NHS staff shortages by working as locum doctors and charging hospitals £1,760 a day for their services, according to a parliamentary inquiry.
The NHS in England’s bill for agency staff has risen to £2.6bn a year
because of hospital trusts’ difficulty in recruiting and retaining
enough doctors and nurses, the public accounts committee also discloses.
“It costs the taxpayer £400,000 to train an emergency consultant, but
there are claims that some consultants are choosing to leave the NHS to
work on an agency basis at a substantial cost to the NHS, with typical
charges of £1,760 per day,” said Margaret Hodge, the former Labour
minister who chairs the powerful cross-party committee of MPs.
Barking, Havering and Redbridge university hospitals NHS trust in
east London is paying such sums because it has only half the number of
A&E consultants it needs to cope with patient demand.
Matthew Hopkins, its chief executive, told the MPs that his trust was
paying consultants in emergency medicine £110 an hour to work at its
two hospitals, Queen’s in Romford and King George’s in Ilford, both in
Essex. Asked whether it could end up paying £1,760 for an A&E
consultant to work a 16-hour shift, Hopkins replied: “That is what the
market is dictating.”
His trust’s struggle to hire salaried staff was so acute that it was
paying £1.5m a month to employment agencies for supplying all sorts of
temporary staff, Hopkins added.
The College of Emergency Medicine, which represents A&E doctors,
blamed the NHS’s failure to recognise the unique stresses on them for
the nationwide shortage and hospitals’ consequent “shocking expenditure”
“It is retention that is at the heart of the problem, with 50% of
emergency-medicine doctors leaving their training posts each year and
almost 100 consultants emigrating,” said Dr Cliff Mann, the college’s
president. That amounts to “a waste of human resource and taxpayer
He added that the NHS should give A&E doctors extra time off to
help them avoid the burnout that can accompany such demanding work. This
would make the job more attractive and reverse the growing “brain
drain” in A&E.
The amount that staff shortages force the NHS to spend on agency
staff to ensure all medical rotas are filled rose by 22.9% in a single
year from £2.1bn in 2012-13 to £2.6bn in 2013-14, the committee found.
Richard Douglas, the Department of Health’s director general for
finance, told the MPs that such spending “has grown exponentially in the
past couple of years”.
The £2.6bn total is understood to include the cost of all non-payroll, bank and agency staff combined.
The committee also reports that the proportion of NHS trusts in the
red has soared from 10% in 2012-13 to 80% by July, August and September
last year. “From all our work across all of government, the fragility of
NHS finances causes me greatest concern,” Hodge said. “The financial
health of NHS bodies has worsened in the last two financial years.” The
NHS will need to make “radical changes” to the way it delivers services,
and the government provide “significant upfront investment” to help it
do so, if it is to remain sustainable, she claimed. “It is clear that
the old ways will no longer work.”
The committee concluded that money available for the upfront
investment necessary to deliver planned reforms was being eroded as
increasing numbers of NHS bodies fell into deficit.
Andy Burnham, the shadow health secretary, said: “People will be
appalled to see the bill for agency staff spiralling out of control. It
confirms that coalition cuts to nurse training places were a false
economy on a grand scale.
“Many trusts are in trouble on all fronts and trapped in a downward
spiral, without enough staff and lacking the funds they need to stop the
The Guardian reported last week that hospitals were recruiting more than 100 foreign-trained doctors a year,
from at least 27 countries including Syria and Poland, in an attempt to
tackle shortages in a wide range of specialities, including A&E,
radiology and ophthalmology.
The Department of Health said the Mid Staffs care scandal had forced hospitals to hire extra staff.
“Patient safety is top of our agenda and, in the wake of Mid Staffs,
agency workers have been used to correct historic understaffing, but we
are helping the NHS to use its workforce more efficiently and reduce
long-term reliance on expensive agency staff,” a spokeswoman said.