The Agency Worker, Information Revolution and Boorman’s NHS

Amid the horror story that emerged today about the agency nurse who switched off her patients ventilator, further leads to big questions about the provision and quality of care by agency staff. The failure in this case was that this nurse had no training/or the training failed her when required in resuscitation techniques. Nor in the first instance, any knowledge of how to use the ventilation equipment. Although the Nursing and Midwifery Council and the PCT involved (Wiltshire) have yet to reach a verdict pending investigation – the CCTV footage, recorded by the patient who feared poor care, is incontrovertable.

This relates back to another controversy in 2008, the case of Dr Daniel Ubani, the agency supplied, out-of-hours, German doctor who mistakenly administered 100mg of diamorphine to elderly patient, David Gray.  Some of the main system failures identified in this case have be found to be poor language  and clinical competence checks by the NHS Trust (Cornwall). Another one is the failure of NHS Trusts to share information on poorly performing clinicians.

At least partly a move towards better information sharing and data management will improve. Something that we hope Christine Connelly’s, Department of Health’s Director General of Informatics announcement for the publishing “information to support patient choice” will address. But this will bring us full circle to the problems in NHS IT…

The value of agency staff to the NHS is not in question. It’s important to remember that agency workers are of great value to employers and there has been rapid growth in the number of organisation taking on agency workers over the past few years with the transition to a 24 hour day, 7 day a week economy. They can be deployed to cope with unforeseen demand, cover sickness, holiday absence and maternity leave and provide extra support due to seasonal demand. This is no less true for the NHS, where agency or ‘bank’ staff form a crucial part of the flexibility in NHS Trusts.

However, in recent years there has been some questions raised about competence and cost of agency workers. In 2006 the National Audit Office produced a report on Improving the Use of Temporary Agency Staff correlated over-reliance on agency staff to poor patient satisfaction.

I think this latest controversy highlights bigger problems in training, information sharing and vetting references. There is also another causal relation that needs to be addressed. The over reliance on agency staff that can lead to these errors are caused by the gap left by permanent staff. Permanent staff who, Boorman’s research suggests, would spend 3.4 million more days at work if their health and wellbeing needs were prioritised – Ergo less agency staff equals cost savings, error reduction and better patient satisfaction. The potential for the reduction in error alone should be a motivator.

2020health have campaigned for the better provision of health and wellbeing services and will be publishing a new report on 4th November titled “HealthWorks: Creating a healthy workforce in the NHS”. Also on the line of better use of human resource and technology, 2020health will be launching our report on telehealth on the 24th November.

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