With the Recruitment and Employment Confederation urging the government to rethink its proposed ban on agency staff working in the NHS, Dr Anas Nader explains why cracking down on agencies alone, without addressing the core issues driving workforce shortages, will fail to solve the NHS staffing crisis.
The NHS spends too much money on agency staff. In 2022-23, our health service gave an eye-watering £4.6bn to third-party agencies. Since coming to power, the government has introduced a series of measures designed to clamp down on the use of these temporary workers, leading to savings of around £1bn over the last year.
NHS retention
Petition calls for rethink on NHS agency staff ban
But while the health secretary Wes Streeting’s campaign against wasteful overspending is a laudable one, his latest proposal – to ban NHS trusts from employing agency staff altogether by the end of this parliament – will not fix the staffing crisis on its own.
Over-reliance on agencies is a problem the government is right to address, and many NHS trusts are already making great strides in the right direction. But it is a problem that has deep roots.
The rise and rise of agency reliance is symptomatic of a health service that has, for too long, been grappling with a retention crisis, with staff scrambling to meet demand while being hamstrung by outdated systems and a fundamental lack of flexibility.
Until now, we’ve relied on expensive agencies to step in and fill these critical gaps. So if the government’s battle to wean the service off agencies is to be successful in the long term, it must come hand-in-hand with concrete measures to fix the underlying issues which led to this costly dependence in the first place. Without delivering tangible improvements for permanent NHS staff, pursuing agency reduction won’t translate into the long-term benefits our health service needs.
While it’s true the NHS has more staff now than ever before, relentless pressure on service delivery means there are still major gaps in its workforce. Chronic shortages in key frontline positions are leading to overstretched clinical teams and dangerous delays for patients. Add to this the fluctuating nature of service demand, and it is easy to see how desperate managers often feel they have no alternative but to rely on agencies during times of need.
Moving overseas
A driving force behind these shortages is the NHS’s ongoing struggle to retain top talent. Just this month, the General Medical Council released figures showing that 43% of doctors have researched careers in other countries, while one in five are actively considering the move. In the same survey, 72% of doctors cited inadequate staffing as a barrier to delivering patient care, while 23% said they had been forced to take leave due to stress during the past year.
While higher pay was a consideration, the leading factor attracting NHS doctors to move abroad was a belief that they would be treated better elsewhere.
This has to change. If we want to sustainably reduce the reliance on agencies and reposition their use as a safety net rather than a daily requirement, we have to make it more attractive for NHS staff to remain in the service. That means giving them access to the same basic working conditions that we have come to expect in other modern professions. Flexible working, greater career autonomy, tailored support – these are all things that NHS staff see their peers outside the health service take for granted. It’s time they got them too.
Flexibility in the NHS
As the previous government’s Long Term Workforce Plan recognised, giving doctors access to more flexible working arrangements is crucial to improving NHS retention. This doesn’t mean moving every in-person consultation to a video call or allowing doctors to work from home. Rather, it means giving people greater input over when and where they work, making it easier for staff to go part-time while remaining in their current role, or allowing existing NHS doctors to pick up extra shifts on their own terms through a functioning internal bank.
These steps would give doctors the autonomy they need to progress their careers in the way that they want to, something which only 39% told the GMC they are able to do under current conditions.
Giving staff more control over where and when they work has consistently been shown to boost retention, as well as improving employees’ health and wellbeing. By offering them the same level of flexibility enjoyed by those outside the service, the NHS can stem the tide of talent leaving their roles.
The main barrier to embracing these more flexible arrangements are outdated approaches to workforce management. On top of grappling with mounting pressure and overworked teams, managers across the country are often forced to draw up rotas and deploy staff manually, without access to basic information like service demand. Faced with this chronic lack of visibility, rosters inevitably fail to match up to service needs, and managers have little choice but to turn to agency workers to plug the gaps.
By replacing outdated rostering systems with smarter, more integrated digital tools, we can allow managers to see all the data they need to deploy staff effectively, allowing them to flag concerns and fill vacancies in advance, and reducing the need to resort to agencies at the last minute.
NHS staffing is in crisis, and there’s no doubt that the over-reliance on agency staff is unsustainable. But introducing an outright ban on agencies with no clear plan to address the underlying causes of this issue – or to replace the critical contribution that agency staff currently make to our health service – is like trying to perform surgery with a sledgehammer.
To cut costs sustainably, the government must first understand the forces that are driving so many talented workers away from our NHS. By improving conditions and introducing greater flexibility for permanent staff, and giving managers better tools to plan ahead, we can reduce our dependency on agencies without compromising patient care.
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