Leadership, Management and Co-Ordination in Health and Social Care

Agency Nursing an effective way of managing staff?




Leadership, Management and Co-ordination in Health and Social Care

                                    Report Contents. 


Front Page……………………………………………………………..Page 3
Report Contents…………………………………………………….Page 4
Abstract …………………………………………………………………Page 5
Aim of the report……………………………………………………Page 5
Audience………………………………………………………………..Page 6
Data Protection………………………………………………………Page 6
Situation…………………………………………………………………Page 6
Search Strategy………………………………………………………Page 6/7
Introduction……………………………………………………………Page 7
NHS Background……………………………………………………..Page 7
What is an Agency Nurse?..........................................Page 8
NHS Expenditure on Agency Nurses………………………..Page 8
The Warwick 6 C Framework......................................Page 9
Concepts…………………………………………………………………Page 9/10
Characteristics………………………………………………………..Page 10/11
NHS Nursing Staff Sickness Levels……………………………Page 11
Context……………………………………………………………………Page 11/12
Challenges………………………………………………………………Page 12
Safe Staffing Levels in Wales…………………………………..Page 12/13
NHS Budgets…………………………………………………………..Page 13
Capped Overtime……………………………………………………Page 14
Capabilities……………………………………………………………..Page14
Consequences…………………………………………………………Page 14/15
Conclusion………………………………………………………………Page 15/16
Recommendations………………………………………………….Page 16
References………………………………………………………………Page 17/21










1. Abstract 

1.1. The purpose for this report is to gain an understanding on the management decisions to why agency nurses and bank healthcare assistants are needed. According to Gopee and Galloway (2013) a manager is someone employed particularly to ensure that objectives of their organisation are successfully met.

1.2 This report is based on a situation that the author experienced whilst completing a placement on a NHS hospital ward within a local health board. Firstly, the situation that that occurred during the placement will be explained.  Secondly, the author will introduce The Warwick 6 C Leadership Framework which will be followed. The Framework will be used to evaluate the situation and aid to achieve an effective analysis. The framework is also the foundation on which the report is structured. Lastly, the author will also provide definitions of leadership, styles of leadership and statistics on the use of agency nurses and other relevant aspects. The author will critically analyse the incident, specifically looking at the ward sisters’ managers leadership style.

1.3 A motive of this report is to explore the need for ward managers to use effective management, leadership, and co-ordination when making decisions in the dynamic environment of the hospital ward. The author will assess the attitudes, skills and knowledge that is required to develop effective leadership within the National Health Service.

1.4 The report will also explore whether agency nursing is an effective way of managing staff. Aspects such as sickness levels of full time staff, safe staffing levels and the shortage of nurses have been explored in relation to why agency nurses are needed.  

1.5 The report reveals that there is frequent use of agency nurses in NHS Wales health boards due to the increased demand of healthcare.

2. Aim of the report

2.1 The main aim of this report is to investigate if there is a better way of providing good legislative cover than using bank/ agency nurses. The report aims to focus on the health board that the placement was completed in, in South Wales.  A key objective is to focus on the managerial aspects of people management and if this has a relation to the use of bank/agency nurses. The report will identify the different reasons to why bank/ agency nurses are needed. The rationale for choosing this issue is on a professional level and due to the authors personal interests.








3. Audience 

3.1 This audience for this report is an academic audience, healthcare professionals and any other persons that this topic may be of interest to.  

4. Data Protection

4.1 There are seven health boards within South Wales, however, due to the enormity of potential data this report will focus on one of these health boards. To protect the privacy   of this health board and any individuals involved, all the information throughout this report will be anonymised. Therefore, the Welsh Assembly Government Confidentiality Guidance (2013 and the Data Protection Act (1998) will be complied.

5. Situation

5.1 On numerous shifts during the placement, the author noticed that there were more bank health care assistants and agency nurses than there were permanent staff. The author had established that there are usually four registered nurses and four healthcare assistants on per day shift.

5.2 The day staff can also change, at 13:30 some staff may finish and others may start with the use of more agency nurses.  On one particular day shift, two out of the four registered nurses were agency nurses. Two out of the three healthcare assistants were bank staff. The ward was short of one healthcare assistant due sickness.

