This article appeared on Open Democracy: Our NHS on Tuesday June 2

The market is reaping as  Jeremy Hunt sows

Tough talk by the Health Secretary on NHS agency costs belies the fact that the problem occured on his watch – and as a result of his government’s market policies.

Today’s announcement on reducing the costs of agency nursing staff sounds like good old Tory get tough stuff. The NHS “needs to deliver its side of the bargain, which is to make efficiency savings”, Health Secretary Jeremy Hunt said today.

He continued: “Can we really afford the kind of care we all want? With a strong economy, the answer is yes – but only if we care as much about every pound the NHS spends as every patient it treats. Because money wasted is money that can’t be spent on those needing care.”

But Hunt’s greatest efficiency here is with the truth behind the wastage.

The Public Accounts Committee repeatedly warned him that Trusts’ finances are being squeezed as they are forced to rely on agency staff.

But under Hunt’s watch, the money spent on agency fees soared to record highs.

“Hunt ignored agency issue and [is] guilty of neglect”, Alan Maynard, Emeritus Professor of Health Economics at York University commented today.

The Royal College of Nursing (RCN) revealed in February how spending on agency nurses leapt from £327m in 2012/3, to £486m in 2013/4 – and is predicted to be just shy of £1 billion in the last financial year.

And – according to the Nuffield Trust – the overall spending on agency workers across the whole NHS increased 31% last year alone, “largely accounting for an £800million hole” in hospital finances.

(That’s the £822million hole that was revealed even as the Tories basked in their election victory, a sevenfold increase from just £114million the previous year).

NHS trusts don’t want to rely on agency nurses or locum doctors. They know they are expensive.

But without them, patients will suffer, and some will die.

Money for recruitment, training and retention has been cut. Healthcare professionals are being asked to cope with a cocktail of strains. Demand is up thanks to an ageing population and cuts in social care and the rest of the welfare state.  Hospital budgets are being slashed by stealth cuts. And staff face continued pay-freezes and a relentless stream of negative press and attacks by Hunt himself. Morale is rock bottom and many are leaving.

As one nurse, who will remain anonymous, told me just last week: “It’s the torment that people have to live with every day that is so exhausting. There really are no words. Life on the frontline is getting more difficult by the day, so much so that I’m pretty much out. Just timing to be sorted to resign”.

Hospitals have been placed in a precarious positionas a result of government policies. Recommended nurse-to-patient ratios are no more than four to six patients per nurse. Many English wards have twelve or more patients per nurse, and nearly half had more than 8 patients per nurse as the impact of government policies began to unfold in 2013.

So hospitals have to pick up the phone and hand over those “exorbitant” sums Hunt now wants to crack down on.

It’s with a heavy heart that hospitals get the agency staff in. Not because they’re not excellent – the majority have been trained by the NHS. But because a nurse or doctor who arrives at a new hospital for a shift is never going to know the ins and outs of a ward as well as a permanent staff member. And without an ongoing interaction with a patient they have to get up to speed very quickly, often at the expense of other staff members’ time.

In many cases the balance has shifted absurdly: an A&E doctor told me earlier this year that she is often the only doctor on a ward who isn’t a locum.

This is yet another example of gross false-economy in healthcare. And, in effect, of the privatisation of public money – just under £3bn in total in the last financial year – that should all be spent on healthcare, not have large chunks creamed off for agency fees.

Hunt’s attack on unscrupulous profiteers is disingenuous. It’s his government that has done more than any in British history to bring profit-driven companies into healthcare.

Rather than treating the symptoms, Hunt should be looking at the root causes.

As Unison’s head of head Christine McAnea puts it:

“The rise in the use of agency staff is down to the chronic underfunding of the NHS over the last five years, the need for trusts to meet safe staffing levels and the impact of long-term pay restraint.

Blaming unscrupulous agencies for taking advantage of the situation is classic misdirection. The appalling cost of temporary agency staff is a symptom of the markets in which Hunt puts so much faith.

How can he open the door for more market forces, and not realise that the core principle of business, supply and demand, is going to apply?

Forcing trusts to make the £22bn of efficiencies as Jeremy Hunt and Simon Stevens are doing will not solve the problem of temporary staff. In reality, they will probably make it worse.

The NHS needs proper funding, now. As Unite head of health Barrie Brown says, this needs to be invested in getting “proper training and development in place, coupled with robust recruitment and retention policies”. If not, this and many other false economies will continue to burgeon in the new market NHS.

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