Managers are being asked to deliver more for less, and NHS managers in particular face a challenging future. With up to £20bn of efficiency savings to find, it is inevitable that frontline clinical services will feel the squeeze.
One tried and tested solution is to freeze permanent recruitment and respond to fluctuating demand by making greater use of doctors, nurses and allied health professionals employed through locum agencies. But following some highly publicised incidents involving unsupported and inexperienced locums, some trusts and health boards have announced plans to cut locum spend.
An unprecedented situation
My 30 years in healthcare provision – firstly as a nurse, then with my own healthcare staffing businesses - have taught me that this approach is misguided. The NHS is facing an unprecedented situation where an era of austerity coincides with the maturation of long term demographic trends which will increase demand for healthcare.
Kate Bleasdale
Our growing and ageing population will need more frequent and acute care. Over a third of nurses are due to retire in the next decade, with not enough school leavers replacing them. There is a 5.2% vacancy rate for hospital doctors and dentists, and now that European law sets a maximum 48-hour working week for junior doctors, there are even more gaps in the rotas.
That's why locum cover is vital to the NHS infrastructure: it enables managers to flex their workforce up and down to meet fluctuating demand. Since agency staff incur only upfront costs for the hours they work and don't receive public sector rates of pension provision, annual leave and sick leave, they are economically viable as the public sector is pruned back.
Sadly, some sections of the media portray locums as inexperienced, uncommitted and even dangerous. This is inaccurate and unfair, since around two thirds of locums are also employed directly by the NHS, and all are subject to stringent credentialing checks set by the NHS before they can be fielded to work.
I recently debated this issue on BBC Radio Five Live with Professor Chris Isles, the author of an article in the BMJ which criticised locum agencies. While I was sorry to hear of Professor Isles' frustrating experience in trying to hire a locum, it struck me that the key issue was the quality of communication between hospitals and agencies.
Professional responsibility
Locum agencies are not staffed by clinicians. That's why it is our professional responsibility to supply as much information as possible – including all mandated certification, full clinical references, copies of all qualifications and full health clearance - about the locums we field so the hospital can make an informed decision.
On the other side of the equation, managers need to give locum staff a full induction and encourage support from the permanent workforce. If there is dissatisfaction, managers and agencies must cooperate to resolve the matter.
It's counterproductive to view locums as the enemy of the NHS. Demographic trends and economic necessity dictate that they are vital to it.
I'm calling for more open dialogue and cooperation between locum agencies and public sector managers. The continued delivery of a world class health service depends on it.
Kate Bleasdale is executive vice chairman, HCL plc
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