More than £160m spent on temporary nurses in one year

A high dependency on agency nurses has led to Northern Ireland health trusts spending more than £160m on private staff in a single year.

The amount has tripled in six years and is on top of the £1.1bn cost for permanent NHS nursing and midwifery staff, according to a report from the auditor general.

Dorinnia Carville also said Northern Ireland needs an additional 2,195 nurses to ensure safe and effective nursing levels.

The Department of Health said agency staff costs are incurred to ensure that "safe and effective" services can be sustained.

They added that a planning group aimed at reducing unsustainable agency and locum spend across health and social care (HSC) had been established.

In their statement, the DoH also said that agency use in social work has been "entirely eliminated" and that "significant progress has been made in recent years to stabilise and grow" the HSC workforce.

The use of temporary nursing staff remains high because of absences, unfilled vacancies, high population demand and inadequate workforce planning, said the auditor general's report.

A 2023 initiative to scrap the use of off-contract agencies who were commonly able to dictate payment rates to health trusts had been successful, however, "agencies had developed a strong market hold" with rates significantly higher than England, said the report.

It showed some agency nurses were paid up to 64% more in Northern Ireland than in England.

Agency staff were also paid an average of £11 more per hour than those temporary nurses - known as bank nurses - hired directly by health trusts.

The auditor general said that if agency staff had been paid the same as those hired directly by trusts, Northern Ireland could have saved £186m over the past four years.

"While the use of temporary staff to fill short-term workforce gaps is inevitable to some degree, this must be planned and managed effectively to ensure the long-term sustainability of services," she said.

"The introduction of a new agency framework has delivered some important improvements, but agency costs remain high and better value for money could be achieved."

The report recommends the Department of Health takes targeted action to reduce agency nursing usage and expenditure and looks to other parts of the UK which have significantly lower levels of expenditure.

Director of the Royal College of Nursing (RCN) in Northern Ireland, Rita Devlin, said the rising spend on temporary staff is "neither sustainable nor acceptable for patients or staff".

She pointed to the fact some of Northern Ireland's health trusts are "hugely replying" on temporary staff, but admitted "you can't just turn the tap off because that would impact patient safety".

Devlin told BBC Radio Ulster's Good Morning Ulster programme that the level of spending represents a "missed opportunity".

"The report makes clear that the same funding could employ more than 2,600 full-time nurses," she said.

"At a time when services are under extreme pressure, this is money that should be invested in building a stable, permanent workforce, not plugging gaps at a far higher cost."

Devlin added that an over-reliance on agency staff is a "symptom of deeper, long standing issues" and will not be resolved "unless we address the failure to properly plan, recruit and retain nurses".

A solution she said would be: "increasing training places, improving retention through better pay and working conditions, and making nursing an attractive long-term career".

Bank nurses are a pool of professional temporary staff who cover planned or unplanned absence. Some bank staff already work within a health trust and may take on additional shifts to top up their pay.

Agency workers are registered nurses and healthcare professionals who are employed by private staffing agencies rather than a single hospital or care facility.

John Patrick Clayton, from Unison, one of the largest healthcare unions in Northern Ireland, said not enough is being done to incentify the current bank system.

"This is one of the reasons why, over many years our trusts seem to have become reliant on very high cost agency staff," he said.

Clayton described the report as a "shocking wake-up call" and said it shows "how much more needs to be done to tackle a problem that has persisted for years".