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Supply of clinical staff in NHS fragmented and not cost-effective

Too many variations across staff groups and regions; reasons behind use of agency staff not being tackled

Caroline White

Friday, 05 February 2016

Current arrangements for managing the supply of clinical staff are split across too many bodies and don’t represent value for money, finds a report* published today by public spending watchdog, the National Audit Office (NAO).

Efficient workforce management is essential to meet the demand for high quality safe healthcare in the NHS, says the report, but with the Department of Health, various arm’s-length bodies, healthcare commissioners and providers all involved in this, all too often the supply chain is fragmented, it says.

Around half of healthcare providers’ costs are spent on employing clinical staff adding up to an estimated £43 billion every year.

But in 2014, the reported overall staffing shortage was around 5.9%—equal to a shortfall of around 50,000 clinical staff, with considerable variations between different staff groups and regions.

The creation of Health Education England (HEE) means that there is now a national body specifically tasked with making strategic decisions about planning the future workforce, and working collaboratively with local healthcare providers.

The national workforce plan is developed from plans prepared by local providers, which means it should be informed by a detailed understanding of local circumstances. But the process for developing this plan needs strengthening, and HEE should be more proactive in ironing out variations in workforce pressures in different parts of the country, says the report.

Agency costs are another bugbear. Hospital trusts’ use of temporary staff has increased significantly, putting pressure on their budgets, but there is room to reduce this spend, says the report. While agency staff enable trusts to cope with short-term workforce pressures, this spend is an inefficient use of resources, with costs ballooning from £2.2 billion in 2009-10 to £3.3 billion in 2014-15.

Although the health secretary announced a cap in October 2015 on how much trusts can pay per shift to help curb spending in this area, the NAO notes that these measures are unlikely to fully address the underlying causes of the increased demand for temporary staff. Almost two thirds (61%) of temporary staffing requests were to cover vacancies in 2014-15, says the report.

At the same time as the use of temporary staff has increased, the NHS has made much less use of overseas recruitment and return-to-practice initiatives to plug gaps in the workforce, suggests the NAO.

The number of overseas nurses has fallen, particularly from outside Europe, from 11,359 in 2004-5 to just 699 in 2014-15, partly as a result of tighter immigration rules for nurses during this period, the report suggests. But this has only partly been offset by a large rise in recruits from within Europe, says the report, which points out that there were 3,106 fewer nurse training places in 2014-15 than in 2004-05—a drop of 19%.

“Given the size of the NHS, workforce planning will never be an exact science, but we think it clearly could be better than it is,” concludes the report. “Equally, the way in which staff shortfalls are filled can be, and often is, unnecessarily costly and inefficient. Since clinical staff are the NHS’s main resource and cost, these shortcomings are serious and the current arrangements do not achieve value for money.”

Danny Mortimer, Chief Executive of NHS Employers, said that the report was “a helpful analysis of the challenges that employers across the country are facing.”

He added: “Attracting and retaining the best staff is important for the NHS, and we need to get it right to build a sustainable workforce. Work is already happening, with our recent survey showing that over 99% of providers recognised the need to invest and retain their nursing workforce.”

But he said: “We need to move away from a model of short-term fixes through agency staff to investing in attracting the best talent to work in the NHS – both from within and outside of the EU. Many NHS trusts are currently facing a stifling shortage of nurses so we continue to lobby for nurses to be added to the shortage occupation list so that NHS trusts can ensure safe staffing for patients.”

* Managing the supply of NHS clinical staff in England. National Audit Office, February 2016

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