum scene has suffered from a poor reputation in the past due to occasions when some agencies would supply staff without doing thorough checks on their qualifications and suitability. This concern, as well as the need to regulate costs, led to the development of the NHS Purchasing and Supply Agency (PASA) Framework Agreements. This framework has helped filter out any rogue agencies by providing a standard for agencies to adhere to when taking on staff, as well as implementing a simplified pricing structure. Now the industry is more legislated and the NHS is receiving greater quality of staff and better value for money.

A collaborative approach
Despite these improvements, there is still a need for the NHS to better manage its temporary staffing costs. To do this, NHS Employers, in partnership with NHS Professional Doctors, is working with mental health trusts and PASA to communicate best practice and learning across the NHS.
    
Using a collaborative approach, trusts will be provided with a platform to share good practice and improve communication and transparency regarding locum rates. This will help manage local variation in rates and put trusts back in control of expenditure.

Out-of-hours
So what does this mean for agencies and staff who enjoy the flexibility of being a locum? Although there is a drive to better manage temporary staffing and a strong focus on filling and retaining permanent positions, there will always be gaps that need to be filled. That is not to mention filling those ‘hard to cover’ shifts such as evenings and weekends. In 2004, family doctors were given the choice to opt out of night and weekend care for a reduction in pay.         

As a result, 90 per cent of doctors decided to stop working these hours. To try and combat the problem of filling these awkward shifts, a recent phenomenon has been to fly foreign doctors in to cover weekend shifts - after working in their own surgeries during the week.

Specialist shortages
The National Audit Office recently reported that there was a shortage of neonatal staff. On average, each unit had nearly three nursing vacancies for nurses qualified in neonatal care.         

Only half of units met the British Association Perinatal Medicine (BAPM) standard for high dependency care of one nurse to two babies and only 24 per cent met the standard for intensive care of one nurse to one baby. The majority of level three intensive care units, which require a one-to-one ratio of nurses to babies for the whole unit, did not meet these standards.
    
The lack of qualified neonatal staff, as well as other factors such as the lack of suitable cots available, contributed to unit closures to new admissions on average once a week. The report has recommended that the NHS and Foundation Trusts should develop a targeted action plan to address neonatal staffing shortages.
    
This example shows that the problem of qualified staff shortages is still around. There will always be areas that need to be covered, often at short notice. Temporary staff offer a highly skilled and flexible workforce and without being able to call on them, patient care would be greatly compromised.