2. What is the Welsh Government’s strategy for reducing the cost of agency working in the NHS? OAQ53329

I thank the Member for that question. A new control framework has enabled a reduction of £30 million in agency working costs in the Welsh NHS over the last financial year. A set of priority actions from that work has been identified for the second phase of our action in this area.

Thank you very much, First Minister. Clearly, we have to replace people if members of staff become sick, particularly at very short notice. But it seems that there is an issue with the use of agencies that don't passport on what the health board is paying for those staff, as opposed to having bank workers who are able to come in at short notice. So, I think there's a particular issue here around the cost of agency working, which some health boards are managing much less efficiently than others. I'm glad to hear about the new strategic plan that the Government has, because I'm sure this money could be better spent on patients.

Llywydd, I thank the Member for that supplementary question. She's quite right to point to the fact that there are different sorts of agency spending. Some agency spending, where staff are brought in to cover parental leave, or study leave, for example, is planned agency spending and is necessary in any large organisation such as the NHS. The plan has been drawn up to bear down on the costs of non-planned use of agency staff, and there, as Jenny Rathbone has said, some health boards have already made greater progress than others. Cardiff and Vale University Local Health Board, in the area that she represents, spends on agency 1.8 per cent of its pay costs as a whole, and that is the lowest percentage of any local health board in Wales. The second phase of the work that I mentioned in my opening answer will involve all health boards in Wales learning from one another, but it will also, in the way the Member said, consider the benefits of an all-Wales staff bank, so that we can use the staff that we have more directly under our employment in order to bring down costs but also to provide a better service.

First Minister, I'm sure you'll want to commend the work of the Auditor General for Wales, who has pointed out that 82 per cent of this spend is to cover for vacancies. And he also says there's a real issue of skills shortages and poor data, especially the lack of consistent and comparable data, which is impeding the leadership that we need from the health boards. What are you going to do with his observations there, and how soon might we see better performance in this important area?

I thank David Melding for that. I do, of course, welcome the report of the Wales Audit Office. It was that report that highlighted the fact that there had been a reduction of £30 million in the cost of agency working staff in the last year in the NHS. And it was a balanced account of the achievements that have been made in Wales, but also pointing to new ways in which we can address skills shortages and costs in the future. In the second phase, which I've mentioned already, there will be further development of data collection, to provide standardised national data, to enable benchmarking and monitoring of improvement in spend, directly in response to some of the work that the auditor general summed up in his report.

I'm sure that the First Minister will be aware that one of the issues leading to the problems with agency staffing is problems with retention in the nursing workforce. One of the reasons for these problems of retention, in some cases, is a lack of flexibility. I'm aware of a number of cases where nurses have asked for flexible working patterns on the wards where they're employed, and the local health boards have been unable to provide, or unwilling to provide, those flexible working patterns. Those nurses have then left their positions, gone to work for agencies and ended up in exactly the same wards, doing exactly the same work, costing the national health service more money, but receiving the flexibility that they've asked for, to enable them, for example, to balance their family responsibilities with working in the NHS. If there is one case of this, this is too many, I'm sure the First Minister would agree with me. A number of such cases have been drawn to my attention. What more can the First Minister do, working with the Minister for Health and Social Services, to ensure that local health boards take a more flexible and pragmatic approach to providing nursing staff with flexible working opportunities and to promote the retention of these highly skilled members of staff directly in our national health, rather than employing them through agencies?

Well, Llywydd, I do agree directly with the main point that Helen Mary Jones has made. If you think of staffing in the NHS, there are three consecutive issues that you have to think about. First of all, there is training of new staff to come into the NHS, and, for the fifth year in a row, we have record spend in supporting health professional education and training in Wales, with record numbers of people being trained to come into the nursing profession in Wales. The second issue is recruitment. Having trained people, you have to recruit them, and the number of nurses, midwives and health visitors in Wales was up by 134 again last year. We have a record high number of people recruited into the health service, but then we have to retain them in the way that the Member said. And the message I always gave to the health service, and I know it's repeated by Vaughan Gething, is that they must show maximum flexibility in order to retain the skilled and dedicated staff that they have. And the question should not be, 'How does this person fit into the health board's patterns?' but, 'What can the health board do to enable that person's needs to be responded to flexibly?' in order that we can retain that person who has been often expensively trained, where investment has been made in them while they work for the health service, and where there is every reason why a local health board should do everything they can, in as flexible a way as they can, to go on retaining the service of that person for as long as they possibly can.