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Video Accompanying the NAO Report: Improving the use of temporary nursing staff in NHS acute and foundation trusts

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A video to accompany the report is available. 


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Text Transcript


Transcript of Video Clip accompanying the NAO report “Improving the use of temporary nursing staff in NHS acute and foundation trusts” (HC 1176, 2005-06)

 

The clip features interviews with:

  • David Moss (Director of NHS Temporary Staffing at the Department of Health);
  • Karen Taylor (Director of Health Value for Money Audit at the NAO); 
  • Val Carse (Assistant Director of Nursing at Guy's and St Thomas' NHS Foundation Trust)

Clip Start:

 

Voice Over

For the NHS to work flexibly and meet fluctuations in activity levels, and cover vacancies and short term absences, it needs temporary nursing cover, either from their own nursing banks or from commercial nursing agencies.

In 2001 the Audit Commission highlighted the rapidly escalating costs of the increasing reliance on bank and agency staff, as well as identifying inconsistencies in the quality of temporary nurses and the lack of reliable information systems to manage demand.


David Moss

We're still spending one billion pounds a year on temporary staffing overall. We're keen to focus on this and trusts are looking at this as part of their financial planning to make sure this is being spent as effectively as possible.  

Because the NHS is trying to develop a flexible response to patient needs,  trusts may need to increase their capacity or reduce their capacity. They may need to transfer services from hospitals to the community, and so trusts need to plan to have a flexible response when they're planning their total workforce. 

So, managing the right balance between permanent and temporary staffing is very important.


Voice Over

In response to Brief Encounters, the department set up NHS professionals, its own national temporary staffing service, designed to manage the reliance on higher cost agency staff and improve quality by ensuring that its entire staff met defined standards. It also established regional framework agreements to improve the cost and quality of staff provided by commercial agencies.


Karen Taylor

We were concerned that there were issues around the use of bank and agency staff in the NHS and there were some concerns about the quality.

And there was evidence that the desired reduction in reliance on temporary staff wasn't happening. What we've identified is why there's variation within regions where you might expect there to be less variation and so, for example, in London the variation is from 6% to over 30%. So what we think is that they could actually improve the management by reducing the sort of regional averages.

NHS professionals, by being able to recruit and train a large number of nurses, have been able to sort of cut the cost to the hospitals of employing their staff. Within hospitals they have themselves have looked at their own arrangements for providing temporary staff within their nursing banks and they have been able to consolidate those nursing banks and therefore reduce the cost of running banks.

So they have been looking at lots of different ways of improving it and there are some really good practical examples and we've got a good practice guide that we are publishing with the report which shows some really impressive savings.

But alongside that there are trusts that are still not trying to improve them in the same way that other trusts are.


Voice Over

Some trusts have improved their use of temporary nurses by revolutionizing the way that they run their own nursing banks. For example, Guy's and St.Thomas'  has had a major effect on the use and management of temporary staff.


Val Carse

It used to be the case that wards and departments could book temporary staff by simply ringing up an agency. They now have to put all those bookings through a central bank office detailing their reasons. It has to be signed by a budget holder and all of this  information that we've gathered about the reasons for booking and who booked them and all the other things and, in particular, the amount of money that's spent on it, has enabled senior management to become very involved in looking at how we reduce our expenditure on temporary staffing.  

The ward areas have been given guidelines on how they should make their decisions on whether they actually need an extra member of staff.

In addition we have made it slightly more difficult by not taking bookings over the phone. On the whole we ask them to fax or email their bookings through, which increases there accountability. They have to give the reason for the booking and we can then capture that and use it in management information to make sure that people are actually using valid reasons for booking temporary staff. 

In the last four years we've reduced our reliance on temporary staff From 21% of the total nursing bill down to less than 5%, so that's obviously saved us huge amounts of commission and we've reduced the amount of money we spend on bank and agency staff by about twelve million pounds over the last four years.


Voice Over

As part of the NAO report, a good practice guide highlights good practice examples.


Karen Taylor

The key findings are around needing to improve the information available within hospitals to determine that they need to go and recruit some temporary cover for a permanent staff member who may not be available. We think temporary staffing is actually very much needed in the NHS and as they move forward under payment by results and commissioning a patient led NHS there will be much more need for flexibility.

So we're not saying flexibility is bad, we actually believe it's a good thing, but it needs to be properly managed.

We also believe that by better flexible management of their own workforce, better procurement, through the agencies, and agencies should only be used if they are one of the purchasing supplies agencies framework contracts.

So, better procurement, better management of a temporary workforce and better more flexible management of their own workforce. Those together will add significant savings and more importantly improve the quality of the nursing.


David Moss

Well, we're very encouraged by the report because it highlighted some of the good practice that's going on but also sets out an agenda for improvement.

We want to use the report as a springboard for action really. It sets out a series of recommendations for NHS organizations and for the various national agencies that are involved and we'll be putting together an overall action plan at the Department of Health and following through to make sure that best  practice is spread across the country on this.


Voice Over

The NAO believes that implementing these recommendations will improve the safety and quality of temporary nursing staff and the efficiency and effectiveness with which NHS hospitals procure and manage temporary staff. Overall, the NAO believes that savings of between thirty-eight and eighty-three million pounds could be made across the NHS with little, or no, additional investment.

 

End of video clip.