Is Patient Safety Being Compromised Due to The Pay Cap?

The Government, in an effort to cut down on costs and to bring back nurses into the NHS fold had introduced a pay cap on the amount that an agency could charge for a healthcare professional.  The cap came into force in November 2015, at which time the Health Secretary Jeremy Hunt had said that staffing agencies had been able to “rip off the NHS by charging extortionate hourly rates”.  However, in case the trusts felt that there was significant risk to patient safety, they could bypass the pay cap.  Beginning November 23, 2015, when the rules first took effect, the “break glass” clause has been used 35,662 times between 228 hospital trusts.

Simon Stevens, chief executive of NHS England, said that he wanted to see “good paying permanent jobs” being created instead of paying £1.8bn to agency and contract staff.  The reason why healthcare facilities were adding a larger number of nurses was due to the official report that identified the lack of nurses as a key reason for the Stafford Hospital scandal.  According to the health regulator NHS Improvement, hospitals in England were short of 15,000 required nurses.

While many trusts managed to stay within the regulated pay caps for the first 12 weeks, they were soon struggling to do so.  The number of times the “break glass” clause has been used since 1st April when the cap was further brought down to 55%, had increased by 30% as compared to the previous month.  According to the Economic Director of NHS Improvement, Chris Mullin, “Predominantly, it’s about has the nursing director got good workforce systems in place, good advanced planning, and good rostering of shifts, and are they working effectively with the finance director and the rest of the board to tackle the agency challenge.”

The Royal College of Nursing claims that the NHS has not done enough to meet the demand for nurses, resulting in hospitals turning to agencies for filling in their requirements.  According to figures obtained by the BBC in February 2016, more than 23,000 nursing vacancies existed in the NHS across England, Wales and Ireland.  This constitutes about 9% of the workforce – compare this to typical vacancy rates across all forms of work, which stands at 2.7%.

However, given the pay cap, the hospitals found themselves not being able to bring in the nurses from the agencies and so in the interest of patient safety, they had to make use of the “break glass” clause.  According to chief executive of the RCN, Janet Davies, “Agency cap breaches are a barometer of the scale of the NHS's workforce problem, and it shows clearly that the problem is getting worse.  NHS Trusts are unable to recruit nurses and are rightly prioritising patient safety over sticking to the cap. This is a workforce planning issue. The number of nurses being trained in the UK has been reduced, for short-term financial reasons."

On the other hand, a spokeswoman for the NHS Improvement said, “The cap has saved up to £300m since October.  We know that trusts will need to override the cap where patient safety is a concern and it's important that they are able to do that. But as the new rules set in, whilst overrides did increase temporarily, they have begun to steadily decline as we expected.  Overuse of agencies is bad for patients, bad for the NHS and unfair on other staff.  These measures will help those staff currently working in agencies to come back into the NHS.  Average prices paid for agency nurses have fallen by around 11% since October, so NHS nurses can be assured that their agency colleagues aren't being paid over the odds for doing the same job."

Our take on the issue

As an agency helping you with your staffing needs, we understand your issues with recruiting and retaining nursing staff.  At the same time we also empathize with the stand taken by the NHS.  However, we believe that the primary goal of any healthcare facility is patient care and safety. There should not and cannot be any mitigating factors that compromise patient care.  We understand that your healthcare facility cannot make any compromises with the safety and care of your patients and are thus here to ensure that you do not face staffing shortage.

If you have faced any issues with the pay caps and the clause, we would like to hear from you about your experience.  Even if you haven’t, we would love to know your views on the above. And if you need any help, remember, we are there to bring your troubles to an end.

If you need help in understanding more about our training courses,

If you need support for Revalidation,

If you are interested in International Recruitment with The Flame Lily,