"We are always going to need temporary staff" - NHS staff shortages show no sign of slowing down
21 Mar 2019
Zofia Bajorek, Research Fellow
Last year the NHS celebrated its 70th birthday. There were stories about the transformational impact that the NHS has had on the provision of health to the nation, how new technologies and advancements in medical science has meant that illnesses that we once deemed incurable can now be cured, and this of course was hugely welcoming and something to be proud of. Yet, on the other side of the coin, not a day goes by where we don’t hear about patient targets not being met, sad stories about unmet care needs, and increasingly how under-resourced the NHS can be. This has been highlighted again, just this morning with research suggesting that the NHS is unable to train enough GPs and nurses to meet patient demand and the situation is now at crisis point.
My interest in the NHS, and in particular how the workforce is managed was significantly spurred by my PhD I completed a number of years ago, focussing on the management of temporary staff in NHS accident and emergency departments and their implications for patient safety and service quality. When you scratch the surface of this issue, you immediately understand just how complex the situation actually is. What is clear is that temporary staff are used extensively in healthcare, and will remain a key component of a hospital’s ability to meet fluctuations in demand, as one participant said: “We have recruitment difficulties, it is a challenge, we are currently running about 300 nurses light…when we are short of staff, we need someone.”
Inevitably, when discussions around temporary staff use occur, questions are raised about the level of patient safety they provide. Are these concerns justified, and does the NHS currently have an alternative to their use?
If only the answer to these questions were a simple yes or no! Temporary staff in the NHS are not a homogenous group, but there is a clear preference for temporary staff who are known to the Trust or who work as part of the staff bank as “better the devil you know…temporary staff we don’t know are a little more challenging”. But importantly they need to be managed correctly as “you need to develop a relationship with them as they do become your critical friends”. This proper management chimes in nicely with discussions around ‘good work’ practices, and was clearly articulated by one participant when they said “If temps are enjoying their work, if they feel respected, they will think more positively, and this will be reflected in their work practices.”
The actual ‘hard evidence’ showing a link between temporary staff use and patient outcomes is hard to find, but staff often spoke about the ‘real risks’ of using temporary staff: “Their awareness of the system is limited…it’s not knowing the system rather than the level of physical care they provide”, or “they may not have the confidence to speak to more senior staff, they may not feel like they belong. They may feel unsupported.” In many cases participants felt that it was better to have someone rather than no-one as patient safety and patient care targets needed to be met. Consequently, it could be argued (and I do argue this) that how temporary staff are managed and supported is something that the NHS should be focussing on.
The pressure of staff shortages can have an impact on the remaining staff, causing increased stress and potentially leading to increased sickness absence and staff turnover. Brexit was not an issue when I was writing my thesis, but the implications that this will have on NHS staffing are already being raised, and quite justifiably a cause for concern. Thus at the moment, the use of temporary staff is an important resource and one that should not be constantly criticised for both costs and quality issues. As staff often explained: “It is a supply and demand situation. There are targets to be met and patients to be seen, and there are not enough regular staff to do the job. Short-term staff are just a way of meeting these needs.”
My colleague Stephen Bevan wrote a few months ago how the lack of workforce planning remains a missing link in the NHS long term plan. Recent staff survey results recently published a reduction in staff feeling that NHS organisations take positive action on health and wellbeing, an increase in musculoskeletal problems, an overall decline in staff health and wellbeing and a reduction in the level of reported staff being satisfied in the quality of care they are able to give to patients. If the under-resourcing and staffing issues continue – which looks inevitable – the prediction of a number of staff members in my PhD of “we are always going to need temporary staff” seems increasingly likely. But, this is not always a negative, as if managed correctly this does not have to be a bad thing.
To read a recent publication of this research in more detail, please go to: https://www.emeraldinsight.com/doi/full/10.1108/JOEPP-09-2018-0074
Any views expressed are those of the author and not necessarily those of the Institute as a whole.