A question that crops up regularly from both parents and Local Authorities is whether we use agency workers to deliver care at Home From Home Care.

There is a perception that agency workers are a negative aspect of delivering good care.  Whilst this may be true in some organisations, we feel that the issue goes deeper than simply asking if an organisation uses agency staff.  Here’s what we think you should be asking instead.

What proportion of your staff are agency?

In some cases, agencies are negative but you also need to weigh up the following: in our experience to actually use an agency worker it costs about £5 an hour more than to use our own staff so there is a financialb negative about using them.  Therefore, an organisation is not going to just use them for the sake of it, they are going to use them because they need to, to maintain the standard of care.

If a company claims not to use any agency, it’s very important to ask why.  Are they saying that when somebody calls in sick they can always cover it with their own staff?  I suspect not.   Are they saying that in every case they do a risk assessment and say they do not need to cover that shift? I suspect that that is not possible either.

Capacity in the rota is often picked up by permanent staff offering to do extra shifts.  If this happens on a continuing basis and they regularly work beyond the EU Working Time Directive, fatigue sets in and the quality of support that staff members are able to offer can degenerate.   The individuals they are supporting suffer; with more complex people who have challenging behaviour, this can affect their behavioural stability and if the staffing situation isn’t quickly rectified, the placement can go into crisis and good staff may burn out and leave.

So there is the question that if a company claims to not to use any agency at all, then actually they are either the most extraordinary, unrealistically effective organisation (I would love to know who they are) or alternatively they are disingenuous about the process and that they are not fully protecting the people they are supporting.

So don’t automatically assume that the use of agency is the be all to end all.   In our experience, after one’s own staff pick up extra shifts and our multi-base team (who work across all our homes) cover the shortfall, there is still a need to have approximately 3% flexible agency-type staffing.  This is particularly important to be able to support extraordinary circumstances, e.g. the outbreak of flu.

At the other end of the spectrum, alarm bells should ring if agency use represents a high proportion of the staffing levels.  In these cases it is an indicator that there is no staff structure, there is no team, there is no proper management and there is no continuity of care

How are those Agency Staff Managed?

If you are satisfied on the level of agency use, it is also important to ask questions about regulation and control over those agency staff.  Unlike permanent staff, who are regulated under the registered provider requirements, agency workers are not formerly regulated by CQC.   Once an agency worker comes into a home the registered home manager is responsible for that member of staff as though they were a permanent member of staff.

The home operator must access training records, CRBs and similar required paperwork but that can also be a little bit suspect at times because you have no control over the training programs and you just don’t know how effective that training is.

So the questions to ask are,

• What controls do you have over the agency staff you use?; and
• What is the process to ensure they are compliant?

Not satisfied with the lack of control over regulation, here at Home From Home Care we are launching our own agency.  We recognise that there will always be a need to have a more flexible staff team and we see this as the way forward.