€40m spent on agency nurses last year, €30m so far this year

Yesterdays Controller and Auditor’s general report devoted over 100 pages scrutinising how specific monies have been spent on health. In particular it highlighted €44 million the HSE spent on agency staff in 2009. Figures obtained by me today show that so far this year just another €30 million has been spent on nursing agency staff. Clearly this is not the best use of public money. Agency staff are staff hired through an employment agency, not directly by the HSE or hospitals, maybe to fill in for a shift or more likely to cover a vacant post which the HSE can not replace due to the current public sector moratorium on recruitment in place since March 2009. Remember though in the HSE there has also been a staffing embargo in place since September 2007 which has really hit nursing numbers.

There are now over 1,500 fewer nursing staff than there was at the end of 2007 – (39,000 down to 37,500).  Under to the embargo and moratorium, nursing staff cannot be replaced unless a business case is made but if they absolutely need staff to cover a ward or service they get around this by using agency staff.

The C&AG cites the HSE’s own internal audit which shows that agency staff exceed the cost of employing nursing staff by 36.5% and he clearly implies that this is not the most efficient use of tight resources. Yet internal HSE figures for 2010 show that up to July of this year just under €30 million has been spent on agency nursing and €37 million on other agency staff, doctors, allied health profs etc..

This practice continues because if health managers want to keep services open they have no other choice to keep services safe, but it clearly highlights the blunt instrument that the moratorium is and the constraints its putting on the health service. It impacts on the quality of nursing care but also we are also seeing its impact on closed wards and reduced services.

The C&AG cites two examples from St James and Beaumont where nurse banks have been set up. A nurse not working in the hospitals can register with a nurse bank or someone in the hospital who is happy to work extra hours or overtime. They are paid hourly rate and only overtime if exceed 37 hours. Both St James and Beaumont found it very  successful and made savings of 16/17% by not hiring agency staff. C&AG says there is no HSE plan to put them in place nationally but suggests it might be and also suggest it could be done in primary care.

The Croke Park agreement could have an impact on the tens of millions spent on agency nursing as it proactively facilitates redeployment also newer innovative practice such as the nursing banks. However, the moratorium issue remains and this month many of the newly qualified nurses trained to a world class level in Ireland are leaving in their droves as no new posts in the system even though we spent €90,00 educating each of them. And part of Croke Park is taking another 6,000 out of the health workforce – where will they come from?