Dr Anas Nader, CEO of Patchwork Health, stresses that the NHS must find more sustainable ways of plugging gaps in its workforce.

When £2.4 billion goes missing, you can usually guarantee that people will sit up and take notice. So why, when the NHS is forced to shell out this sum every year to patch over the consequences of “criminally” outdated workforce systems, is no one talking about “the great NHS bank robbery”?  

Over the past 18 months, NHS hospital staff banks have consistently and unequivocally proven their worth. Although these reserve pools of healthcare workers – a valuable asset for every hospital – have existed for years to plug rota gaps and meet the ever-fluctuating demand for staff, they truly came into their own during the pandemic. It was staff banks that helped keep wards, theatres and departments safely staffed through peaks and troughs, enabling lifesaving care to continue, and filling a colossal number of urgent shift vacancies.  

Nevertheless, despite the best efforts of managers and administrative teams, the analogue and anachronous operating systems behind staff banks are holding them back. Despite huge strides forward and much effort to make internal banks work, hospitals are still all too often forced to turn to private locum agencies to meet their staffing needs. Although agencies have their place and many offer a vital service, this over-reliance comes at a cost.  
Published figures reveal that every year the NHS is forced to spend £2.4 billion of its increasingly stretched budget solely on agency locums. This is money that is desperately needed to tackle the crushing impact of Covid-19. Money that could be invested in new treatments for patients or on delivering much-needed mental health support to burnt-out staff. We are spending too much money on reactive, short-term, temporary staffing solutions. This “bank robbery” is also reducing NHS trusts’ chances of creating and sustaining thriving internal pools of reliable temporary staff.  

Storm clouds gathering 

The escalating staff burnout crisis and the record-breaking elective care backlog are now placing crippling pressures on the NHS workforce.  

With full-time NHS staff suffering “emergency levels” of burnout (as reported by the UK Parliament cross-party Health and Social Care Committee in June), Brexit disrupting overseas recruitment and one in five employees seriously considering leaving their roles, staffing shortfalls are set to get worse. If internal staff banks aren’t able to respond to these ever-growing gaps in the full-time workforce, hospitals will have no choice but to plug them with agency staff. 

Not only is this state of affairs draining budgets, the revolving-door nature of over-reliance on agency staffing makes building relationships between colleagues an impossibility and offers patients little to no continuity of care. We are moving towards a state of affairs far removed from the founding principles of the NHS, creating an unattractive, depersonalised work environment that poses a real risk to patient outcomes.  

A rock and a hard place  

Curing this chronic condition demands more than simplified “sticking plaster” solutions. If the NHS is to even come close to staffing self-sustainability, it is essential that we empower all trusts and integrated care systems to drive up their staff retention and strengthen their internal banks. The only way this will be achieved is by creating healthier, more sustainable career paths for all staff, releasing hospitals from the trappings of short-term, “patch and pray” cycles and ushering in a new era of tech-powered staff banks designed around real human needs, and developing staffing policies that put wellbeing first.  

Currently, NHS staff face a stark choice.  

Their first option is direct employment with a trust, meaning a rigid rota, a restrictive leave policy and too much red tape preventing movement between different trusts or hospital sites. Arranging to take annual leave at the same time as friends and family is a mammoth endeavour, gaining experience at a different trust is a process burdened with administrative hurdles, and even study leave for professional exams demands complex negotiation.  

The second option is to work as an agency locum, a role that might offer higher wages and shift flexibility but can come at the expense of the stability of contractual employment, long-term relationships with colleagues and a sense of workplace belonging.  

Too few take the third way of the internal staff bank, with its often “clunky” processes and inconsistent approach to shift alerts.  

As things stand, NHS staff, whose primary motivation is to help their patients and their colleagues, must either remain inside a system that often demands the sacrifice of their self-determination and wellbeing, or exit the system altogether (which often means sourcing work through a private agency). It is hardly a surprise that so many are leaning towards the latter option.  

Banking on rebuilding banks  

But things could, and should, look very different. With the right tech tools and intelligent systems in place, trusts can create a new breed of staff banks that work for the NHS – and for workers – in 2021 and beyond.  

We need to make work better for those on full-time contracts and transform the internal staff bank into the go-to option for all temporary staff. Both need to work for the clinicians as well as the NHS itself.  

It is high time that we saw the roll-out of shared staff banks that enable pan-regional collaboration and the fluid redeployment of personnel in line with demand. These banks could offer the flexibility and choice that has been proven to improve staff wellbeing, while also giving managers easy oversight of data and demand, enabling joined-up workforce planning, preventing understaffing and ensuring continuity of patient care.  

Most importantly, it is time that workers were treated like people, rather than names on a spreadsheet. The pandemic has shone a light on exactly how important a role is played by the healthcare temporary workforce, and this lesson should not be forgotten as we move forward. By putting people back at the centre of workforce management, humanity is restored to healthcare staffing, all made possible with the right user-friendly digital tech. This is the change that all staff groups have been crying out for, for too long. This is the change that will save money, save administrative time, and keep talented, dedicated people in their NHS jobs. Ultimately, this is a change that will ensure that all health and care staff are equipped to deliver the best possible care to patients.