healthmedicinet

All the sums included fees paid to agencies, which usually take around 15 per
cent of the bill. Some doctors were rewarded not just for the hours they
worked, but for all the time they were on call, including when they were
sleeping.

The figures suggest that the total bill for these agency workers in 2013 was
almost £250 million, a rise of one third in two years. This would have been
enough to pay the annual wages of 3,000 consultants or more than 7,000
junior doctors.

Experts said the figures disclosed the full extent of a crisis in which
casualty departments have become “entirely dependent” on temporary workers,
amid desperate shortages of senior doctors and consultants.

Senior managers have previously insisted that rates of £1,000 per shift or
more are paid only in crisis situations where there is no alternative.

The investigation by The Telegraph shows that NHS trusts are routinely paying
out such sums to meet staff shortages.

The analysis found:

• Heart of England NHS Foundation Trust in Birmingham paid at least £1,000
  per shift on 719 occasions last year;

• Kettering General Hospital Foundation Trust paid such rates 595 times in 2013,
  while Northern Devon Healthcare Trust did so for 255 shifts;

• Barking, Redbridge and Havering University Hospitals Trust in Essex had the highest
  bill for AE agency staff, spending £7.1 million last year,
  including 217 shifts paid at rates of at least £1,000 each.

The hospital was recently put on special measures after its casualty unit was
found to have the worst shortages of senior doctors in the country, with 13
out of 21 posts vacant.

The College of Emergency Medicine, which represents AE doctors, says there is
a shortage of almost 400 consultants in Britain.

They say shortages have occurred because not enough doctors were trained,
while hundreds more have emigrated to countries where the workload is less
onerous.

Experts say the crisis is prompting consultants to take on extra work at
highly lucrative rates, while others come here from abroad.

Dr Cliff Mann, president of the College of Emergency Medicine, said: “The use
of agency doctors has become endemic in the NHS. There are units which would
implode if they weren’t relying on them, day in, day out.”

Dr Mann, the most senior AE doctor in the UK, added: “The figures are
shocking and ludicrous. The worst of it is that with the money we are
wasting on temporary staff we could double the number of AE consultants, if
only a more long-term approach was taken. It doesn’t make economic sense,
nor does it make clinical sense — because this is not good for patients.”

In total, 64 hospital trusts, out of 144 with AE departments, responded in
some form to freedom of information requests.

Of those, 36 trusts provided details on how many times they had paid more than
£1,000 to cover a shift in AE in 2013. Between them, they spent such sums
on 2,317 occasions last year — the equivalent of 9,268 shifts, when
extrapolated to cover all 144 hospital trusts in England with a casualty
unit.

The trusts provided details of the highest amounts paid to a single doctor or
nurse at any time since 2011. At Lancashire Teaching Hospitals Foundation
Trust, a consultant was paid £2,400 in May 2012 to work nine hours in the
hospital, plus 15 hours on call.

Hospitals also spent heavily plugging gaps for nurses. Royal Devon and Exeter
Foundation Trust paid £1,620 for a 12-hour nursing shift in January 2012,
while University Hospitals Bristol Foundation Trust spent £1,235 on an
11.5-hour shift last April. Nearby North Bristol Trust spent £1,150 on a
12-hour shift in May last year.

Amid desperate shortages, even the most junior staff were paid at inflated
rates. Walsall Healthcare Trust paid £968 for a clinical support worker to
work an 11.5-hour shift last Christmas. Such staff, who assist in clinics
and laboratories, are normally paid between £14,000 and £17,000 per year.

The trusts also provided figures for the overall total spend on temporary
medics for each of the last three years. These were used to calculate an
NHS-wide figure, which shows £242?million spent last year, compared with
£181?million in 2011 — a rise of 33 per cent.

Many of the trusts said they struggled to find staff because of the national
shortage of consultants and that safety of patients came first. Several said
they were working to reduce their spending on agency staff, but that
payments were in line with standard fees paid for locum staff.

Heart of England NHS Foundation Trust said it was one of the largest trusts in
the UK, and that its priority was providing safe care, which sometimes meant
exceeding standard costs. It said it had just recruited 10 more AE doctors.

Kettering General Hospital Foundation Trust said reducing spending on agency
staff was a priority, while Northern Devon Healthcare Trust said it suffered
“abnormally high” staff sickness among AE consultants last year.

Wye Valley Trust said its difficulties were compounded by its rural location
in Herefordshire.

Barking, Redbridge and Havering University Hospitals Trust said it was working
“tirelessly” to recruit staff despite the national shortage. Last winter,
senior medics warned that AE units were like “war zones” as they struggled
to cope with rising numbers of patients, many of whom had failed to secure
help from out-of-hours GPs.

On Friday, figures disclosed that casualty departments have had their worst
week yet, with 100 of England’s 144 NHS trusts with AE units missing
targets to treat patients within four hours.

A Department of Health spokesman said: “Holding on to doctors in AE has been
a problem for over a decade. There are more than 20 per cent more AE
consultants than there were in 2010, but we know we need even more and we
have a plan to make that happen.”

A spokesman for NHS England said: “We recognise there are difficult issues
around senior medical staffing in the emergency medicine specialty, and this
is compounding pressure on hospitals as AE attendances increase
year-on-year.”