£350m bill for hiring agency health workers ‘unacceptable’

The Belfast Trust alone paid over £119m to agencies.

Information provided by Trusts details upwards of £181m spent on nursing and midwifery, and £44m was spent on administrative and clerical staff from agencies.

Data for locum doctors is incomplete as the Belfast Trust and Western Trust did not provide figures. Of the three Trusts which did, it shows that over an 18-month period £102m was paid to locum medics.

The Belfast Telegraph recently revealed that NI health trusts have over 6,000 unfilled vacancies with more than 10,000 workers leaving in the past two years.

Agency and locum staff are utilised to fill vacant posts or cover gaps in service rotas.

Agency workers are retained for Agenda for Change roles, be that within nursing, ancillary services or administration. Meanwhile, a locum is a temporary medical or dental appointment.

Agency workers are being paid significantly more for a shift than HSC staff.

Niall McCarroll of Unison, the public service union, said “failed workplace planning” and the absence of a retention strategy has led to many nurses and frontline health and social care workers leaving full-time positions to take up jobs with agencies.

“This leads to loss of staff morale and lack of cohesion, creating unhealthy working environments,” he said.

Not everyone will choose the option of working for an agency because pension benefits, for example, would not be as favourable. But for someone who wants more flexibility or has had enough of the current pressures it can be an attractive option.

Health Trusts have argued that agency and locum staff are necessary to fill workforce gaps and to ensure that patients and clients continue to receive a safe service.

Staffing resources, they say, have been under enormous strain during the global pandemic, exacerbated by staff absences and ongoing recruitment challenges, making locum and agency staff essential to ensure services are available.

The Belfast Trust pointed to a combination of increased use of outside staff in areas such as Emergency Departments and ICU. It said further administrative support was required for new services such as vaccination centres.

Rita Devlin, director of the RCN in Northern Ireland, said: “The sharp rise in agency spend is extremely worrying and the RCN has been raising concerns about the high costs of agency staff for some time.

“Unfortunately the figures we are seeing reflect the very serious nursing shortages being experienced in all areas of health care, which continue to get worse.

“A reduction in agency spend will only be possible when health and social care services and the independent sector are able to recruit and retain enough nursing staff to meet our needs.

“A fair pay increase must form part of any strategy to try and resolve these issues. This needs to be sufficient to offset the pay differential that exists between agencies and private health care providers, and the health service.

“Working in the health service needs to become a more attractive prospect, otherwise this high level of spend on agency staff will continue.

“While the current levels of expenditure are completely unacceptable, the reality is that they are plugging gaps which were not of their making and should never have been allowed to develop.”

David Farren, committee chair of the British Medical Association’s consultants, acknowledged that staff recruitment is a major issue. He said: “It is one of the key pillars in addressing the problems in our health service. BMA has been seeking consultant expansion for many years and workforce planning has failed to meet this.

“But this is not something we can fix in the short to medium term. We need to make sure the doctors that are currently in our hospitals stay there and keep providing the high quality care that they have delivered.

A Department of Health spokesperson recognised that ongoing significant increases in agency expenditure are “not sustainable”, particularly at a time of serious budgetary pressures across the health service.

He said: “Staffing pressures exist across all areas within Trusts and active recruitment to permanent vacancies is led by each HSC Trust employer.

“Officials are currently working with HSC employers and trade union colleagues on detailed proposals to reduce agency and locum spend in NI, beginning, as a first step, to examine root causes of agency expenditure.

“HSC Trusts employ agency staff for several reasons, for example, cover for sickness and maternity/paternity leave, cover for existing vacancies, and when demand increases over the winter months. The primary aim of this is to ensure that safe and effective services are sustained at all times for patients and clients and this applies equally to the need to have admin and support staff as it does to healthcare staff.”

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