Vocal Voices

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How brilliant are the management to have come up with this idea? Where on Earth have they been? Why was this not done years ago? Last year agency staff cost £1.8bn.

A member of the family works for the NHS in the offices. She tells us that the hospital can pay agencies as much as £47 an hour when a trained UK nurse gets £11.50 ish. It is not that there are not enough nurses otherwise the agencies would not have them either. It is more to do with the Ts&Cs and pay for those within the NHS. I know three who have quit because of them and become agency staff. They get roughly the same pay as FT nurses but can pick and choose hours and shifts, the problem is the agencies creaming off the profits from their excess charges.

Pretty disgraceful really, so about time this was addressed

The top line looks pretty dire doesn't it.

Let me tell you how it works.

The agency gets £47 per hour. Most of the nurses are employed as temps. They get about £20 - £25 per hour. They get a two week holiday entitlement and no pension.

The agency pays the 13.8% employers NI and is liable for SSP if the nurse is sick, but is not able to bill SSP to the NHS.
Any profit the agency makes is liable to 20% tax.

The nurse pays 12% NI on the first £815 in a week plus 2% on any more earned in a week.
The nurse also pays 20% tax after the tax allowance and also, if the rate is over £24 per hour, 40% tax on any pay over the £42.385 higher rate threshold.

When the job requirement is over (load or surge), the temp Nurse is released. Probably between 2 and 4 weeks notice, no severance and no redundancy. As stated before, no pension.

Now the permanent Nurse.

£11.5 ish per hour.
Pays 20% tax on some £9,600 of the wage over the personal allowance.
Is in a NHS pension scheme which means contracted out so pays 5.8% national insurance.

Once a Nurse has worked for 6 months it's extremely difficult to remove the role, especially with tight resourcing. Which means no way of short term staffing.
The current pension load of staff currently on pensions for all public institutions, due to the insane actions of public bodies during the last Labour administration, is about 60% - 65% of the annual wages bill. So, simply put, every permanent nurse they take on today completed knackers the staff budget 30-40 years from now in pension entitlements.

Looking at the base number of £47 sounds like insanity.

Reality is something entirely different when you look at how much of that money comes back to the government and what the long term cost of a permanent nurse is. Benefits and entitlements come at a cost and that cost is a lower wage. Temping or Contracting is a short term employment strategy where the temp employee takes the majority of the risk of the employment and the employer pays more for the flexibility.

BTW in my job agencies are usually restricted to a max 17% overhead. But for that we have to run our own companies, pay both employees and employers NI and sign a waiver indemnifying the agency from SSP (we pay that too).

I expect someone in the NHS has done those sums too or at least I would like to think so.

It's a standard calculation for all non permanent resources. It only hurts if you keep them in the job (or staffing the role), for 10 years or more. Then it's more viable to take on permanent staff.

I live in this world and have to know the mechanics or I can't work out how to make a living out of it....

What's annoying me is that rates for IT staff are not only about 30% over permanent. Companies are coining it.

Irrespective of the costing of permanent staff versus temporary staff, it is the continuity of care that most affects the well-being of patients. The NHS needs to train, re-train, and keep qualified staff, both doctors and nurses. A large enough supply of nurses should ensure the flexibility in working hours that perhaps the temporary nurses are seeking.

All very good but the figures stand thus.

NHS England >1.3m employees
Average wage as of 2013 (more now), 29.500

Total wage bill £38 Billion

Total budget £95.6 Billion

Or put another way, 40% of the NHS costs are staff.

Leaving £57.6 Billion to cover Hospitals, Transport, Fuel, Heating, Buildings, Building and equipment repair, medicines, cleaning and laundry, dressings and clothes....

Or is it? We haven't even talked about pensions yet and, yes, those pensions have to be fully funded from the budget.

Care to guess how much actually goes into the non staff area of the NHS???

The numbers are truly massive, but it's best to take a few 000's off when working with them, it's easier to comprehend....