Report calls for NHS to hire more self-employed workers to assist with staffing crisis

    A nurse checking a womans blood pressure

    Report calls for NHS to hire more workers to assist with staffing crisis

    The Association of Independent Professionals and the Self-Employed (IPSE, formerly PCG) and policy thinktank Public Policy Projects (PPP) have published a report calling for the NHS to hire more self-employed workers to help to solve its current staffing crisis, as part of a wider reform of its policy on flexible working.

    The report blames the current crisis in part on the introduction of the Off-Payroll IR35 rules to the public sector in 2017, which has shifted the burden of IR35 assessments onto NHS trusts and hospitals, causing confusion and disruption and leading some health professionals to refuse to work.  In a survey of 1,290 contractors, almost a third (31%) said they were previously working in the public sector but had not been since the IR35 changes.

    The number of NHS vacancies hit a record high for England in June last year at 107,643 unfilled posts.  This figure dropped slightly to 102,821 in September but is still 8% of the total number of NHS staff.  IPSE and PPP argue that a relaxation of the tax compliance burden now facing the NHS would allow it to hire more flexible workers and that would help to reduce vacancies.

    CEST, HMRC’s much criticised online IR35 status checker, was further maligned, with the report declaring it “significantly undermined by a series of high-profile failures”, and calling for it to be either reformed or replaced with a system that works.

    PPP’s chairman, former Health Minister Stephen Dorrell, said “We all know that staff shortage is a challenge facing virtually every NHS organisation (and many other employers in the economy). More flexible NHS employment practices are an important part of the response to that challenge, and this report is a timely reminder of the role professional self-employed people can play.”

    Simon McVicker, IPSE’s Director of Policy, commented: “This is a hugely significant and timely report. The NHS is one of this country’s most prized and praiseworthy institutions, but its ability to keep delivering is being undermined by overly rigid employment practices and its misguided approach to IR35 compliance. The NHS must recognise the contribution that self-employment can make and review its practices.

    “The government should also consider the report’s findings very carefully. That the NHS has struggled with the implementation of IR35 is hardly surprising given the inherent flaws in the legislation. IR35 urgently needs to be reformed ahead of any extension of the rules to the private sector.”

    The report lists a number of additional policy recommendations, including:

    • The need for NHS Trusts to consult with their HR service to better understand the issues in planning and managing their workforce and for NHS hiring managers to recognise self-employment as a model which can benefit their organisation
    • A new contract to be approved by HMRC – a changing society means more flexible working practices are going to be needed
    • The difference between scrupulous and unscrupulous contracts needs better understanding. There must be greater transparency on the employment status established within a contract and how working arrangements are to be agreed between parties
    • The need for a definition of self-employment recognised by HMRC and NHS employer bodies following a consultation with the relevant parties

    The full report can be found here:

    2nd January 2019.