14 July 2006
Most of the savings NHS acute trusts have made in reducing their spending on nursing agencies have been offset by increased use of the in-house NHS Professionals agency and their own nursing 'banks', the National Audit Office has found.
In 2004/05, acute trusts spent £790m on temporary nursing staff – 9.4% of their total nursing spend, and down by just 0.6% since 2000, according to the NAO report Improving the use of temporary nursing staff in NHS acute and foundation trusts.
This is despite the establishment in 2001 of NHS Professionals and in 2002 of a framework agreement to set standards and maximum costs for supply agencies contracting to the NHS.
'Most trusts lack adequate control over their demand for temporary staff, and as a result total expenditure on temporary nurses has not fallen by any significant amount,' said Edward Leigh, chair of the Commons' Public Accounts Committee.
The failure to reduce the volume of temporary staff was due to a lack of knowledge about actual staffing needs on each ward, rather than staffing 'demands', which were often determined by historical levels rather than rational analysis, said Karen Taylor, director of health value for money at the NAO.
Until very recently, decisions on contracting agency staff were often made from the 'bottom up', by nurses rather than human resource managers, Taylor said.
'There was a time when anyone could pick up the phone [and request an agency nurse]… That's not advisable and the combination of deficits and the introduction of payment by results has reduced it,' she said.
If trusts switched to a US or Australian system of establishing a minimum staffing requirement for each ward, £25m-£50m could be saved across the NHS in England each year, the NAO found.
But even the current system was not being used adequately. Although NHS Professionals cost £23m in central funding in 2005-06, it was used by just 27% of acute trusts. The others used their own 'banks' of nurses – paid on a higher rate than regularly contracted nurses – and agencies.
However, 3% of total nursing costs were still being diverted to agencies that were not part of the framework agreement.
The NAO found that if the existing systems and contracts were used to their full potential, the potential annual saving was £38m.
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