1 February, 2018

News > NHS reliance on agency healthcare workers related to staff wellbeing and patient experience of care

A report published by Picker and The King’s Fund has uncovered striking associations between NHS staff and patients’ experiences in hospitals and NHS trusts’ reliance on agency healthcare workers.

The analysis is the first of its kind to be published in the UK. It considers the relationships between the self-reported experiences and wellbeing of NHS staff, measures of workforce pressures in the health system, and patients’ experiences of their care.

The report reveals that there are relationships between staff wellbeing, patient experiences of their care, and the proportion of money NHS trusts spend on agency workers. In trusts where agency spend was higher as a proportion of overall pay, both staff wellbeing and patient experience were typically lower. The NHS provider sector spent £2.9bn on agency and contract staff in 2016/17.

The report also indicated that;

  • Staff wellbeing is related to issues within the NHS workforce.
    Factors that show a relationship with staff wellbeing include numbers of doctors and nurses per bed, and bed occupancy rates. Staff that worked at Trusts with more negative workforce factors and higher spending on agency staff self-reported worse experiences. The authors state that this strongly suggests that ‘staff wellbeing is impacted negatively by a workforce that is overstretched and supplemented by temporary staff’ (page 3).
  • Patient experience is also impacted upon by some of these workforce issues.
    As might be expected, workforce factors such as having fewer doctors and nurses per bed also are also related to patient experience. However, the report also showed that spending more on agency staff has a negative association with patients’ experiences of their care. This signals the risks to the quality of care for patients as the NHS buoys up its struggling workforce with temporary staff.
  • Staff wellbeing is related to a patient’s experience of their care.
    This finding will prove important to NHS management and policy makers, as it provides further evidence of a correlation between staff experience and patient experience. This demonstrates that ‘staff and patient perceptions about quality of care are consistent, and their feedback is both a sensitive and an accurate barometer of quality’ (p18).

The report has been published by Picker; a health and social care charity that champions person centred care, and The King’s Fund; an independent charity working to improve health and care in England.

The report is titled ‘The risks to care quality and staff wellbeing of an NHS system under pressure’ and has been written by Steve Sizmur, Chief Statistician at Picker and Veena Raleigh of The King’s Fund.

Veena Raleigh added:

“Our work shows that pressures on NHS staff – as reflected in factors such as the numbers of nurses and doctors per bed, use of agency staff, bed occupancy, sickness absence – are negatively associated with staff experience. Such pressures can have a knock-on effect on patients, as seen in the correlations between staff and patient experience. The well-being of staff should be a priority for the NHS.”

Steve Sizmur commented:

“The report suggests that investing time and resources into problem-solving some of the systemic issues that necessitate the employment of agency staff – such as long-term absences due to sickness – may improve staff wellbeing and thus patient’s experiences of NHS care.”

The report analysed data from publicly available sources relating to the experiences of staff and patients at NHS Trusts, and on workforce and contextual variables. The data focused on 134 general acute trusts in England. Specialist trusts were excluded as the nature of the care they provide cannot be directly compared to the care provided by general and acute trusts.

The findings add to the developing picture of a NHS workforce that is under increasing stress, and demonstrate the risks to service quality as pressures rise. The report urges policy makers to understand that tackling workforce issues is not just a cost-cutting exercise, but it is also essential in order to maintain and improve the experiences and safety of people using healthcare services in England.

Chris Graham, CEO of Picker, concluded:

“This report shows that patient and staff experiences are typically poorer in NHS trusts that spend more on agency staff.

What policymakers and health service managers must take from this report is that to improve patient experience they must address workforce factors that negatively impact upon staff experience. Patients and staff alike report worse experiences at organisations that rely on using temporary staff to fill gaps in their workforce.

The report does not suggest that agency staff provide lesser care than permanent members of staff, and it is important not to blame or demonise this group. Nevertheless, the evidence demonstrates a need to ensure that the NHS and its workforce are suitably supported to provide high quality person centred care without a systemic reliance on temporary members of staff.”

– Ends –

Notes for editors

  • The full report can be found here: https://www.picker.org/wp-content/uploads/2014/12/Risks-to-care-quality-and-staff-wellbeing-VR-SS-v8-Final.pdf
  • Steve Sizmur and Chris Graham are available for media interview upon request. Please contact Communications Manager at Picker, Emma Newton, for more information emma.newton@pickereurope.ac.uk 01865 208135 / 07825 952160
  • Picker is an international charity and a globally recognised expert in using patient experience to improve the quality of health and social care. Visit our website picker.org or follow us on Twitter @PickerEurope for more information.
  • The King’s Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.


  • Data sources used in the analysis for the report are:
    • NHS staff experience survey 2016
    • NHS patient experience survey 2016
    • Number of doctors per occupied hospital bed August 2016
    • Number of nurses per occupied hospital bed August 2016
    • Spend on agency staff as a proportion of total pay (rankings) Q2-Q3 2016
    • Staff sickness absence levels Q2-Q3 2016
    • Staff sickness absence levels Q2-Q3 2016
    • Proportion of beds occupied Q3 2016
    • Number of admissions Q3 2016
    • Number of hospital beds Q3 2016

Talk to us about

Person centred care

Request a callback