A strong temporary workforce is the key to solving the staffing crisis in healthcare

The NHS must embrace the agency workforce. During this staffing crisis, recruitment agencies and temps are playing a crucial role in keeping wards open and the wheels of the NHS turning, writes Yerin Seo, senior campaigns advisor at the Recruitment and Employment Confederation

The pressure of working in frontline NHS and social care roles, especially within the context of the current staff shortages is well recognised by the public now. We have grown used to seeing images of striking nurses and doctors on TV, and the ensuing debates in parliament and the media. The high number of people out of work due to long-term illness and the long length of waiting lists are frequently in the news. The connection between a health service that isn’t equipped well enough to deal with patients quickly and people not being well enough to work is documented in ONS statistics. So we know the sector’s importance on our labour market and potential for economic growth.
The high number of vacancies across the sector at all levels is a concern for patients. Our data shows vacancies for nurses and care workers average at around 80,000 to 100,000 each quarter. The likes of nursing assistants, public health managers and medical practitioners are also in high demand.

Temps keep the NHS turning
The UK’s world-class temporary workforce has come into its own to keep the heart of the NHS beating at a regular pace. The NHS and the care sector will always rely on contingent staffing because healthcare is unpredictable – this makes temps vital for patient safety.
Temporary staff fill around 15,000 nursing, medical and related support role vacancies every quarter. At NHS England, an astonishing five million hours of shifts are supported by the contingent workforce each month.
Despite the significant contribution they make, the way that agencies and agency workers are perceived by the public, media and politicians is often based on misconception and inaccuracy.

Seven years on frameworks
In England, the majority of recruitment agencies adhere to the rules and price caps set out within the NHS procurement frameworks – introduced and set in 2016. To be an ‘approved supplier’, agencies must go through a rigorous tender process. This is by no means an easy task, especially for SMEs. The bar is set high to ensure all suppliers maintain strong standards and compliance before they can supply workers to the NHS. This often includes evidence of historic activities and ISO (International Organization for Standardization) certificates. For example, during the tender process, agencies often have to demonstrate that they have previously supplied workers to fill in particular roles, meeting ‘hours threshold’. This can be a challenge for many SMEs.
The small number of agencies that successfully jump all the hoops are awarded with contracts. And even after an agency makes it on to a framework, they are subject to a series of audits and strict terms and conditions. One of these terms is price caps, the maximum amount an agency can charge per hour for supplying a worker. In emergencies, agencies can go above this rate but that is not the norm on a framework. And the pay to an agency is broken down to cover a number of different things – it’s not all profit! The vast majority of the money goes to the worker, it’s their hard-earned wages, after all. Then there are things such as national insurance and employer’s pension contributions. At the end, the agency is left with a thin margin.
For example, to supply a healthcare assistant, agency fee on frameworks is capped at just over £2 out of an £18 hourly rate. And out of this margin, agencies pay a framework fee, train people, must meet strict compliance standards and pay for their 24/7 operation. In this scenario it is difficult to agree with the more prevalent narrative that agencies are making fortunes and taking the advantage of the staff shortages.

No more sitting on the frame
The REC has always encouraged its members to supply on framework. Being an REC member is even considered favourable as part of the tender process when getting onto an NHS framework in England and Wales. But a review into frameworks and price caps is a long overdue, as there has not been one since they started in 2016. We have had five different health secretaries in that time. With the lack of a review or an update, it’s increasingly difficult to meet the changing demand of the sector and reflect economic influences such as inflation. And over time, the agencies going above and beyond to follow the rules have been squeezed. This is because the price caps have not changed despite inflation and the national minimum wage going up each year. This leads us to why some agencies supply off framework.
There is a consistent narrative from NHS England and the Department for Health and Social Care (DHSC) that they want a reduction of agency spend. This combined with other factors means some NHS Trusts wait until the very last minute to turn to agencies for staffing support, at which point an off framework agency is often the only option. That is because no agency on a framework can supply within that tight timeframe while remaining within the price caps. Even as a worker, it is harder to reject a higher pay offer from an off framework agency if the same shift is being offered by an on framework agency for a significantly lower pay rate for the same exact job.

Recruiters to the rescue
Combined with the financial difficulty and the growing number of off framework agencies, many small agencies have gone out of business over time, with others struggling. This means a smaller external staffing market for NHS England amid severe worker shortages.
Recruitment agencies are an important part of solving worker shortages and getting a better workforce plan for the NHS. By thoroughly engaging and consulting with them, the public sector can enjoy a procurement system that delivers value for money for taxpayers, efficiency and quality.
The REC’s door remains open. We are ready to play our part in solving the difficult problem of healthcare staff shortages. The REC has been calling for a long-term workforce strategy for the sector for long time, so we welcome the news of its imminent publication from the DHSC. But without the expertise of recruitment and retention experts, a workforce strategy is unlikely to be effective.

The REC is the voice of the recruitment industry, speaking up for great recruiters. We drive standards and empower recruitment businesses to build better futures for great candidates and themselves. We are champions of an industry which is fundamental to the strength of the UK economy.