The cost of nursing and midwifery agency staff in Northern Ireland has more than trebled in the last five years, new figures have revealed.
In the last financial year, £52million was spent on nursing and midwifery agency staff - compared to £12m in 2014/15.
This represents an increase of 330%.
The Department of Health (DoH) said agency staff were needed to ensure safety and effectiveness of services.
While an agency is paid a fee for providing staff, it does not necessarily mean those workers are paid more than their NHS counterparts.
The Belfast Trust, Northern Ireland’s largest health trust, spent the most on the staff, racking up a bill of £19.2m bill in 2018/19. The lowest spend was in the South Eastern Trust, which paid £3.9m.
The figures were released by the department following an Assembly written question by the SDLP’s Patsy McGlone.
The MLA said the expenditure was “astounding” and questions had to be asked of the health minister.
“There has to be some way of addressing the situation were staff get paid a proper wage and you don’t have this case where agency staff are being paid much, much more than NHS staff are being paid,” he told the Belfast Telegraph.
“It’s a very, very unfair situation. The excess money that’s being paid to agency staff could have amply sorted out nurses’ pay a long time ago. The question I would emphasise is: how many extra hours are being returned for the extra money that’s being spent?”
Last month, nurses and other healthcare workers took unprecedented industrial action in a dispute of over pay and staffing levels.
An estimated 15,500 nurses took part in walkouts across Northern Ireland in December and January, demanding pay parity with nurses elsewhere in the UK.
It was the first time in the 103-year history of the Royal College of Nursing that its members voted in favour of strike action.
Alliance Party health spokesperson Paula Bradshaw said the increase in agency costs shows the “poor workforce planning” by health chiefs.
“There will always be cases where it is necessary to hire agency staff to ensure safe staffing and appropriate levels of care for patients,” she said.
“However, the increase in costs of hiring agency staff to cover nursing and midwifery posts from £12m to £52m over a five year period is an indictment of the poor workforce planning that has resulted in increased waiting lists and led to industrial action.
“Additionally, there was a failure to cap agency fees in line with the rest of the UK. When pay parity is fully implemented I would hope staff will be encouraged to stay in the NHS and provide the high levels of care I know they are dedicated to providing.”
A DoH spokesperson said the cost of agency staff has been incurred to “ensure that safe and effective services are sustained” and locum staff are employed for several reasons, such as covering sick leave and existing vacancies.
“Transformation of health and social care in Northern Ireland is a priority. The department has undertaken significant work to try and alleviate the workforce pressures across HSC and it is examining all potential options, and the implications, as to how to address the issues of rising locum expenditure,” an official said.
“As set out on the Bengoa expert panel report, it warned of ‘stark increases in costs associated with locum and agency staff to provide a safe service where it is not possible to recruit to permanent positions’. The report made clear that rising locum and agency costs are due to the current configuration of services and that ‘changing the model of care’ is the only solution.”
The spokesperson added they are working with Health and Social Care (HSC) employers to reduce agency and locum spending.
Pat Cullen, director of the Royal College of Nursing in Northern Ireland said agency costs have increased dramatically over recent years.
"This situation has been created over a number of years as a result of inadequate workforce planning and short term cost-savings measures including reductions in the number nurses trained in Northern Ireland," she said.
“There are nearly 2800 nursing vacancies within the HSC and probably a similar number in the independent sector. As a result, the cost of deploying nursing staff via nursing agencies has reached unprecedented and unsustainable levels.
“One of the core reasons that nurses took industrial action and strike action recently was due to safe staffing levels. The majority of nurses are working unpaid hours in an attempt to provide the best care for patients and many have reported that they are concerned that there are not enough staff to do their jobs properly."
Ms Cullen said pressures have caused many nurses to work for agencies or leave the profession altogether and the current agency expenditure is "completely unacceptable".
"The reality is that they are plugging gaps which should never have been allowed to develop," she added.
Following negotiations between unions and the DoH the industrial action by nurses was halted on January 16 when Health Minister Robin Swann struck a deal to restore pay parity.
Robin Swann said £79m would be spent on increasing wages and an extra £30m would be pulled from existing finances at Stormont.
Two previous offers had been made by the department to end the dispute, but both were rejected by trade unions. Last month, the department offered a 3.1% increase in overall pay and an additional £38m for the health service.
The latest figures on the cost of nursing and agency staff in Northern Ireland come at a time of substantial nursing shortages.
According to the latest quarterly update from the DoH, the were 2,269 registered nurse vacancies as of September 30 last year.
In November last year, the Belfast Telegraph revealed that more than £1,600 was paid out for a single agency shift in the South Eastern trust in 2018, sparking calls for health officials to introduce a cap on “rip-off” agency fees.
Figures show that, in some cases, trusts spent up to £155 an hour to fill gaps in their workforce. The cost of hiring temporary staff across the health service is currently running at £640,000 a day.