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Monday, 21 November 2011

This is going to hurt

Over the weekend we got the usual guff from the left about NHS nursing jobs being under threat.  The following from the Morning Star is typical:

NHS nurses today blew the lid off a looming crisis in the service because of Tory budget cuts that have seen 56,000 posts axed or threatened. A Royal College of Nursing investigation revealed that 56,058 NHS jobs have now been lost or at risk - double last year's figure. Data from NHS trusts showed that that figure has shot up from 27,000 a year ago and 40,000 this April. Roles affected included thousands of nursing and doctor positions as well as support staff. Among potential job losses include those at Birmingham Own Health, a service designed to help people with long-term conditions, and others in mental health services in Camden and Hampshire. RCN general secretary Dr Peter Carter said the figures showed a "deeply worrying acceleration" in job cuts that would threaten patient care.

Now for the truth.  The number of nursing jobs in the NHS is only 1% lower than in 2007 when Labour was throwing money at the service.  Once they are through training nurses pay is not at all bad (although they have to reach Band 7 to have a lifestyle equivalent to 80,000 of the unemployed).

But many nurses, particularly in inner cities, earn far more than this by working through agencies.  The logic of using agency nursing is to give flexibility when demand changes.

Two years ago I wrote a very innovative report for a part of the NHS, NHS Professionals, to teach them about option pricing, or effectively, what premium should be paid to meet variable demand for nurses.  From this, and using data on the number of shifts worked through out the year it was possible to work out which trusts had too many fixed positions and thus excess capacity, but worse than this, which trusts had more agency nurses than were warranted by the relatively small variability in demand.

Needless to say, the results were quite astounding.  In many inner London trusts the nursing staff were predominantly employed through agencies even though the average tenure of positions was many years.  In effect, agency nurses were not there to fill swings in demand, but were permanent.  In some nursing specialties, on qualification nurses would quit there NHS jobs and join the agency closed shop, returning to the same hospital on higher pay.

Effectively, you dear tax payer are paying way over the odds for these services, and the proposed savings are simply clawing back some of those costs.

1 comment:

Bill Bell said...

Glad to hear you're as modest as ever in touting your own research.

I can see the shock on their faces as you blew them away with your finding that lots of nurses work for agencies in London and that many of these were effectively permanent. Any person could walk into one of the parasitic nursing agencies or talk to a full-time member of nursing staff and find the same thing out in ten minutes. But why do that when you can pay some overpaid, windbag, know it all consultant to regurgitate some data for you.

Helpfully, your post does point out failings in the NHS that have arisen from the drive to make it more 'market orientated'.

1) They've realised that shifting staff into agency arrangements decreases your pension liabilities, weakens collective bargaining and allows rapid near term cost-cutting when they've sprayed the budget on some high profile, low return, PFI disaster. This is disastrously short-term thinking and effectively saddles them with short-term flexibility for longer term cost.

2) When you employ nurses/anyone through agencies you can hack the cost base very quickly without a direct impact on headline headcount as agency workers are not counted in the same way.

3) Destroying the 'Bank' (in-house agency), along with the centralised purchasing system the NHS used to have resulted in higher costs with no corresponding increase in efficiency or patient welfare.

Hopefully they can hire you back in a few years when they'll need someone to come up with some more bullshit so they can justify another round of short-term 'market based' idiocy.

The first of these being the use