Creating increased competition within the NHS: could it work to our advantage?
Edmund Stubbs, 2 April 2015
Today, Civitas has released a report which suggests a possible solution to the problem of filling those vacancies within the NHS where staff are unwilling to enter undesirable specialities such as emergency care or GP practice. At the same time this paper explains how the NHS could simultaneously reduce its dependency on locum doctors and agency staff, and reduce it’s reliance on overseas recruitment.
As a solution, the report advocates increasing the competition for jobs inside the NHS. The service could do this if it adopted a policy of increasing training places for new NHS staff while requiring that in return for obtaining their largely taxpayer financed qualifications, new staff agree to work for the NHS on a permanent basis for a stipulated period before seeking employment elsewhere.
An increased volume of new health staff, working within the NHS could lead to patients experiencing many advantages.
Firstly, competition for positions inside the NHS would encourage more staff to consider less favoured specialities to ensure they obtain and remain in employment. Secondly, as a consequence, employment conditions inside these specialities might well improve as all vacancies are filled with committed, permanent staff, keen to improve the specialities in which they are employed. These permanent staff, would get to know each other and their working environment better, and thus work more cooperatively to enhance the quality of the treatment their patients receive. This would improve the working experience of the staff themselves, making them far more likely to remain in the service once their required post training period of employment within the NHS is completed.
Thirdly, it is likely that agency staff might feel less secure working on a temporary basis and would thus be keen to apply for permanent positions within the NHS. The report reveals that the cost of employing agency staff can easily be up to 4 times that of permanent NHS employees. Once current vacancies have been filled, the NHS would, it is to be hoped, be in a position to create at least some new staff positions, making increased numbers training cost-effective.
Evidence suggests that the NHS’s current high usage of temporary agency staff and locum doctors reduces the quality of care for patients. Overseas recruited staff, sometimes with deficient language skills and different patterns of training than those trained in the UK, often stay less than a year in the Service and thus are never really established as part of a healthcare team. Again, they are unlikely to become truly familiar with their working environment.
Reliance on agency staff can also undermine workforce morale when permanent NHS staff see those from agencies receiving much higher rates of pay. Temporary staff who can often ‘pick and choose’ the duties and wards they prefer, will avoid the responsibilities that come with a permanent position, such as a requirement to cover night shifts.
In short, increasing numbers of health professionals training in the UK, and thus stimulating internal competition for posts, could prove to be cost effective while increasing the quality of healthcare and improving staff morale. The NHS needs to train to gain!
The full report is available here
Edmund Stubbs, Healthcare Researcher, @estubbs1