Different staffing models

HSJ has launched  investigation into the causes and consequences of the NHS’s growing reliance on temporary clinical and medical staff. In February, the RCN produced a report on the full costs of agency nursing in the UK. The government has declared its intention to cut the costs of agency staff.

Never has agency staffing been more ‘front of mind’.

Today’s CQC report is an important one, and I shall take some time to have a deeper delve, but I do feel immediately compelled  to raise an issue. ‘Agency’ staff perform a vital role:

  • staffing for the unexpected is simply not feasible when budgets are a massive issue – bank and temporary staff are one answer to this, and generally cheaper than than keeping an extra full time team member- Murphy’s Law has it that you may well need two extra staff at one time anyway.
  • wages are being increasingly capped. Extra shifts here and there may not be desirable, but are a fact of life for care staff when wages are so low.
  • people rarely compare like with like when looking at agency staff costs. They see that regular staff are paid x per hour. We then see that see agencies charge 3x or 4x assuming that they are creaming off a lot of money. The reality is that regular staff don’t just cost their hourly rate – add national insurance, holiday pay, training costs before comparison. Agencies have a person there all of the time, even when they’re not sorting out staff for care units, which is where much of their costs arise.

I  contend that this reliance on temporary staff is not all bad. Good temporary staff can cross-fertilise good ideas from one place to another. And temporary work can keep good people in the care system who would otherwise leave due to the lack of scheduling flexibility in many places. And let’s tell it how it is: in well established, well oiled wards, new people are often excluded by what they perceive as ‘cliques’. Because things work well in those wards, improvement suggestions are rejected along with any other changes to working practise. Temporary staff are often a good way of ‘try before you buy’, decreasing the chances of high staff  turnover and the accompanying costs. What makes a good care worker isn’t just qualifications and ability but empathy with patients and ability to work well with other team members – that’s not something that’s easily measurable, but staff turnover is costly.

The cost? Yes, the costs of agency staff are incredibly high, and the Care Locker seeks to change that very broken model.

But there are also other areas of cost that could easily be cut.

The Care Locker is just one start up in a sea of care and medical startups. My MP,  John Redwood, very kindly introduced me to Mr Hunt, The Secretary of State for Health.  Despite the stated Government aim, he referred me back to regional CCGs (Clinical Commissioning Groups).

I am sure I am no less passionate about The Care Locker than many of the other startups out there are about their own ideas and innovations – and I’ve seen some amazingly simple, useful innovations.  So I’m not alone.

I am working my way through the CCGs as  instructed- it gives me far more opportunities to succeed. But all the other start ups will be doing the same thing – surely a slow and wasteful system in itself? If one person could see them all, rate, review and share that information with a brief evaluation – enabling each CCG to proactively look at what they want to, rather than wasting time being hounded by each of us for their time – perhaps the speed and quality of change would be faster, both in terms of the start up ecosystem (which we need, as a society, to succeed, and, importantly, the improvements to health and social care.

Why is this an issue? There are 211 CCGs in the UK. Suppose I take an hour of each of their time (conservatively, as that assumes I get through to the right person, first time, and get a 30 minute meeting), that’s around six weeks of NHS paid time I’ve gobbled up – irrespective of the quality or viability of my service, and six weeks of my time. Multiply that out by all of the companies trying to deliver services and innovations, and I’d suggest that the purchasing process itself could be an area for massive savings!

So here’s my call:

  • Consider that it’s the agency model rather than the use of invaluable temporary staff that ‘s the problem;
  • Look at how we fail to engage efficiently with people who have the products, services and ideas with potential to help deliver a better, faster service.

The pace of change in healthcare is necessarily conservative, but currently means we are missing out: surely fixing the system is better than throwing the baby out with the bath water.


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