NHS pays £1,600 a day for nurses as agency use soars
NHS hospitals are hiring agency nurses at rates of up to £1,600 a day in a bid to cope with rising staff shortages, an investigation by the Sunday Telegraph has found.
Experts said many hospitals had made swingeing cuts to their workforce - only to find that they were left short-staffed, and forced to pay far higher rates to bring in workers at short notice Photo: Getty Images
By Laura Donnelly and Melanie Mulhern, 9:00PM BST 14 Jul 2012
The number of shifts filled by the temporary workers has risen by more than 50 per cent in a year - with private agencies receiving more than seven times the rate paid to nurses on the pay roll. Experts said the disclosures show how hospitals' attempts to improve their efficiency have backfired, with jobs being cut, only for temporary staff to be hired at vastly inflated rates. The scale of job losses is fiercely disputed, with unions claiming thousands of frontline posts have gone since 2009 while ministers say less than 500 posts lost involve nurses. Meanwhile, the number of nurses from overseas who have registered to work in Britain has soared by 70 per cent in just two years. Disclosures under the Freedom of Information Act show that since 2009, private agencies have been paid up to £1,600 per shift to provide the health service with specialist nurses, compared with an average rate of around £212 a day for those on the NHS pay roll.
General nurses were on rates of up to £1,400 a day, compared with average pay of £188 for those on health service contracts.
Our investigation found:
* Derby Hospitals Foundation trust paid £1,632 for a specialist nurse to work a 12-hour shift in its Accident and Emergency (A&E) unit - a rate equivalent to an annual salary of £229,500. The NHS pays between £25,528 and £34,189 for the same role. The same trust spent £1,399 on a 13-hour shift for a general nurse;
* Princess Alexandra Hospital trust in Essex spent £1,356 on a shift for a specialist nurse to work 12.5 hours in April 2010. Last year the trust announced plans to cut 250 staff posts in order to find savings.
* Mid Staffordshire Foundation trust paid £1,303 for a specialist nurse to work a 10.5 hour shift last December, and £1,061 for a general nurse;
* Figures from NHS Professionals, which supplies a pool of "bank staff" to hospitals, show that in just 12 months, the total number of nursing shifts filled by agency workers has risen by 51 per cent;
Previous investigations by this newspaper have disclosed doctors being hired at rates of £20,000 a week to cover hospital staff shortages caused by European rules. Although the NHS has been protected from cuts by being guaranteed a rise in annual spending in line with inflation, the service is attempting to save £20 billion by 2015, to ensure there are sufficient funds to cope with the rising demands of an ageing population. Experts said many hospitals had made swingeing cuts to their workforce - only to find that they were left short-staffed, and forced to pay far higher rates to bring in workers at short notice. Research from 39 trusts - around one quarter of those in England - shows that 21,000 shifts were filled by agency staff during the month of March, a rise from around 14,000 a year earlier. Experts said the true figures are likely to be far more than four times as high, because the sample was made up of trusts which use bank staff supplied by NHS Professionals before they turned to more costly private agencies.
Figures for the group of trusts show that temporary cover was sought for 155,000 shifts in March. Of those, 90,000 posts were filled by "bank" nurses and around 21,000 by agency staff - while more than 40,000 shifts were left unfilled. Dr Peter Carter, General Secretary of the Royal College of Nursing (RCN) said the figures demonstrated "lamentable" planning by the NHS, which had left hospitals at the mercy of high rates charged by agencies. He said: "Now the hospitals have made such drastic cuts, the agencies have got them over a barrel and can charge what they like." Earlier this year the RCN said nurses had been stretched to "breaking point" with more than 26,000 frontline posts lost during the first year of the Coalition. Ministers have said they do not recognise that figure, and that the number of qualified nursing staff has fallen by just 450 since 2009. The report by NHS Professionals says much of the demand for temporary staff in the last six months of 2011/12 was unforeseen by hospital trusts, which in fact had forecast a reduction in the number of shifts which needed to be filled.