5.3 The sister was unaware of this as she did not return the call that the staff member made several days before giving notice of why he would be absent. The ward sister phoned the staff bank office and other wards to enquire if another bank healthcare assistant was available. This resulted in 3 out of the 4 healthcare assistants being bank members.

6.Search Strategy 

6.1 In order to acquire the relevant literature, a thorough search was conducted on the university library accessing the appropriate databases such as CINAHL Plus and Social Care Online.

6.2 The application of PICO was applied.  According to NICE (2016) the 4 separate components of PICO : Population, Intervention, Comparators and Outcome encourages you to think about what literature you are aiming to seek.  By using suitable key words and limiters of research papers published within the last 5 years and geographically within Wales/ South Wales or UK relevant literature was found.

6.3 Literature from before 2013 have been included due to its relevance. Information was also gathered via books, web pages and government policies.

7. Introduction 

7.1 The demand for healthcare services within the National Health Service (NHS) is higher than ever and constantly rising due to our growing and aging population. The Office for National statistics (2016) state that there is that there are half a million more individuals over the age of 75 than there were in 2010.  Demand is often described as ‘all the requests / referrals coming in from all sources and how many resources they need such as staff and equipment and room time) to be dealt with, (NHS Institute for Innovation and Improvement,2013).  

7.2 The increased demand for healthcare automatically increases the demand for NHS staff. NHS Hospital & Community Health Service (HCHS) (2017) highlight that there has been an approximate increase of 8000 more doctors, nurses and healthcare assistants working in the NHS within the last two years. The Kings Fund (2016) acknowledge that health boards struggle to keep up with such demand which results in the need for Bank/Agency nurses and healthcare assistants.

7.3 The Welsh Government (2016) invested £85m with aims to tackle the rise in demand by increasing nursing staff and student nurse places. The package highlights a 32 % rise in nursing figures since 2015, which is the highest level of nurse training places in Wales since devolution.

7.4 Leadership in healthcare is seen as central to improving the organisation and quality of healthcare, (Bailey and Burr, 2005). 

8. NHS Background

8.1 The National Health Service (NHS) is the publicly funded national healthcare system which was established in 1948. Stoye (2017) highlight it is the largest single-payer healthcare system in the world. NHS Wales (2018a) highlights that the NHS in Wales employs close to 72,000 staff which makes it Wales’ biggest employer.  There are seven health board within South Wales, (Health in Wales,2018b).

8.2 However, despite these figures the Royal College of Nursing (2017) highlight that a recent survey of 30,000 nurses in the UK revealed that 55% stated that shifts do not have the planned or needed number of nurses which results to needing agency nurses and bank healthcare assistants to cover the vacancies.

9.What is an Agency Nurse? 

9.1 Adams and Dominy (2015, pp51-58) define an agency nurse as a nurse that works for agencies that are outside or external to a health care organisation.

9.2 Northcott (2002) explains that bank and agency nurses were introduced into the UK in the mid-1970’s to temporarily fill nursing posts that could not be filled by the fulltime staff. Stoye (2017) explain that agency nurses account for a large percentage of the NHS expenditure.


10. NHS Wales expenditure on agency nurses. 

10.1 As demand for healthcare and staff increase, so do financial figures. The Kings Fund (2016) reveals that NHS Wales spent £54.9 million in 2017 alone on agency nurses .The use of agency nurses is to ensure there are sufficient staff to provide care, although it is more suitable to have stable teams and professionals who are familiar with the surroundings, patients, and the quality of standards expected, the shortage of nurses means this is not always achieved,(Shuldham,2016).

10.2 Griffin and Kleebauer (2015) reports that on a typical day there are around 20,000 agency nurses working across the NHS in the UK, covering 10 per cent of shifts.
Kleebauer (2016) also highlights that agency nurses typically cost around 50% more than full-time nurses employed by the health boards. NHS Wales spent £1 million every week within 2015 on agency nurses to fill staffing gaps, (Griffin and Kleebauer,2015).  Since then, figures have more than doubled.  Stoye (2017) reveals that NHS Wales spending on agency staff increased by £400 million last year (2017).