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