To ask the Minister of Health, pursuant to AQW 18487/17-22, why the amount spent on agency nursing staff by Health and Social Care Trusts increased in 2019-20 to nearly 600 per cent of the cost in 2015-16.

The charging structure within the Agency framework (that is payable by HSC to agencies) is made up of several elements including the equivalent Agenda for Change (AfC) hourly rate for a given pay band, experience level and shift. There should be no difference between what a Trust employee receives and an agency worker receives, assuming they are on the same pay Band and point of the AfC scale.

Whilst the basic hourly rate is the same as AfC, the amount that the agency pays to the individual could vary. Appointments made outside of the Framework will not be the same as they are based on individual agency costs and taking account of demand and supply for the specific post needing to be filled.

Precisely what an agency nurse is actually paid is not known to the HSC Trust.

HSC Trusts employ agency staff for several reasons, for example, cover for sickness and maternity/paternity leave; cover for existing vacancies; and when demand increases over the winter months. The primary aim of this is to ensure that safe and effective services are sustained at all times for patients and clients.

The Bengoa expert panel report warned of “stark increases in costs associated with locum and agency staff to provide a safe service where it is not possible to recruit to permanent positions”. It made clear that rising locum and agency costs are due to the current configuration of services and that “changing the model of care” is the only solution. Pending this transformation, locum and agency expenditure is required to maintain safe services and keep hospital units open. It is accepted that ongoing stark increases in these costs are not sustainable in the long-term.

The agency worker expenditure provided in AQW 18487/17-22 relates to the total nursing & midwifery workforce including registered and support workers. During the period in question it is important to note that the directly employed HSC nursing & midwifery workforce increased by a headcount of 1,033 (4.7%), comparing staff numbers in post at 31st March 2016 with those in post at 31st March 2020. However, HSC nursing & midwifery vacancies actively in recruitment also increased during that period but reached a peak of 3,057 vacancies (12.0%) as at 30th June 2019.

A Regional Agency Reduction Implementation and Planning Group has been established to co-ordinate the improvement of staff utilisation, with the aim of reducing unsustainable agency spend, beginning with off-contract arrangements. The main function of the Group is to develop and implement a plan, with local and regional commitment and coordination, to safely facilitate, and manage the service impact of, reducing unsustainable agency and locum spend.

We are committed to sustained investment in growing the local nursing and midwifery workforce to meet ever increasing demands, for example, this year we have commissioned the highest ever number (1,325) of pre-registration nursing and midwifery training places.

This unprecedented level of intake will be in maintained for a minimum of a further 2 years.