Private agencies are exploiting the NHS nurse shortage – and this is having an impact on how care is delivered

While the free market facilitates competition, and this is viewed as healthy, I believe it has no place in healthcare. If you were in any doubt, look at the current example of nursing agencies blatantly profiteering from the shortage of nurses in health and social care. While the NHS pays nurses £16.52 an hour, these agencies are charging three times that, demanding upwards of £52 an hour.

Nursing agencies are private businesses that have a pool of nurses they can call on at short notice. The NHS and social care sector have always relied on these agencies to fill staffing shortfalls in hospital wards and in community care teams. But now these agencies are exploiting the record number of NHS and social care vacancies – more than one in 10 posts are unfilled – and this is having a significant impact on how care is delivered.

Hospitals are struggling to discharge patients, as demonstrated by recent reports of paramedics unable to hand over patients to hospitals in a timely way. The lack of space in residential homes means patients needing care are unable to be discharged from hospital. Some innovative hospitals are redeploying their nursing staff into these residential units to provide care so that they can discharge their hospital patients into these homes and free up beds. Although this is clearly not sustainable in the long term, as these hospital wards also need to be staffed, it demonstrates the desperation of hospital management in trying to break this circular conundrum.

Hospitals are left with no choice other than using these nursing agencies to ensure that their wards have enough staff to provide the basic level of care needed by patients. The NHS could and has recruited nurses from other countries but that can take months and is not the answer to the shortage of staff today. That’s where these agencies come into their own, as they are able to quickly supply nurses to ease pressures on hospitals and residential care, albeit at an increased cost.

There are a number of factors playing into this current scenario. When there is a shortfall in nurses, existing nurses are asked to do overtime, which paradoxically contributes to the problem, as they then become unwell and have to take time off. On top of this, the NHS is effectively poaching nurses from social care into vacant roles, which in turn drives up costs, as increased hourly rates and other financial incentives are offered. But there are limits to how much can be offered, irrespective of how desperate these organisations are for staff – they have finite budgets that we know are already being squeezed.

While using nursing agencies might help fill a vacancy on a hospital ward today, these businesses are actually contributing to rather than solving the problem. They drain the NHS and social care sector of money and don’t provide anything more than a very temporary fix to a long-term problem.

It is difficult for the leviathan that is the NHS to be as nimble and proactive in recruitment as the private sector. So, unless there is a plan to fix the record number of nursing vacancies taxpayers will continue to foot the bill these private nursing agencies are charging.

The solution is clear but unfortunately isn’t quick. Instead of waiting for nursing and social care shortages to happen then trying to respond, a longer time horizon is needed. For decades, health secretaries have naively commissioned nurse and social care staff training on economic grounds rather than looking at what future demand will be. This isn’t a particularly complicated assessment, as predictions on staffing can be made by examining population demographics. We’ve known for years that we have not only an ageing population but an ageing health and social care workforce. These two have now constellated increasing demand for care at a time when large numbers of the workforce are retiring.

Despite this intelligence, we have rarely matched nursing demand with supply. Instead, it is only when demand for nursing emerges that additional training places are commissioned by politicians, even though it will take three years to produce these registered nurses. There is a compelling case to relieve politicians of this responsibility and hand it over to an independent body who can objectively and realistically commission nurse training places based on evidence rather than ideology.

The recently announced rise in national insurance rates which is earmarked for health and social care will soon be eroded by these opportunistic nursing agencies charging elevated hourly rates for staff. Staffing is the number one cost in health and social care budgets so any upward pressure on this is significant.

Politicians are currently defending their right to have two jobs. I support their assertion but only if that second job is to work at least one day a week in health and social care, as former Labour shadow chancellor Ed Balls is doing for a new BBC show, Inside the Care Crisis. If politicians had even the briefest experience of providing care, the sector’s staff shortage might be solved overnight.

Ian Hamilton is a senior lecturer in addiction and mental health at the University of York