Audit Commission: temporary nurses work one in ten of all shifts

Commercial nursing agencies that hire temporary nurses to cover for absences on hospital wards are holding the NHS to ransom, an investigation by the Audit Commission has shown.

Nurses tempted by high hourly rates of pay, which can double their NHS salaries, are being lured from NHS trusts to join the agencies, which offer flexible hours and less stress. But the increasing number of temporary nurses on the wards is putting patients at risk, the commission says.

Spending on agency nurses rose by one third last year and has trebled in the past five years to £360m, the commission says in a report published today. In addition, NHS trusts increased spending on their own "banks" of nurses available on call to provide temporary cover by 14 per cent last year.

In total the NHS spent £810m on temporary nursing cover in 1999-2000, 20 per cent up on the previous year, because increasing pressure on the wards has driven more nurses to take up freelance work. One in ten of all shifts is worked by temporary staff.

The NHS Confederation, representing health authorities and trusts, said that as nurses left, the pressure on those who stayed increased, leading to more sickness absence and a greater reliance on temporary staff. It was "a vicious circle", a spokesman said. The shortage of nursing staff was blamed for rising waiting lists in the South-east.

Agency rates for specialist nurses such as those working in theatre or intensive care units ranged up to £33 an hour for a grade E theatre nurse, with the agency receiving 45 per cent on top of that, the Audit Commission found.

Official acknowledgement of the crisis came from the Department of Health. It announced it was rolling out the NHS's in-house recruitment agency to 50 new sites. The agency, NHS Professionals, will compete with the commercial agencies by building up its own bank of freelance nurses.

Sir Andrew Foster, the commission controller, said: "With the shortage of nurses across the country it is hardly surprising that has had a knock-on effect on agency recruiting. The 20 per cent growth in spending is substantial and does demand attention. Nurses are the biggest part of the NHS workforce."

Sir Andrew said it was "an area of vulnerability" for the NHS. An attempt by the commercial agencies to exploit the NHS labour shortage in Birmingham is cited in the report. It says the agencies took advantage of a severe shortage of theatre staff to recruit staff from the trusts by offering better pay.

"There were also concerns about the skill levels and experience of the staff provided," the report said. NHS trusts in Birmingham responded by agreeing a single contract with one agency, saving £200,000 a year across the group.

Sir Andrew said proper checks were not being made on the training and qualifications of temporary nurses. He cited the case of Angelina Anunuso, a nurse struck off the register last week after she switched off a patient's alarm and ignored flashing warning signals at the Royal Free Hospital, London.

The patient was left in a vegetative state and died later. Ms Anunuso had been supplied to the hospital by a nursing agency. Nine years earlier, she had been convicted of conspiring to smuggle heroin into America.

"There are a small number of cases where appropriate checks are not happening but it only needs a small number for a disaster to happen," Sir Andrew said.

The report said temporary staff made a huge contribution by keeping the NHS running. But NHS trusts had to do pre-employment checks, organise inductions for temps and cut costs by agreeing better contracts with the agencies.

Robert Murgatroyd, president of the Federation of Independent Nursing Agencies, said the NHS paid derisory rates and there was outrage when his members paid reasonable rates. "You could argue we are maintaining the NHS by allowing nurses occasionally to top up their earnings."

Brief Encounters: getting the best from temporary nursing staff, Audit Commission, £20