NHS Providers response to NHS Improvement consultation on agency spending proposals
In March 2019 NHS Improvement consulted on proposed changes to restrictions on the use of agency staff in the NHS for non-clinical and unregistered clinical shifts, as well as admin and estates roles. This submission responds to the proposals, highlighting the impact of the proposals on the provider sector. Some key points are highlighted below.
- While there have been some positive effects on agency spending following the introduction of off-framework agency restrictions for doctors and nurses, there is still a significant overspend on agency and bank staff, with the key driver of agency overspending being volume of shifts filled rather than agency rates of pay.
- There is a large number of vacancies in the trust sector (estimated to be 100,000), and the NHS staff survey identified a fifth of NHS staff are considering moving on from their current role, with a large number saying they face unrealistic time pressures or a need to work long hours. Therefore reductions in agency spending must be accompanied by measures to address the wider pressures on recruitment and retention in the NHS workforce with the aim of reducing the need for agency staff in the first place.
- There is further pressure on recruitment and retention associated with proposed new immigration legislation, in particular the salary floor of £30,000 which would exclude international staff from working in NHS roles not meeting the minimum salary threshold. Given this context of transition and uncertainty, and the fact that workforce profile of lower-paid roles typically features a higher proportion of international staff, a phased approach to introducing restrictions is likely to be helpful.
- We are not supportive of the introduction of restrictions on the use of admin agency workers, given the more diverse labour market available to staff working in these roles and thus the more competitive environment in which the NHS is recruiting to these roles.
- There is evidence that trusts face significant challenges recruiting and retaining IT staff, particularly those in specialist roles. More work needs to be done nationally to determine the extent of work shortages in IT roles and address these, before introducing blanket restrictions which may affect trusts’ ability to maintain their operational performance.
- Trusts are unlikely to be able to implement changes to rules around agency use at short notice, given the timing, and the time needed to adapt their ways of working including recruitment and on-boarding models. We have expressed concern that the period of consultation for these proposals has not been sufficient to fully identify and address the needs and concerns of trusts affected by these changes