Locums contribute to £10m Health overspend

Thursday 07 December 2023

Using locum consultants has contributed to an overspend of almost £10million by the Health Department so far this year and created a clinical risk to patients, a monthly board meeting has heard.

At the December meeting of the Health Advisory Board, members were told that using locums was a "red" risk, threatening the continuity of care while until permanent staff members could be recruited.

Concerns were expressed that while locum staff were well-qualified and provided good care, significant progress needed to be made in the recruitment of permanent staff.

The Health Department has been reviewed by the Royal College of Physicians, leading to a series of recommendations which were analysed at the meeting.

Locums "not invested in the long-term future"

In a report presented by Adrian Noon, Chief of Service Medicine, it was stated that "virtually all our ward-based care is provided by locum consultants who, although they are providing an excellent service, are not invested in the long-term future of the care group and can leave at short notice, causing disruption to rotas and patient care".

He added: "This has been well documented across internal and external reviews and the need to recruit substantively to allow for consultant care to be resilient."

Pictured: "Virtually all our ward-based care is provided by locum consultants..."

A finance report presented at the same meeting stated that the equivalent of 191 full-time posts were occupied by locums, resulting in total costs of £30.1m so far this year – although this cost was “substantially mitigated” by underspends of £20.3m due to vacancies amounting to the equivalent of 473 full-time posts. This added up to a total overspend of £9.8m.

Board Chair Professor Hugo Mascie-Taylor said that consistently good care would not be provided unless permanent members of staff were in place.

While recognising that it would not be possible to recruit new consultants quickly, Professor Mascie-Taylor asked that the board be provided with a clear picture of the extent of the problem in time for its meeting on 25 January 2024.

A "major and necessary investment"

Julie Garbutt, Chief Officer at Health until 2018 and newly appointed as a Non-Executive Director of the board, said the issue arose because there were far more specialist consultants, rather than generalists who could cover a wider range of areas.

"There's been an inability to find a sustainable business model and we won't be able to respond unless we change the model," she said. "It will be expensive [to achieve that change], but it would be a major and necessary investment."

Pictured: Julie Garbutt said the issue arose because there were far more specialist consultants, rather than generalists who could cover a wider range of areas.

Professor Simon Mackenzie, Medical Lead for the Change Team, said that a move back towards more general care would require "quite a major cultural change" that would not be welcomed by everyone in the organisation.

Health "vulnerable to reputational and financial risk"

A total of 26 recommendations were made, with eight of these listed as having achieved significant progress and four having been completed.

The report presented to the board concluded: "If the service is not improved, then clinical risk will remain. Failure to address this would leave [Health] vulnerable to reputational and financial risk in the event of proven harm to a patient."

Obi Hasan – financial lead of the 'Change Team' parachuted in to help transform the struggling Health service – said that the service delivered by locums is not as good as hiring permanent staff.

He explained: “If you have your own staff employed, who work day in, day out, they're committed to the island, they're not contractors, they’re committed to the island and live here, they’re working in the same team, they know the team, they cover for each other, they build relationships.

"You’re going to get a better quality of service, that's just called teamwork. You don't get that with temporary staff.”

Pictured: "“If you have your own staff employed, who work day in, day out, they're committed to the island, they're not contractors..."

Not all of the department’s hiring processes are in HCS’s control, Mr Hasan added.

He said that shared services, like Government HR, need to help in areas such as making it attractive for people to come to the island and hiring quickly.

Gov "absolutely committed" to reduced temporary staff costs

In February, Deputy Chief Minister says the Government is "absolutely committed" to reducing the millions of pounds spent on agency and other temporary staff every year after it emerged that former Chief Minister John Le Fondré's government spent more than £100m on consultants, interim staff and agencies in its final year.

Of this figure, around £30m was spent on consultants, while more than £27m was spent on fixed-term contractors and £18m went to healthcare and social workers from agencies.

Deputy Kirsten Morel said: "Where we can, we need to do everything possible to recruit people permanently to live in Jersey, do their jobs in Jersey and get to know the island as islanders – that is particularly important in healthcare."

Pictured: "Where we can, we need to do everything possible to recruit people permanently to live in Jersey," said Deputy Morel earlier this year.

However, the issues of locums has been a long-standing area of concern in Jersey's Health department for many years.

Back in August 2021 – when there were 199 vacancies in Health – the Friends of Our New Hospital Group published a report criticising the “worryingly high” vacancy levels.

It was later revealed that overall, £11.1m was spent on sourcing locum health workers from agencies during 2021 – with around a third of that cost (£3.9m) being an agency "premium".

Meanwhile, in Guernsey, the use of UK-connected doctors reached its highest level in 2022 when compared to the previous four years.

At the end of 2022, there were 285 doctors on Guernsey's register. Of these 158 were “local practitioners” and 127 were “UK-connected practitioners”, the island's latest Responsible Officer report showed.