There is widespread discrimination against temporary staff in the NHS, which is creating a culture of fear that stops them speaking up about patient safety, new research reveals.
The report from the Health Services Safety Investigations Body (HSSIB) reveals discrimination experienced by temporary workers is due to their work status and sometimes due to their ethnicity.
As well as having a negative impact on their wellbeing, the report states that temporary workers' experience of discrimination and barriers to speaking up may mean they do not share patient safety concerns, and therefore mitigations to safety risks may not be put in place.
HSSIB carried out site visits and engaged with NHS trusts, providers of bank staff, agencies that supply staff to the NHS, substantive (permanent) NHS staff, bank and agency staff, and a range of national stakeholders.
Agencies told HSSIB that because of the culture that can exist within healthcare providers, temporary staff can feel vulnerable about raising concerns.
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. They also described feeling unwelcome, not part of the team and ‘disposable' while working in the NHS.
The investigation spoke to a number of national organisations and the report states they ‘all agreed that certain elements of the NHS are currently unable to function safely without the use of temporary staff'. However, we also heard a common perception from national stakeholders and substantive staff (NHS frontline and senior management) that the knowledge, skills and attitudes of some temporary workers could put patient safety at risk. Temporary staff and agencies acknowledged that, as with substantive staff, skills, knowledge etc. varies and both groups shared concerns that some staff in the NHS made generalisations that temporary staff provided poorer care to patients.
The report emphasises that staff from ethnic minority backgrounds face known barriers to speaking up. Status as a temporary worker then adds an additional challenge to raising concerns. The investigation observed that some staff accepted such behaviours as the norm saying, ‘that is just the way it is'.
The NHS Race and Health Observatory told the investigation that workers from ethnic minority backgrounds are less likely to speak up as they are more likely to experience "harsher consequences" if they do. This was also described by the National Guardian's Office. Both organisations said there was a high number of people from ethnic minority backgrounds employed as temporary workers, which is supported by NHS data.
However, HSSIB also heard of trusts striving to improve relationships. Initiatives included a local temporary staff survey to understand their experience, and a celebration event for bank staff.
The investigation also heard from some temporary workers who felt integrated into teams and were viewed as part of the substantive workforce. They had commonly worked a number of shifts on the same ward, and this had enabled them to demonstrate their abilities to the wider team.
The report concludes with one safety recommendation to the National Guardian's Office, that they work with relevant groups and individuals to identify all the barriers that prevent temporary staff from speaking up and develop ways to address those barriers.
Matt Mansbridge, senior safety investigator at HSSIB, said: ‘It is clear that much change is needed, especially as discriminatory narratives and perceptions around temporary staff are not only seen but also tolerated across the NHS. 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.'
Responding to the report, chief executive of NHS Providers Sir Julian Hartley, said: "All NHS staff must feel empowered to speak up. 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.'
Hartley said 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,' he added.
