Why it pays nurses to leave NHS

The number of nurses leaving the NHS has reached crisis proportions with London's 32 acute hospital trusts showing a shortfall of 4,454 staff for its 32,643 nursing posts at the end of September. The capital's hospitals are now spending £405million a year on agency and part-time nurses - the battle to retain staff seems doomed to failure despite multi-million pound campaigns and special benefits.

At the heart of the problem is the fact that a qualified nurse earns approximately £9.40 an hour while an agency nurse standing next to her on the ward and doing the same job could be earning as much as £20 an hour or more. In one case we discovered an NHS nurse is being paid £12 per hour, but earns £22 to do a similar job in the same hospital when he comes in on his day off as an agency nurse.

A major campaign to stem the exodus seems to have achieved little. Millions have been spent on trying to tempt qualified staff back to the NHS, and a "housing czar" has been appointed to work with hospitals to explore initiatives aimed at accommodating nurses priced out of the capital by the high cost of living.

The Government is even setting up its own NHS staff agency in a bid to cut the prohibitive costs of paying for private agency cover. The national cost of agency and temporary nursing is now said to be running at £810 million a year.

NHS Professionals, as the new body will be known, has been set up to match the freedom and flexibility of hours of agency work. NHS staff will be able to choose when, where and how many hours they want to work, while retaining their health service pension and holiday rights.

The body will match staff with vacant shifts, helping hospitals to avoid paying huge commissions to private agencies. Some charge as much as 25 per cent for providing staff.

A group of 22 London hospitals has now got together to effectively cap the amount agencies can charge by agreeing to only use those from an approved list. However, the London Agency Project only covers accident and emergency, intensive care and theatre nurses so far. It was launched in September and managers say it is too early to say whether it has succeeded in driving expenditure down.

The Government has set itself a trap by publicly promising 20,000 new nurses by 2004 and it has now dangled a series of enticements in front of staff to help meet that target. Earlier this year a cost of living allowance was introduced for nurses in London and the South-East, worth between £400 and £1,000 a year. Health staff are also to be offered cheap home loans in an effort to keep them in the capital.

Together with a 3.7 per cent London weighting, nurses received pay rises of between 6.2 per cent and nine per cent this year.

As part of the campaign to encourage those who have left the profession to return to the NHS, the Government is offering them a lump sum of £1,000 while they complete a refresher course, as well as £135 a week towards childcare, rising to £200 a week for two or more children. London nursing students have also seen their bursaries rise this year by 10.4 per cent to £6,232 a year.

Despite the initiatives the proportion of vacant posts in the capital has been reduced by a mere 1.6 per cent over the past year. With an NHS nurse's earnings approximately half of an agency nurse's it is little wonder that he or she will find the idea of leaving the service - albeit one which has spent £35,000 on training - an attractive one.

An Audit Commission report showed the average hourly rate for agency nurses working in the capital is 20 per cent higher than the rest of the country.

It paints a bleak picture of London hospitals trapped in a vicious circle. Agencies are able to push up the charges for nurses because there is a desperate need to provide cover for empty posts, while even more NHS staff are lured away by better pay and flexible working offered by agencies.

Geoff Martin, London convener for Unison and director of pressure group London Health Emergency, said: "The NHS is being bled dry in London, because of this massive spending on agency nurses. This money should be going to front line services.

"The Government really needs to wake up to this and start paying NHS staff more. Unless they do, more and more will be lured to work for agencies. We are losing experienced staff from the NHS every day."

He added: "It has a huge impact on morale for staff to know they are quite literally working alongside people who are earning twice or three times as much as they are. It has got to the point where it is almost suicidal for NHS nurses not to leave and work for an agency."

The campaign to increase the number of nurses working in the capital has been spearheaded by Christine Beasley, director of nursing at the London regional office of the NHS Executive.

She is heartened by the overall drop in vacancies from 15.2 per cent to 13.6 per cent over the past year and is confident the reduction will continue.

She said: "Obviously we would like to see a bigger drop but I think it does represent a significant-reduction in a very difficult area." However Michael Walker, Unison's nursing officer for the capital, said increasing numbers of nurses are finding themselves ground down by the pressure of working on short-staffed wards for little reward.

"People are just not coping," he said. "The drop-out rate for student nurses is continuing to rise. Junior nurses are finding it impossible to live in London on what they earn and wards are increasingly staffed with agency nurses - which puts more pressure on existing staff."

He added: "It is estimated that between 15-20 per cent of nurses in London will reach retirement age in the next four years and at the same time a large proportion of student nurses are dropping out before completing their training."