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Wales safe staffing law plays key role in rising agency spend, report finds

Wales Audit Office also cites lack of NHS pay growth as contributing factor

Wales Audit Office also cites lack of NHS pay growth as contributing factor


Picture: Guzelian

Safe staffing legislation and the lack of a significant pay rise for NHS workers in Wales are among the reasons for a large rise in agency staff spending in the country, a report has concluded.

The Wales Audit Office’s study reveals that total agency expenditure in the country’s health service was £135.7 million in 2017-18 – which is a 171% rise on 2010-11 when the figure was around £50 million.

A total of £52 million was paid for agency nurses and midwives alone in 2017-18.

Legal influence

Meeting the requirements of the Nurse Staffing Levels (Wales) Act 2016 was one factor driving the increase in agency staff spending, according to the report’s authors.

The act requires a senior nurse to calculate the staffing level for their workplace using a range of factors, which is then increased to cover absences such as sick and maternity leave.

The report adds: ‘Anecdotal evidence suggests that the lack of public sector pay growth has been a key factor for people registering with agencies for additional shifts, or simply leaving substantive posts to work for an agency.’

Further factors

Other reasons for the rise in total agency spend include:

  • The escalating hourly rate of pay charged by agencies
  • NHS skill shortages
  • Difficulties recruiting and retaining staff

Counting the consequences


RCN Wales interim director
Helen Whyley

RCN Wales interim director Helen Whyley warned that an over-reliance on agency nurses can affect patient care.

‘For example, agency nurses are unlikely to be familiar with the hospital or community setting, therefore productivity and patient outcomes will be reduced considerably,’ she said. 

Student increase

Ms Whyley added that more needs to be done to recruit and retain nurses in NHS Wales, and called for more nursing student places to be made available.

A Welsh government spokesperson said several management processes have been introduced to reduce agency spend, and highlighted that spending on agency staff was £30 million lower in 2017-18 than the previous financial year.


Read the Wales Audit Office report


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