Why are recruitment agencies being made the NHS’s scapegoat?

Mark Thomas/REX
Mark Thomas/REX

After last week’s clampdown on recruitment agencies supplying the NHS with doctors and nurses, the Recruitment and Employment Confederation’s chief executive Kevin Green outlines why the Government’s poor workforce planning is to blame.

Over the past week, recruitment agencies supplying doctors and nurses into the NHS have been criticised by ministers and other NHS stakeholders. These accusations are wide of the mark. In fact, they have been outrageous. It is incredibly disappointing to see the Health Secretary attack our industry and vilify the vital work that agency nurses and doctors do day-in, day-out.

There’s a wider question that the Government needs to be asking: why are good-quality doctors and nurses choosing to leave permanent jobs in the NHS in favour of agency work?”

Poor strategic workforce planning has left the NHS short of nurses and doctors, and, although they are advertising, they cannot find people willing to take the jobs.

For the past 11 months, nursing has been in the top six in-demand areas for permanent staff according to data. This is not a new issue, but one that has been building for years.

There has been a huge increase in demand on the NHS, due to an ageing population and rising hospital admissions, as well as the inquiry into Mid Staffordshire, which highlighted a lack of nurses.

At the same time, the NHS has reduced supply by cutting the number of student nurses being trained, and permanent staff are leaving because of inflexible shift patterns. In this context, it is no surprise that an increasing number of NHS Trusts are turning to agencies to provide the people they need to maintain safe patient ratios.

Existing pricing frameworks

In the vast majority of cases, the provision of temporary staff is regulated by existing NHS framework agreements with set prices. These rates are negotiated and recruitment agencies must adhere to them.

This point has often been omitted, and, instead, the rhetoric has been about agencies “ripping off” the NHS because the recruitment industry is an easy target.

Many media outlets have focused on an isolated number of instances where nurses or doctors are paid “off-framework” – often these are for highly specialised roles requested at very short notice to cover antisocial shifts.

There will always be times when the NHS will need to call on a pool of vetted, highly skilled professionals at short notice, and we must not lose sight of the fact that being able to do this ensures patient safety.

The Government appears to be making policy up as it goes along. The reality is that the vast majority of agency staff are paid fairly for the service they provide. Band 5 agency nurses will earn £20-£25 per hour, and locum doctors in A&E can expect around £50-60 per hour.

As for the agencies, their income will typically amount to between 10 and 20% what the client is charged. For this fee, the agency has to find staff, vet them, conduct eligibility-to-work checks, run Disclosure and Barring Service checks, and conduct immunisation procedures, as well as pay and train them. All of these represent costs that the NHS would incur if it was recruiting staff directly.

There is a wider question that the Government needs to be asking – one that should be on everyone’s lips considering how difficult it is to find permanent staff: why are good quality doctors and nurses choosing to leave permanent jobs in the NHS in favour of agency work?

Agency nurses like the flexibility that working in this way gives them. They value the ability to fit shifts around their family and other commitments. The majority of these nurses have already had long careers within the health service and bring valuable experience to where it is needed most.

So to hear spending on agency workers described as a “waste” is, frankly, disrespectful to the hard work these people do within difficult environments.

If the Government is serious about improving the NHS, making agencies the scapegoat for inefficiencies and poor workforce planning does not help: fix the supply problem by training more nurses and doctors in the UK; make the NHS a more attractive place to work by introducing flexible working arrangements; and invest in proper workforce planning so that deep-rooted problems are addressed, rather than patching them up with ad hoc regulation.

Specialist recruiters who have been plugging the gaps in the NHS for years, and who understand the latent problems better than anyone, have not been asked for their insight”

The recruitment industry is ready to play its part in improving the cost-effectiveness and sustainability of framework agreements so that the NHS can continue to access properly vetted and trained staff 365 days a year, 24/7.

The debate we should be having is about how to make these frameworks more effective and viable so that more small and medium-sized enterprises can enter the market and provide competition to existing suppliers, thereby driving improvements to the services that recruiters provide.

But so far we have not been consulted – specialist recruiters who have been plugging the gaps in the NHS for years, and who understand the latent problems better than anyone, have not been asked for their insight.

It looks like more problems will be created for the NHS as the Government rushes through ham-fisted reforms that fail to address the supply of good quality staff into the NHS.

Kevin Green

About Kevin Green

Kevin Green is chief executive of the Recruitment and Employment Confederation (REC).
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