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NHS pressures to fuel agency staff spend


Spending on agency staff in NHS hospitals is predicted to climb as frontline pressures intensify, according to a report shared with Nursing Times.

The report, by healthcare market analysts Laing and Buisson, lays bare the dependency of health service on expensive agency staff, which cost taxpayers more than £2.1bn in 2012.

It reveals that spending on agency staff by NHS hospitals and community services rose by 42% in real terms over the five years between 2008 and 2012.

According to the analysis, this was driven by a “sharp jump” in dependency on overseas staff in the last three years of the Labour government, due to “substantive staffing shortages” as the NHS sought to achieve targets.

It said the coalition government had “clipped” agency use as part of its NHS efficiency drive, which included a demand to shave £300m from agency spending – but warned this represented only a temporary success.

NHS agency spend fell by 10% and 16% during 2010-11 and 2011-12, respectively, although it still accounted for 4% of total health service spending. Nursing staff accounted for almost a quarter of total agency spend during 2011-12.

But Laing and Buisson predicted figures for the 2012-13 financial year, which finished at the end of March, would show an increase that was likely to have continued into the present financial year.

An investigation by Nursing Times has already provided early evidence to support the analyst’s prediction.

The investigation in March was based on Freedom of Information Act requests from 100 acute trusts. It found payments for agency and bank staff were likely to be 20% higher in 2012-13 than in 2011-12.

The expected increase, Lang & Buisson said, was being driven by heightened pressures on frontline services, which separate evidence shows are now reaching record levels. These pressures will be exacerbated by growing shortages in nursing, the report warned.

Report author and economist Philip Blackburn said: “Pressures on the system are likely to encourage greater use of flexible staffing resources to offer short-term solutions, providing there is necessary funding to meet these demands.”

In February Nursing Times revealed there could be 47,545 fewer nurses than the NHS needed by 2016, based on estimates from the Centre for Workforce Intelligence, an independent agency set up to advise the government.

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Agency nurses provide a vital service in the NHS, covering unplanned absences at short notice.”

But he added: “They should not be used as a solution to short-sighted, boom and bust workforce planning.

“This [report] is a clear example of short-term cuts to staffing levels actually proving more expensive in the long run, as hospitals are forced to use expensive agency staff to fill gaps in their workforce that they created.”

He called for a longer term approach to workforce planning to ensure enough nurses were trained to cope with demand now, and in future years.

The Laing and Buisson report highlighted “cyclical” trends in agency spending, with peaks and troughs over the past 25 years depending on the growth of NHS budgets, the wider economy and level of directly employed staff.

There also appeared to be a north-south divide in agency spending levels. London and the surrounding home counties dominated the market with 45% of all agency spend in 2011-12, compared to other parts of the UK (see table below).

Jacqui Skinner, interim managing director of HCL Nursing, which supplies agency staff to the NHS said: “We cannot emphasise enough the critical importance of agency staffing to the NHS. We believe this staff group is an essential part of the solution to the impending nursing crisis facing the UK.

She said: “We are constantly investing in our nurses to maintain the highest levels of customer service, compliance and in-depth quality management.”

She added: “As a minimum requirement, we ensure every one of our candidates is fully vetted as outlined within the NHS Employers standards for the recruitment of healthcare workers.”


Share of NHS UK agency spending  in 2011-12%
Southern Home Counties10.3
North West10.2
West Midlands9.5
Northern Home Counties9.3
Yorkshire & The Humber6.7
East Midlands6.2
South West5.3
East of England4.1
The North3.4
Northern Ireland3.0
United Kingdom100


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Readers' comments (4)

  • Ms Skinner writes good advertising copy. No matter how good they are they cannot be as committed as an established nurse employed by one trust but some management may not appreciate or care about that.

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  • yet more incompetence by the bean counters (sorry managers)

    lets cut staff on the wards to save money..brilliant

    oh no were understaffed this week I know lets get some agency staff costs more though...erm!!!!!!!

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  • tinkerbell

    a manager told me once agency staff comes off a different budget and works out cheaper. I assume possibly as they don't have to pay annual leave, sick leave, training needs or pension contributions etc., neither does it provide continuity of care but the patient is just a pawn in a game, as we all are, so what does that matter. It' all about the money in our new cut throat privatised NHS.

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  • tinkerbell | 21-Aug-2013 10:53 am

    in this case perhaps you should request or demand to see the balance sheet which is presumble public property and available to all.

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