THE soaring costs of agency medical and nursing staff in the NHS in Gwent are "unsustainable" and a threat to Aneurin Bevan University Health Board's financial break-even plans.

During April-August, the costs of drafting in agency staff to help keep hospital wards and other services adequately manned, rose by more than £2.7 million, compared to the same five months at the start of the previous financial year.

Spending on agency medical staff almost doubled, to £1,657,000, while agency costs for nursing staff rose by £1,079,000, or 39 per cent.

The health board spent a total of £17.3m last year on medical (£10m) and nursing (£7.3m) staff from agencies.

And its latest finance report warns that if year-on-year spending continues to rise at the same rate as it has done during April-August, the total agency spend in 2019/20 will be more than £21.3m (£12.3m on medical staff, and more than £9m on nursing staff).

These eye-watering figures "would not be financially sustainable" the report warns, and pose "a significant risk of the health board incurring a deficit in 2019/20".

Demand on services, the need for additional capacity - such as having to keep extra winter beds open longer than planned - vacancies and sickness are all combining to increase the need to use agency staff.

Gwent's hospitals have been extremely busy during the spring and summer, with little let up from the traditionally busier winter period.


Agency medical staff have been required in the health board's family and therapies division (paediatric services, gynaecology), scheduled care division (ophthalmology, trauma and orthopaedics, and in general surgery and - more recently - gastroenterology, at the Royal Gwent Hospital) and unscheduled care division (care of the elderly, emergency departments, and among junior doctors at Ysbyty Ystrad Fawr).

The 'cap' on spending on agency medical staff has been targeted to reduce in Wales this year by 35 per cent, but the health board's spending remains "significantly higher than the Welsh Government target", states the report.

In nursing, agency staff have been required in unscheduled care (medicine at the Royal Gwent and Nevill Hall Hospitals), scheduled care (general surgery, urology, orthopaedics, critical care and operating theatres), and in the high dependency team in continuing healthcare in the community.

The costs of bank nursing - the health board has a 'bank' of its own staff who work extra shifts) - also increased during April-August by £483,000.

Nursing vacancies are an issue for the health board, as they are across Wales, and were highlighted earlier this year as the biggest risk to maintaining mandatory safe staffing levels on Gwent's hospital wards.

Reducing vacancies is also a key means of influencing spending on agency staff.

In May, the health board reported 310 whole time equivalent (wte) registered nurse vacancies across its services, an overall rate of almost nine per cent, though this did not make it an outlier in Wales.

The Welsh Government's Train, Work, Live campaign, to attract more nurses, doctors and other healthcare professionals to train, work and live in Wales, is ongoing, and Gwent's health board is involved in several initiatives aimed at bringing more staff into the area.