The quango says it is struggling to recruit staff to its bank, because demand is such that private agencies are able to offer potential candidates "almost guaranteed work" at much higher rates. Shortages were worst in the North of England, where demand for shifts rose by 24 per cent, compared with 18 per cent across England. Experts said the figures relating to agency staff alone represented at least 100,000 shifts being filled each month, often on rates of more than £100 an hour. Julia Manning, chief executive of centre-right think tank 2020 Health, said: "The figures are astonishing, and demonstrate such appalling short-sightedness on the part of NHS trusts. "It really concerns me that hospitals are drawing up plans which are based on wishful thinking, rather than reality, only to end up paying so much over the odds." The NHS trusts said the payments for agency shifts included commission to the agencies. Last year, an investigation by the Sunday Telegraph disclosed hospitals sending teams abroad to recruit doctors and nurses, even though local posts had been earmarked for cuts.
The trips were organised despite pledges by David Cameron to cap immigration and protect British jobs, and concerns raised by Lord Winston, one of Britain's most senior doctors, that some nurses put patients in danger because of poor standards of English. New figures show that amid a global recession, there has been a 70 per cent rises in nurses who trained overseas registering to work in Britain, from 2,520 in 2009/2010 to 4,289 in 2011/12. The number of nurses from outside the European Union, where an immigration cap applies, rose from 635 to 1,178. Dartford and Gravesham Trust in Kent sent a team to Romania in November 2010 and hired 20 nurses, even though Barts and the London NHS Trust, less than 20 miles away, was drawing up plans to cut 635 posts including more than 250 jobs for nurses. Barking, Havering and Redbridge University Hospitals Trust sent seven managers to Dublin in October of the same year, returning with seven nurses. Less than two months later, it disclosed plans for 100 redundancies.
Earlier this year, an investigation by this newspaper found doctors being hired at rates of £20,000 a week so that hospitals can comply with the European Working Time Directive, which limits the number of hours medics can work. In some cases the amounts being paid would be the equivalent to a doctor earning an annual salary of almost £1 million. Some doctors were rewarded not just for the hours they worked, but for all the time they were on call – including when they were sleeping. North Cumbria University Hospitals Trust spent £20,000 hiring a surgeon for one week in 2010 and £14,000 on four days' cover for a gynaecologist. Shortages of medics have arisen since the introduction of the working time directive, which set a maximum 48-hour-week in August 2009. Although individual doctors are allowed to opt out of it, they still cannot exceed a limit of 56 hours. In total, 34 hospital trusts responded to requests for information about the highest rates paid for medical or nursing shifts since April 2009.
Of those, 28 admitted to spending more than £1,000 per shift on cover. A spokesman for the Department of Health said the figures from NHS Professionals did not reflect the national picture.
He said the NHS had saved £128 million on agency staff in 2010-2011 and was confident savings would reach £300 million by the end 2013-2014.
General nurses were on rates of up to £1,400 a day, compared with average pay of £188 for those on health service contracts.
Our investigation found:
* Derby Hospitals Foundation trust paid £1,632 for a specialist nurse to work a 12-hour shift in its Accident and Emergency (A&E) unit - a rate equivalent to an annual salary of £229,500. The NHS pays between £25,528 and £34,189 for the same role. The same trust spent £1,399 on a 13-hour shift for a general nurse;
* Princess Alexandra Hospital trust in Essex spent £1,356 on a shift for a specialist nurse to work 12.5 hours in April 2010. Last year the trust announced plans to cut 250 staff posts in order to find savings.
* Mid Staffordshire Foundation trust paid £1,303 for a specialist nurse to work a 10.5 hour shift last December, and £1,061 for a general nurse;
* Figures from NHS Professionals, which supplies a pool of "bank staff" to hospitals, show that in just 12 months, the total number of nursing shifts filled by agency workers has risen by 51 per cent;
Previous investigations by this newspaper have disclosed doctors being hired at rates of £20,000 a week to cover hospital staff shortages caused by European rules. Although the NHS has been protected from cuts by being guaranteed a rise in annual spending in line with inflation, the service is attempting to save £20 billion by 2015, to ensure there are sufficient funds to cope with the rising demands of an ageing population. Experts said many hospitals had made swingeing cuts to their workforce - only to find that they were left short-staffed, and forced to pay far higher rates to bring in workers at short notice. Research from 39 trusts - around one quarter of those in England - shows that 21,000 shifts were filled by agency staff during the month of March, a rise from around 14,000 a year earlier. Experts said the true figures are likely to be far more than four times as high, because the sample was made up of trusts which use bank staff supplied by NHS Professionals before they turned to more costly private agencies.
