Why are radiographers leaving for agencies?

It’s not surprising that many NHS professionals are looking for a way out of the service, with excessive hours and increasing demands making many feel that they are losing control of their working hours or life. 

For predominantly female professions, like radiography, this pressure is acute. With family responsibilities – caring for children or other relatives – still falling disproportionately on women, the need to escape to gain some control is amplified further. Likewise, in NHS families, where both parents are professionals caught up in the same cycle, a decision by one or both partners to opt out in the hope of regaining some control is natural, sensible and probably inevitable. 

There are four obvious escape routes:

1. Retirement, which is a long way off for many in a young profession like radiography. For those potentially old enough to retire, it can seem too complex, with more barriers than flexibility in the system, and often only limited or poor advice available from trusts.
2. Quitting radiography completely, which is a depressing prospect for people who still value being part of the profession and who’ve invested heavily in their own training.
3. Moving to the private sector, where conditions are often more flexible and pay rates competitive. However, radiography has a more limited private sector job market than many other allied health professions and many still feel a strong emotional attachment to the NHS. 
4. Leaving the NHS and opting to work and use their professional agency by signing up to work in the NHS through an agency. 

Doing the maths

This fourth option is increasingly popular and the maths demonstrate why. Even if the NHS pay rates in England increase in line with the current 5% offer, a second-year Band 5 will still only earn £28,408 for a 37½-hour week. Someone at the top of Band 6 would earn £42,617 before tax and stoppages. Someone at the top of Band 7 would earn £50,056. 

In addition, we know most staff are expected to work at least the equivalent of an extra day a week in overtime to meet the roster requirements. In radiography, this comes with some small allowances but they are non-pensionable and often treated as non-contractual. If the person at the top of Band 6 is earning a fifth more in overtime and additional payments, their pay would rise to £51,140. Having passed the £50,270 mark, 40% tax starts to kick in along with other penalties, such as reduced child benefit payments.

SoR evidence shows that agencies advertising for Band 6 radiographers across the UK are offering to pay £40 to £50 an hour as standard and up to £90 an hour for some specialist roles at certain times. Sonographer posts, generally at Band 7, are regularly being advertised in several regions at £120 an hour.

Someone choosing to work for an agency on £45 an hour would, if they worked 37 hours a week for 209 days a year (ie an average of five days a week minus 20 days paid statutory leave, which is the legal minimum), earn more than £76,000. At £45 an hour, a Band 6 could work for three and a half days a week and earn as much as they’re currently earning for the equivalent of a six-day week. Many are doing so in the same department, treating the same patients.

Agency staff lose some protections that come from continuous employment in the NHS – most obviously holiday and sick pay benefits, as well as being unlikely to have the option of staying in the NHS pension scheme. 

However, they may argue that taking control of their work-life balance means they’ll be less likely to need long-term sickness cover; trusts are introducing schemes to sell leave because it’s so difficult to take in over-stretched workplaces; and a pension has less appeal if, to access it, you have to work shift patterns proven to shorten life expectancy. Indeed, the CARE principles, which make the new NHS pension scheme fairer and more beneficial in the long term to women professionals, are undermined by the NHS being the only part of the public sector where overtime is non-pensionable.

This situation is, of course, irrational. It shouldn’t happen. It is not good for the NHS. Taxpayers should wonder why and how we got to the point where the NHS is subsidising agency profits to retain access to staff who were once directly employed by the NHS. But none of that is the fault of any radiographers. 

Working to find solutions

The SoR remains committed to working in partnership with the NHS and government to find solutions. These will require the government to recognise that radiographers and other AHPs are vastly under-valued in their market and to address basic NHS pay so it is more competitive. 

It will also involve being more honest with the public about the scale of the workforce challenge, explaining that 20 years of ineffective workforce planning and underinvestment means there’s no immediate cure to the workforce crisis so there is no magic wand to reduce waiting lists. 

The government will also need to choose strategic solutions and sticking to them honestly and transparently until they work to provide more training places; improve professional transition; and instil safer working practices that shift the workplace culture towards a safer and more sustainable one for staff and patients (for example, outlawing any clinical work beyond 48 hours a week). 

It will mean closing the public sector value gap between the rewards for those who look after people and those who look after money, by committing to long-term public sector pay restoration and taking the politics out of NHS pay rounds.

The SoR will work to find the pragmatic solutions that make these changes possible. In the meantime, we’ll also continue to strengthen support for all our members – whether they’re employed directly by the NHS, some private sector employers or through an agency.