Discrimination of agency and bank nurses ‘affecting safety’

The Health Services Safety Investigation Body (HSSIB) published its latest report today (5 September), titled Workforce and patient safety: temporary staff – integration into healthcare providers.

“They deserve support, not abuse or isolation”

Lynn Woolsey

It is the latest in a series of investigations by the HSSIB into staffing in the NHS.

For this latest publication, HSSIB analysed 30 serious incident reports from acute and mental health NHS trusts in England, which were originally conducted between May 2022 and May 2023 and involved temporary clinical staff, including bank and agency nurses.

Investigators found temporary workers being subject to racism, and other types of discrimination, due to their status as being not permanent members of staff.

Temporary nurses, and other clinicians, felt less able to ask questions, find support or raise concerns about patient safety.

HSSIB noted that a fear, among this staff group, of repercussions or lost future opportunities meant they did not want to rock the boat.

This was particularly acute among minority ethnic staff, who already face “known barriers” and additional challenges to raising concerns, warned the report.

Agencies and other organisations which employ temporary staff told investigators that staff felt “vulnerable” if they raised a concern about practice at their workplace.

“Temporary staff told the investigation that raising concerns can lead to them being seen as a ‘troublemaker’, potentially resulting in them being ‘blacklisted’ from working at the provider,” the report said.

HSSIB noted that, sometimes, temporary staff only told their agency about concerns about a workplace after “probing”, despite a professional duty to report them, for “fear of reprisal”.

Investigators also took evidence from the NHS Race and Health Observatory, which said minority ethnic staff face “harsher consequences” for speaking up than White colleagues – something echoed by the National Guardian’s Office.

As well as issues speaking up, HSSIB’s investigation found other examples of temporary staff being discriminated against or otherwise mistreated due to not being substantive.

Temporary workers told investigators they felt “unwelcome”, not part of the team and, as one described it, “disposable”. Some told HSSIB that they are given a “more punitive response” to complaints about their performance.

The report found that some trusts lacked good responses for when an issue was raised about a temporary clinician, and that often their chosen remedy would be to “block” them from working.

Further, HSSIB found instances of temporary workers being redeployed into different departments without consideration being given to their knowledge, skills and experience.

In addition, the safety body warned that temporary staff were not always provided with “necessary” access to electronic clinical systems and it also found instances of sub-standard inductions.

It concluded that the way temporary staff, without whom certain parts of the NHS were deemed “unable to function safely”, were treated and deployed was potentially putting patients at risk.

The key recommendation from HSSIB was for the National Guardian’s Office, alongside “relevant” other organisations, to identify and address “barriers” which prevent temporary staff from speaking up in their workplaces.

Senior safety investigator Matt Mansbridge added: “The recommendation we have made is a step in the right direction, aimed at helping all workers to contribute to patient safety improvements without fear of reprisal.”

The findings of HSSIB’s report correspond to those of a Nursing Times investigation, published earlier this year, which found a rise in reports of hate crimes across NHS trusts in England and heard from nurses who felt minority ethnic staff in particular struggled to speak up.

RCN chief nursing officer Lynn Woolsey said of the report: “The findings that temporary nursing staff, including those from ethnic minority backgrounds, are being discriminated against and prevented from raising concerns about patient safety are extremely serious.

“All NHS staff must feel empowered to speak up”

Julian Hartley

“This requires swift and decisive action from NHS leaders.

“Temporary nursing staff are highly skilled professionals but are often working with colleagues they have not met, in unfamiliar environments, and in settings where there are too few staff.

“They do an incredibly difficult job and without them services would struggle to function. They deserve support, not abuse or isolation.”

Similarly, NHS Providers chief executive Sir Julian Hartley said the findings outlined by HSSIB’s report were “unacceptable”, and said there was “no room” for discrimination in the health service.

“All NHS staff must feel empowered to speak up,” said Sir Julian.

“This includes temporary workers who play an important role in enabling the NHS to deliver patient care, especially in the face of major workforce challenges.

“It is also unacceptable that temporary workers from ethnic minority backgrounds experienced racism from both patients and staff members.

“This creates further challenges and barriers to raising safety concerns.”

Positively, HSSIB’s report also found some examples where trusts were “striving” to improve the relationship between temporary and permanent staff.

Examples included a trust having a “celebration event” for bank staff, temporary workers being supported to develop their skills, appraisals being done to help them remain up to standard and trusts where temporary staff became regulars, allowing them to feel more integrated.

Sir Julian added: “While much more needs to be done to tackle the negative culture experienced by temporary staff, it is positive to see examples of trusts’ hard work to support temporary NHS staff in speaking up.

“They know that creating a culture of openness and transparency can help enable high-quality care and reduce the risk of future harm to patients.”