Figures for the group of trusts show that temporary cover was sought for 155,000 shifts in March. Of those, 90,000 posts were filled by "bank" nurses and around 21,000 by agency staff - while more than 40,000 shifts were left unfilled. Dr Peter Carter, General Secretary of the Royal College of Nursing (RCN) said the figures demonstrated "lamentable" planning by the NHS, which had left hospitals at the mercy of high rates charged by agencies. He said: "Now the hospitals have made such drastic cuts, the agencies have got them over a barrel and can charge what they like." Earlier this year the RCN said nurses had been stretched to "breaking point" with more than 26,000 frontline posts lost during the first year of the Coalition. Ministers have said they do not recognise that figure, and that the number of qualified nursing staff has fallen by just 450 since 2009. The report by NHS Professionals says much of the demand for temporary staff in the last six months of 2011/12 was unforeseen by hospital trusts, which in fact had forecast a reduction in the number of shifts which needed to be filled.
The quango says it is struggling to recruit staff to its bank, because demand is such that private agencies are able to offer potential candidates "almost guaranteed work" at much higher rates. Shortages were worst in the North of England, where demand for shifts rose by 24 per cent, compared with 18 per cent across England. Experts said the figures relating to agency staff alone represented at least 100,000 shifts being filled each month, often on rates of more than £100 an hour. Julia Manning, chief executive of centre-right think tank 2020 Health, said: "The figures are astonishing, and demonstrate such appalling short-sightedness on the part of NHS trusts. "It really concerns me that hospitals are drawing up plans which are based on wishful thinking, rather than reality, only to end up paying so much over the odds." The NHS trusts said the payments for agency shifts included commission to the agencies. Last year, an investigation by the Sunday Telegraph disclosed hospitals sending teams abroad to recruit doctors and nurses, even though local posts had been earmarked for cuts.
The trips were organised despite pledges by David Cameron to cap immigration and protect British jobs, and concerns raised by Lord Winston, one of Britain's most senior doctors, that some nurses put patients in danger because of poor standards of English. New figures show that amid a global recession, there has been a 70 per cent rises in nurses who trained overseas registering to work in Britain, from 2,520 in 2009/2010 to 4,289 in 2011/12. The number of nurses from outside the European Union, where an immigration cap applies, rose from 635 to 1,178. Dartford and Gravesham Trust in Kent sent a team to Romania in November 2010 and hired 20 nurses, even though Barts and the London NHS Trust, less than 20 miles away, was drawing up plans to cut 635 posts including more than 250 jobs for nurses. Barking, Havering and Redbridge University Hospitals Trust sent seven managers to Dublin in October of the same year, returning with seven nurses. Less than two months later, it disclosed plans for 100 redundancies.
Earlier this year, an investigation by this newspaper found doctors being hired at rates of £20,000 a week so that hospitals can comply with the European Working Time Directive, which limits the number of hours medics can work. In some cases the amounts being paid would be the equivalent to a doctor earning an annual salary of almost £1 million. Some doctors were rewarded not just for the hours they worked, but for all the time they were on call – including when they were sleeping. North Cumbria University Hospitals Trust spent £20,000 hiring a surgeon for one week in 2010 and £14,000 on four days' cover for a gynaecologist. Shortages of medics have arisen since the introduction of the working time directive, which set a maximum 48-hour-week in August 2009. Although individual doctors are allowed to opt out of it, they still cannot exceed a limit of 56 hours. In total, 34 hospital trusts responded to requests for information about the highest rates paid for medical or nursing shifts since April 2009.
Of those, 28 admitted to spending more than £1,000 per shift on cover. A spokesman for the Department of Health said the figures from NHS Professionals did not reflect the national picture.
He said the NHS had saved £128 million on agency staff in 2010-2011 and was confident savings would reach £300 million by the end 2013-2014.
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