Costs of locum cover ‘has gone through the roof’

During a meeting of the Western Isles Integration Joint Board, a forum comprising the health board and the council, it emerged that agency fees amounted to more than £140 per hour, plus VAT.

WIIJB Chief Finance Officer, Debbie Bozkurt, said the cost of agency staff had “gone through the roof,” and were now often five times higher than the substantive rate.

Ms Bozkurt said that the cost of covering the service 24/7 was “eye-watering”, and her report also warned it could result in an overspend of more than £500k.

She said that attempts to fill the vacant post had not been successful and outlined other options that were being explored in an effort to reduce the costs.

Chief Executive of Hebridean Housing Partnership, Dena Macleod, said it left “a huge amount of public money going somewhere which should actually be going into health services”.

She found it “frustrating” that “public money” was “going in a place that it shouldn’t be, because it is tax payers at the end of the day that are funding somebody else’s pocket.” She asked if there was anything WIIJB could do to change the situation nationally?

Debbie Bozkurt replied that the board, and especially the NHS Western Isles, only use “very small amounts of agency nursing,” and said that that was the area the Scottish Government was “tackling first” in terms of the possible introduction of a cap on agency fees.

But, Ms Bozkurt added, the issue is with clinical consultants, and said that other boards, including Orkney and Shetland, were facing the same issues.

She said: “We have been quite successful in recent weeks in negotiating some of our rates down, but that is unusual, so it [the cap] needs to be done nationally, and I would actually say it needs to be done UK-wide as, obviously, without that you would get the consultants going elsewhere.

“We do need to try and attract more people to the islands, substantive post holders are always best”, Ms Bozkurt added. “In some areas we have had good success [in recruitment]. We have full [consultancy staffing] in Orthopaedics and Gynaecology. It’s in the shortage areas we struggle, with medical consultants and psychiatric consultants.”

The Chief Executive of WIIJB, Nick Fayers, said he shared the concerns raised.

He said: “I find it appalling in terms of the position we find ourselves in, and Debbie is correct in that the only way I think you can solve this is with a national cap. If we work with the Scottish Government and get a cap here in Scotland, all you’ll see is that workforce migrating south.”

Asked if they were considering the introduction of a cap on agency fees, a spokesperson for the Scottish Government said: “The use of agency staff is a last resort when temporary staff are required to deal with local workforce pressures. We have over 35,000 nurses and 2,900 doctors registered through the NHS bank and local Health Boards and IJBs should always first make use of NHS bank staff when available.”

Meanwhile, according to information newly released in response to a Freedom of Information request, the cost to the Board of temporary medical staff has soared by more than 50 per cent within four years.

In 2018, the “overall cost of temporary medical staff” was just over £3 million. It rose in each subsequent year until, in 2021, it reached £4,760,556 and is likely to surpass £5 million in the current year.

The information emerges from a series of FoI requests lodged by the recently elected Barra councillor, Kenneth Maclean, who also noted that only 53 per cent of staff employed by the board are classified as “permanent”.

Mr Maclean said that he is trying to build up a picture through FoI requests of how the Board has performed and why it finds recruitment and retention so difficult. Some of the requests he has tabled are specific to Barra and issues like patient travel while other cover the whole Western Isles.

Issues around health provision on Barra have come to prominence recently with the resignation of the only GP in the island’s medical practice, Dr Mark Willcox, following a long-running dispute with the Western Isles NHS Board, mainly over arrangements for out of hours cover at St Brendan’s Hospital.

As of this week, the status of the practice has changed and it is now “Health Board operated” with locums used to maintain services.

The Scottish Government’s national clinical director, Jason Leitch, recently visited Barra to hear a litany of complaints about NHS provision including the delivery of out of hours care and the lack of co-ordination in patient travel arrangements.