A growing number of public sector workers are migrating from permanent positions within the NHS to agency roles. There is a general assumption that this trend largely has to do with the lure of more attractive hourly rates. However, a recently published report by the National Institute of Economic and Social Research (NIESR), debunks that myth.
Commissioned by the Office of Manpower Economics, the NIESR report aggregates a number of key findings - chief among them: public sector staff are being pushed rather than pulled into agency work due to insufficient resources and unmanageable workloads, not predominantly by the opportunity to earn more.
Push versus Pull
Numerous studies and research papers conducted over the last 10 years have explored the motivations of public sector healthcare workers in moving from a permanent to temporary model. On one hand, there are those – the “free agents” – who are attracted by the obvious advantages of agency work, such as flexibility, higher rates of pay, and the ability to achieve a work-life balance. (Kunda et al 2002). Stacked on the other side of the coin are the majority, reluctantly leaving their permanent positions, who regard agency work as “the lesser of two evils” (Rutyer et al 2008).
A common conclusion across such studies is that these ‘push’ / ‘pull’ factors are often intertwined, creating something of a self-fulfilling prophecy in terms of the need for private agency work: as disillusioned employees vacate their permanent posts in favour of agency roles (push), the NHS’ recruitment fissure widens, creating even more of a demand for agency services who are further empowered to offer higher hourly rates and reliable working hours (pull). This creates a domino effect that is difficult to mitigate.
The Employers’ Perspective
There is no denying that, despite pay caps on agency spending by the NHS, the recruitment of agency staff has accelerated, and reliance on agency workers will inevitably continue as employer demand outstrips supply. With patient safety of the utmost importance, emergency provisions necessitate the use of agencies to address recruitment and retention challenges. Employers do so under duress, however, continuing to highlight their concerns around the inflated costs of agency resourcing, in addition to the potential impact on the quality of services provided. A common concern was the threat to continuity of service, resulting in unfamiliarity with ward procedures, policies, equipment, colleagues and patients, as well as a lack of commitment to the employer organisation.
Some Illuminating Stats
A mere 4.1% of agency nurses joined an agency because they were unable to obtain permanent work (Ruyter 2007)
Less than 10% of nurses working solely through agencies wished to return to permanent NHS positions (Rutyer 2007)
Only 1% nurses of agency nurses took up agency work because they could not obtain permanent employment, clearly demonstrating that professionals are choosing agency work for other reasons (Aldwych & Partners 2015)
Nurses leaving permanent positions for agency work have described being overwhelmed by the following factors: (Audit Commission’s Brief Encounters 2001)
Bureaucracy & target setting
Older nurses placed less emphasis on income, more on maintaining skillsets, personal interests and sufficient staffing levels. (Ball & Pike 2006)
66% of nurses who qualified pre-2000 preferred a permanent post compared to only 28% who qualified post-2000. (Ball & Pike 2006)
With many such studies citing deteriorating job quality as the key driver in the switch from permanent to agency work, the evidence is clear that the ‘push’ factor is the primary force at work. The collective research argues that the choice of agency work must surely be the less appealing option with its attendant losses of professional identity, job security and benefits, such as pensions, etc. Aronescu et al 2004, in its research on temporary doctors in Sweden, describes agency work as “an involuntary condition that would not be necessary or desired if the employer provided better working conditions.”
What Does the Future Look Like?
With the dependency on agency staff to meet staffing shortages unlikely to change in the near future, the NIESR report suggests that the agency model could become an effective method of building a skilled, flexible workforce. With certain trusts concurring that there is a fundamental need both to revise traditional ideas about work patterns, and to combat the belief that flexibility can only be achieved through agency work, the report makes the following key recommendation: “Harmonise staffing operations on a regional level, to ensure a ready supply of temporary agency workers, and mitigate concerns around cost and quality.”
Co-Author of the NIESR Report, Nathan Hudson Sharp suggests that “the future of agency work in the NHS would seem to rest on implementing an approach that is much more comprehensive, and that would enable NHS employers to address underlying issues around staff shortages, training, workforce planning, recruitment and retention.”
Several studies highlight the place for agency work within overall workforce planning. Recruitment and Employment Confederation (2014) found agency work to be especially suited to particular groups of workers, particularly those with specialist skills. Guest & Clinton (2006) also reported that highly skilled workers tended to be better adapted to the agency model. Another key finding of the NIESR report highlights the especially heterogenous nature of agency workers – highly skilled with many years’ experience working within the public sector. There are demonstrable benefits to harnessing the varied backgrounds of agency workers. By envisioning a hybrid workplace, and offering the best possible working conditions to both permanent and agency staff, employers may potentially have the best of both worlds.
Long-lasting change can only truly come about with the political will of the government fanning its sails. Until that comes to pass, the report concludes that a more current and short-term solution would seem to lie in increasing recruitment from overseas.
First-Class Healthcare Recruitment
With agencies on framework agreements required to be price-cap compliant, trusts reported this as a “very helpful mechanism in ensuring quality and minimising costs.” The research also found that within those frameworks, trusts chose agencies with whom they had built good relations. As an awarded framework supplier and leading recruitment partner of the NHS and HSC (Northern Ireland), TTM Healthcare is proud to be the agency of choice for many healthcare employers across the UK.
We specialise in sourcing the most highly skilled healthcare recruits to meet the short-term needs of our clients. Our international recruitment programme enables our clients to strategically plan and manage their requirements, offering a robust solution to staffing issues for acute hospitals, private hospitals and homes nationwide. Having sourced over 4,000 nurses in the past 3 years via our extensive global network, we are expert at delivering specialist staff to our clients when they need them most.
Unique to our agency is our bespoke English language training programme. Run, managed and delivered by IELTS-trained mentors and coaches, our English Language Division offers a blended learning approach to enable overseas candidates to achieve the best results. With pass rates in excess of 30%, we are truly delivering marketing-leading services that offer our clients unparalleled cost-savings and efficiencies.
Contact us today for more information on how our first-class services can meet your short-term recruitment needs.
Evelyn Moriarty, Content Specialist
Evelyn Moriarty is a Content Specialist at TTM Healthcare, based in at our Irish headquarters. Joining the company in 2016, Evelyn specialises in both on and offline content creation for the health and social care market.
TTM Healthcare is a specialist health and care recruitment company established in 2002. Now recruiting highly skilled medical professionals from all over the world, TTM has offices in London and Preston, as well as Ireland. A leading framework supplier to the National Health Service, TTM Healthcare was the ‘UK Recruitment Agency of the Year’ finalist (Recruiter Awards 2015), Public Sector Agency of the Year (Recruiter Awards 2016), and Professional Services Agency of the Year (Recruiter Awards 2016 & 2017). We are also proud to be recognised as a Recruitment International Top 500 company.