Stop blaming agencies and doctors for NHS staffing problems

It was dispiriting to read health and social care secretary Wes Streeting’s plan to ban agency workers from performing certain entry level roles in the NHS – before the much-hyped “change” consultation on NHS staffing is even complete. It gives the impression that government has prejudged the case or at least bringing heavy bias into what was pitched as an opportunity for a straightforward, informed and honest conversation.

We are now really concerned that this consultation is the latest missed opportunity by a government to learn and work with the agencies on what will essentially mean inevitable workarounds on flexible working in NHS. 

This is so disappointing because when the prime minister gave a speech in Birmingham ahead of the recent Budget, our ears pricked up when he said Labour will “run towards the tough decisions, rip off the short-term sticking plasters, so we can lead our country finally but decisively out of this ‘pay-more, get less’ doom-loop.”

We were further encouraged when the opening of the Autumn budget “red book” claimed its contents aimed to fix the foundations of the economy and deliver change by protecting working people, fixing the NHS and rebuilding Britain.

This is what employers have wanted to hear for a long time because there is a strong link between the health of the population and a mission to deliver economic growth.

Yet the budget was another missed opportunity to make a real difference to the fundamentals of the NHS by not addressing the flaws in its staffing system. How a service is staffed, and particularly how those teams are procured, has implications for the cost of service delivery, how and when patients are treated, and for staff morale. And NHS staffing procurement has broken down. Small tweaks are failing to address the fundamentals and have instead taken a turn for the worse.

This, at a time when we need the NHS to reduce the economic burden of ill-health and support an ageing population. A healthier population means a more productive workforce, and that benefits everyone – from employers to patients to government.

That’s why the seemingly dry subject of staffing procurement needs to be front-of-mind for the Department for Health and Social Care and the Treasury. The broken nature of the current system has far-reaching implications, and it deserves more than a paragraph or two in any meaningful workforce strategy.

Temporary workers, locums, and interims play a big part in keeping the NHS on its feet, whilst it tries to stem a crisis of care caused by growing demand and chronic staffing shortages. But the current pay cap imposed by NHS England for the cost of these workers hasn’t changed since 2016. They are an important contributor to the workforce – and yet are regularly left out of bonus rounds, and little to no attention is paid to why people choose to work this way in the first place.

Contingent staffing is necessary to keep wards open and services running, but many NHS trusts are now making more costly staffing decisions because of procurement and budget diktats

Take Clare. Clare’s a locum radiologist now, but she spent the first 18 years of her NHS career in a substantive role. Over that time, admin burdens were taking her further and further away from the frontline patient services she wanted to deliver. And she couldn’t get any form of flexibility as a permanent member of staff. So, Clare became a locum, and when she isn’t on shift, she now trains the next generation of radiologists. Clare is far from the exception – there are countless examples of people in the NHS who want or need flexible work. At the same time, the NHS will always need contingent staff – to cover sick leave, emergencies, and peaks in demand.

So contingent staffing is necessary to keep wards open and services running. But many NHS trusts are now making more costly staffing decisions – because procurement and budget diktats means they are having to use a staffing facility that costs more than recruiting with an agency, even for permanent headcount strangely enough, but that will get budget approval. Over the last 12 months, we’ve gathered case study after case study that demonstrates agency supply is cheaper than most alternatives. All the current system is doing is allowing a blind eye to be turned to other models of supply for what seems like political expediency rather than considered reform.

So, who is to blame for this? Well, if you read recent media reports, its suggested consultants are – for taking on overtime and getting paid for it! Who would do the shift if they didn’t? How would a patient get the care they need at the time they need it?

The blame game has got to stop – and it must start with the health secretary himself refraining from attacking agencies in the media like this.

Instead, we need a more collaborative approach between all suppliers of NHS workers, the NHS, and the government; it is long overdue. This will give us the chance to compare different staffing models in a transparent way and demonstrate where to generate better value for money. We need to institute some basic changes in procurement, like pay caps that genuinely reflect the actual cost of providing staff in 2024 which are then reviewed every three years. This will work out cheaper for the NHS by bringing a greater number of roles back under the scope of the on-framework route. An NHS staff procurement working group, convened and chaired by government, set up to build a picture of patterns in substantive staff recruitment and contingent staffing needs, would make a difference.

As the government is working on a 10-year plan for the NHS, due for publication next year, we hope they will consider all parts of the NHS workforce and every model that supplies workers.

Our plea is pragmatism, not politics.

Our message to Mr Streeting is this: Let’s talk openly, frankly, and directly to each other about how we fix the supply of staff into the NHS, so it works fairly for all involved. If serious about creating a more efficient and patient-facing NHS, then the government must get around a table with all of us before announcing their plans to reform the NHS next year.

We all know that reforming the staffing model, patient care and rebooting the economy are all closely connected, so why reject a conversation that can help with all of that?