After several years in development, the Bank Workforce Race Equality Standard (Bank WRES) indicators were published in April 2023. This work will collate data on bank workers (individuals in the NHS who work on an NHS zero-hours contract) and will give employers insights into this section of the workforce for the first time.
There are over 150,000 bank workers across the NHS in England, representing a sizeable proportion of the workforce. For context, there are more NHS bank workers than the current total number of personnel in the UK armed forces. The diversity of roles covered by bank workers is wide-ranging – including, but not limited to, nursing, midwifery, clinical and administrative support, medical, dental, estates and allied health professionals.
Bank workers fulfil a vital function. They provide flexibility, help address staff shortages, offer skills and experience, contribute to organisational cost-effectiveness, and support our ability to undertake workforce planning. This enables our NHS to deliver high-quality healthcare services to the population, even during challenging circumstances.
By understanding the experiences of bank workers, NHS leaders can make informed decisions, implement appropriate policies and practices, and continue to build supportive and inclusive work environments. This contributes to the wellbeing of the workforce, enhancing patient care and strengthening the performance of the NHS.
With a background in mental health nursing, I moved into temporary staffing management in 2016 and joined NHS England's Workforce Race Equality Standard (WRES) team in 2020. These roles developed my passion for ensuring bank workers are treated with respect, fairness, and equity, with similar access to support and opportunities like career development and progression as their permanent colleagues.
Staying focused on understanding the experiences and opportunities of bank workers, my work within the WRES team directly supported the first NHS Bank only worker staff survey in 2022. This survey lays a foundation that ensures the Bank WRES indicators have meaningful value, are nationally relevant and that the Bank WRES can meet its aims and objectives. Ongoing WRES research and a focus on bank workers' experience has highlighted the importance of engagement when addressing the inequity this group faces. This is also a strong focus of the Bank Development Programme Toolkit, published by the national temporary staffing team, available on NHS futures - temporary staffing hub.
It is with huge thanks to the staff engagement and temporary staffing teams in NHS England for their support and drive in making this happen.
Quantitative data, insights, and lived experiences shared by bank workers to date have highlighted their feelings of being 'othered' and undervalued compared to permanent staff, and this theme is also commonplace when listening to agency workers. Whilst recognising the data limitations from the first NHS Bank only worker survey 2022, it offers a robust indication of what a fuller picture may reveal in future findings.
Data cited during the development and research phases of the Bank WRES, supported by the NHS Bank only worker survey 2022 findings, indicate these experiences impact workers from an ethnic minority background the hardest.
For example, 2022 NHS staff survey and the NHS Bank only worker survey showed a disparity in colleagues who worked on COVID-19 wards.
For substantively employed NHS staff, 29.3% of white colleagues worked on COVID-19 wards compared to 45.9% for ethnic minority colleagues. When compared to bank only workers, 40% of white colleagues worked on COVID-19 wards and 57% of ethnic minority colleagues.
Causes of these disparities may be complex, but we must acknowledge they do exist and must understand existing issues in order to rectify them.
Findings in the National NHS Bank Survey 2022 also challenged a common misconception that bank only workers hold alternative employment outside the NHS and provide a small number of hours per week. It found that 72% of respondents had bank work as their only source of employment and 62% were working more than 16 hours per week, with 28% of this number indicating they work 30 hours or more per week. The data also suggests bank contracts may be a gateway into the NHS, with 24.3% of bank workers considering permanent NHS employment as an option in the next 12 months. Reflecting on current workforce challenges, these bank workers could be a talent pipeline in efforts to tackle persistent workforce shortages.
However, there are some uncomfortable truths emerging, and at scale. The NHS Bank only worker survey 2022 shows that one in four bank workers has been physically assaulted by patients, service users and their relatives at least once over a 12-month period. In addition, bank workers are more likely to face discrimination, bullying and harassment from the public than permanent staff, and this is further worsened for ethnic minority bank workers.
In the NHS, the most reported reason for discrimination was ethnic background. This pattern is noticeably higher when looking at the NHS Bank Survey 2022 data, as highlighted below.
It is not the sole responsibility of a stretched temporary staffing team, nor the staff teams that use bank workers, to ensure these individuals feel safe, supported, and valued. NHS trusts as employers should foster an inclusive and fair culture.
NHS leaders need to take a step forward, look inward and question their own perceptions of the bank workforce. They need to review how their organisation engages, involves, and supports bank workers. It is likely that initial actions will not require the reinvention of the wheel, but more the opening of current staffing resources and networks for bank workers.
Speaking on behalf of NHS bank workers, it is essential NHS trust chairs and chief executives review how they are amplifying their focus on engaging bank workers and advocating for the bank survey work and its findings as part of this.
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