Since the General Election we’ve seen bold statements on reducing agency spend in the NHS. It’s an area with great potential savings, but it also depends on shifting agency and locum work back onto a permanent basis. Unfortunately, the government’s stance on working conditions and contracts will drive more doctors into locum work, jeopardising the savings and creating a more mercenary NHS.
Speaking in June, Jeremy Hunt announced a crackdown on the agencies “ripping off” the NHS. Reducing agency spend carries none of the political difficulties of service reconfiguration or overt front-line cuts, making it low hanging fruit for the Health Secretary. A month later when grilled by the Health Select Committee, Simon Stevens said that reducing the agency bill was the “single most important thing” that providers could do to stabilise budgets. Training more staff will alleviate this in the long run, but Simon Stevens rightly points out that making these savings will require converting agency posts into full time equivalents.
The reasons these doctors, nurses and other staff have gone to agencies or locum vary. Sometimes it’s to pursue other part-time work or research, or time needed for family. Pay can also be higher for locum work at the earlier stages of a career, especially when helped by nifty tax tricks. A bigger factor for doctors is likely to be the freedom locum can offer on working hours and locations, especially the ability to take more holiday when needed and to set a work life balance.
In contrast, the new junior doctors’ contracts define ‘social hours’ as including Saturdays and up to 9pm in the evenings. The tweets in the #iminworkjeremy campaign reinforced how many unsocial hours are already worked, not to mention that doctors regularly work beyond their hours or through the breaks. A petition for a motion of no confidence in Jeremy Hunt received 100,000 signatures within the first day, triggering a debate in Westminster Hall over NHS contracts and conditions. As seen in that debate, politicians of all parties are happy to acknowledge that the NHS is run off good will, but the approach taken to hospital workers seeks to turn this good will into contractual obligation on the sly.
Jeremy Hunt has threatened to impose the contract anyway, putting strike action into the minds of some junior doctors. This antagonistic approach will gradually create a mercenary attitude in hospital workers, who will play the market forces of excess demand to get their pay. If the NHS is set up to extract as much as possible from its staff, we should expect them to extract what they can from the NHS.