Precarious Work in Healthcare

Surviving Work in Healthcare






Roger “There are significant numbers of people in the NHS who have chosen to be in more precarious jobs because they may be able to earn more in the short term. And it gives them a degree of choice if they’re people who feel actually I’m being bullied here – if I’m an agency worker I’m paid more per hour but the problem is if they become ill or they become old they are seriously worse off. The reasons why organisations are prepared to pay more for agency workers is that they don’t carry the long term risks if staff become sick or retire with a pension.”


Elizabeth “You see that a lot in mental health services with people being unable or unwilling to navigate the NHS systems and going into private practice – some of them doing OK others less so but we don’t know how many private practitioners or social enterprises are actually making any money. It’s not just about money – it’s also about things like skills degradation. If you work for a private employment agency there’s a very low change of getting training so in healthcare you have about five years before your skills can become quite defunct.”



Roger “That’s going to be an issue around revalidation process. Agency nurses are not going to be doing more than the minimal upgrading because their agency on the whole isn’t going to be paying for them to do anything more than the minimum. There is an issue, which I’m not sure has been thought through enough, about whether agency staff are going to be disproportionately disadvantaged, many of whom will be from black and minority ethnic backgrounds.”



Elizabeth “It’s really interesting the lack of data on this. Coming from the mining sector, where contract and agency labour is the key health and safety issue, seeing the lack of regulation in mental health for example is terrifying. The research says one of the key risks around using contract and agency labour is around the casual workplace relationships that are no longer formed. There are critical incidents around the handover of shifts – people tend to not talk to the agency nurse in the same way they’d talk to a long standing colleague. This patient has this problem, this piece of equipment is playing up – much less knowledge gets transferred which presumably is going to have an impact on patient care. It’s only very recently that the NHS has kept data on Bank staff – the internal labour agency in the NHS – so we don’t really know what’s happening as a consequence of precarious work.”



Roger “One of the consequences of the NHS announcing they are going to put a cap on agency staff numbers is that I suspect they will have to start to collect more data. One of the things you might want to map then is rates of agency staff against for example critical incidents.”



Elizabeth “I thought it was amazing that recently we had Simon Stevens waging war on private employment agencies and we even had Jeremy Hunt saying they were costing too much money. What’s terrifying is that we really don’t know how much this is costing the NHS because no-one has collected this information.”



Roger “What’s worse is that people like the Kings Fund are sceptical that the NHS can even do it. They are determined to drive the costs down but there aren’t enough staff permanently employed. The NHS has failed to make the work sufficiently attractive so that for some people it makes sense to go to an agency or to leave the profession. Simply saying we’re going to cut out precarious working might hit the buffers when a chief executive says we’re way over the four hours in A&E, get more staff in.”



To hear the full conversation with Roger Kline and Elizabeth Cotton go HERE.


To listen to the series of podcasts click on the links below

1. Am I a precarious worker?

2. A lot of people choose precarious work over bullying in the NHS

3. There are levels of insecurity in healthcare

4. We don’t know the real costs of precarious work

5. If you look at social care you can see the problem of precarity

6. The value of emotional work

7. Who holds the duty of care in precarious workplaces?

8. How do you protect yourself?

9. How do I raise concerns at work?

10. Tackling precarity hurts

11. The precarity template

12. Very small things are very important


Surviving Work in Healthcare is a free online resource Surviving Work in Healthcare designed for people working on the frontline. The website is a joint project by Surviving Work and the Tavistock & Portman NHS Foundation Trust offering podcasts, videos and survival guides that take a jargon free, de-stigmatizing and practical approach to addressing the real problems of working in healthcare.


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