HSSIB investigation report. Workforce and patient safety: temporary staff – integration into healthcare providers (5 September 2024)

Summary

This investigation by the Health Services Safety Investigations Body (HSSIB) explores the challenges of integrating temporary clinical staff (bank only staff, agency staff and locum doctors) into healthcare providers. Integration is important because temporary staff coming into a new healthcare setting may be unfamiliar with its systems, processes and patient groups, which can pose a risk to patient safety.

Content

Findings

• Temporary workers are being discriminated against by some staff, organisations, and national bodies because of their working status, and in some cases because of their ethnicity. This can affect the support they receive and their ability to ask questions, which can in turn impact on patient safety.
• Some temporary workers feel unable to raise concerns about patient safety with the organisation in which they are working because they fear they will lose future opportunities to work in that organisation. Staff from ethnic minority backgrounds face known barriers to speaking up because of their ethnicity; their status as temporary workers adds an additional challenge to raising patient safety concerns.
• Where temporary workers are needed to fill gaps in the workforce, these gaps are advertised with limited information about the knowledge and skills required of the worker to help maintain safe care. This makes identification of suitably trained and qualified workers challenging.
• The knowledge, skills, and levels of experience of temporary workers may be unknown to their place of deployment. This affects an organisation’s ability to deploy workers in ways that make best use of their abilities, and can create patient safety risks when workers are placed in situations they are not confident to manage.
• Temporary workers are often redeployed to different areas of an organisation to meet the fluctuating demands on that organisation. This redeployment may also not take into account the abilities of the worker or the impact on patient safety.
• Local inductions to a new place of work for temporary workers are not always effective in preparing the worker to provide safe care in that particular environment.
• Temporary staff do not always have the necessary access to electronic clinical systems which can mean they are unable to access vital patient information, record details of patient care or request tests.

Local-level learning

HSSIB suggests that healthcare providers can use the findings from this investigation as prompts to help them consider how to integrate temporary staff into their workforce:

• How do you enable temporary workers to feed back on their experiences of working in your organisation, to understand the organisational culture in relation to this group?
• How do you ensure that temporary staff know how to speak up and that they feel safe to raise concerns?
• How do you ensure that you are clearly advertising the skills required of a temporary worker to fill a rota gap?
• How do you ensure that the skills and experience of temporary workers are taken into account when redeployments are being considered?
• How do you work with providers of temporary staff to understand the skills and experience of temporary workers so they can be used most effectively?
• How do you ensure that temporary workers can access electronic systems and physical environments that are vital to providing safe care?
• How do you ensure that inductions are carried out and that the time needed to complete local inductions is factored into the workload of staff?
• Do you have a dedicated and accountable professional lead for ensuring that local inductions are carried out?

HSSIB made the following safety recommendation

HSSIB recommends that the National Guardian’s Office, working with relevant stakeholders, identify the barriers that prevent temporary staff from speaking up and develops mechanisms to address those barriers. This will build on their work to explore barriers for other staff groups and enable all workers to contribute to patient safety improvements without fear of reprisal.

HSSIB made the following safety observations

• National bodies can support patient safety by developing credentialing systems which enable staff to verify their competencies when moving between NHS organisations.
• Organisations that provide temporary staff to the NHS can improve patient safety by including information about the NHS England Learn from Patient Safety Events service to temporary staff as part of their onboarding process. This is to enable temporary staff to record patient safety risks if they do not have access to a healthcare provider’s reporting system.