Press Release - Improving the use of temporary nursing
staff in NHS acute and foundation trusts
12 July 2006
The National Audit Office has found that while the NHS has
successfully reduced its expenditure on agency nursing staff,
temporary staff remain a key component of trusts’ ability to be
flexible and expenditure on temporary nursing staff employed
through nursing banks and NHS Professionals has increased. Many NHS
trusts do not have robust information to help determine
cost-effective staffing levels or to understand their real staffing
needs. The National Audit Office’s report estimates that between
£38 million and £85 million a year can be saved by better
procurement of temporary nursing staff and better management of
permanent nursing staff.
Acute and foundation trusts in England spent £790 million on
temporary nursing staff in 2004-05, 9.4 per cent of their total
nursing expenditure, down from 10% in 1999-00. Trusts have made
good progress at reducing their expenditure on agency nursing
staff, the most expensive type of temporary staff. This has fallen
from its peak of seven per cent of the total spent on nurses down
to three per cent in 2004-05. However, trusts have paid less
attention to addressing the wider issues of controlling and
managing demand for all types of temporary nursing staff.
There is wide variation in spending on temporary staff. In
2004-05 expenditure as a percentage of total nursing expenditure
ranged from less than five per cent to as much as 29 per cent with
trusts in the south of England relying more on temporary nursing
staff than trusts in the north.
NHS trusts have to be able to respond to fluctuations in demand
and staff availability through flexible staffing arrangements. The
use of temporary staff forms a key part of this flexibility for
many trusts. However, high levels of unmanaged use of temporary
nursing staff can be costly, particularly when trusts place high
levels of reliance on agency nursing staff. In addition high levels
of vacancies and extensive use of temporary staff can worsen
patient satisfaction and staff morale.
In response to concerns about the cost and quality of temporary
nursing staff and in recognition of the fact that some staff want
to be able to work more flexibly within the NHS in 2001 the
Department of Health launched NHS Professionals, a national
temporary staffing service. It also encouraged the NHS Purchasing
and Supply Agency to set up and audit a series of framework
agreements to improve the cost and quality of nursing staff
procured through nursing agencies. This report finds that work by
NHS Professionals and the NHS Purchasing and Supply Agency have
improved the cost and quality of temporary nursing staff but more
needs to be done to ensure that all temporary staffing suppliers
are operating to consistent standards.
The National Audit Office recommends that trusts need to
concentrate further on managing their demand for temporary nursing
staff. Many trusts do not have adequate and timely information on
staffing needs nor do they have a clear understanding of the
factors driving their demand for staff. It is particularly
important that trusts develop this understanding as NHS reforms
such as Payment by Results and Commissioning a Patient Led NHS take
effect across the NHS and activity levels and funding levels in
individual trusts are likely to fluctuate from year to year. Trusts
need to able to operate a mechanism that will allow them to flex
their staffing levels and remain in financial balance whilst
ensuring that they can provide a safe and effective service for
patients.
Sir John Bourn said today:
“Trusts have been successful at reducing expenditure on
agency nursing staff but there is scope to obtain greater value for
money by improving the procurement and management of all temporary
nursing staff. It is very important that trusts further develop
their understanding of their demand for all nursing staff as the
ability to be able to manage the workforce effectively will play a
major part in determining whether trusts remain in financial
balance under Payment by Results.”
Notes for Editors
- “Nursing staff” includes Registered Nurses, Registered
Midwives, Operating Department Practitioners and Assistants,
Healthcare Assistants, Nursing Assistants and Nursing Auxiliaries.
“Temporary nursing staff” includes nursing staff working through
trusts’ own internal nursing banks, independent nursing agencies
and NHS Professionals (the NHS’ own “in house” temporary staffing
service).
- Press notices and reports are available from the date of
publication on the NAO website, which is at www.nao.org.uk. Hard
copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 850 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Press Notice 52/06
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