Government’s health plan risks misleading public about NHS staffing

Responding to the Department of Health and Social Care (DHSC) today publishing its 10 Year health plan, the Recruitment and Employment Confederation (REC) Chief Executive Neil Carberry OBE said:

“Sustainable approaches to staffing the NHS need in-depth expertise and an understanding of the complex needs of the service, not the politics of the stump. Despite this – and its willingness to use private providers operating outside the NHS to address shortages – the government continues to issue misleading information to people about temporary staffing in the NHS.

"Banks are generally more expensive than on-framework agencies, and we know that good agencies offer better compliance, safety, and cost control than less regulated alternatives.

"Trust leaders know agency needs to be a well-controlled part of the mix – it is time for the government to start dealing in realities. It is misleading for the DHSC to claim that staffing Banks are cheaper than employing agency workers and that the NHS can eliminate deploying agency staff and still reduce backlogs with safe staffing levels. The truth is that high staff turnover has become endemic across the health workforce; this is the result of a broken staffing model that fails to recruit and retain permanent staff, pushing Trusts away from politically disfavoured on-framework agencies and into the arms of pricier off-framework options and staffing Banks.

“Planning to ban the use of agency staff by the end of the Parliament is short-sighted and will end up pushing costs up, not down as wards close due to short staffing and more care leaves the NHS to entirely private settings. Instead of this, we need a sensible partnership that gets the balance right between permanent staff being the backbone of the service and agency and bank staff being there to fill gaps when needed at reasonable rates. If private-public partnerships can be achieved elsewhere in the NHS then staffing which is integral to the success of this plan should not be excluded from a similar arrangement.

"Quashing the ability of people to work flexibly through agencies will also exacerbate the recruitment crisis in healthcare, with our data showing nearly 42,000 job postings for nurses and medical practitioners right now and qualified medics working outside the sector as they cannot be placed with the flexibility they need. Plans on paper, aren’t enough. The Secretary of State shouldn’t avoid sensible engagement with staffing partners – more could be achieved in partnership.”

Neil Carberry added:

“We urge the Department of Health and Social Care (DHSC) and the Treasury to convene a one-day summit to take urgent stock of the current approach to staffing, set clear priorities, and commit to a transparent reporting and monitoring of demand and costs of using agency workers. This is the moment to bring structured public-private partnerships to the table, harnessing the innovation and scale of consultancies and tech providers to transform workforce procurement and planning.”

Notes to editors

1.     Views from the frontline: “they can work in retail or hospitality for better rates”

Simon Taylor, Chief Executive Officer of Your World Recruitment Group, said:

“Governments are facing a difficult reality: thousands of skilled professionals want to work in the NHS, but only via agencies. For many, agency work offers a better work-life balance, more autonomy in their clinical practice and a significant reduction in day-to-day stress. Rotating across different hospital settings also provides richer opportunities for professional growth than a permanent post.

“In our survey of over 800 agency workers, 35% said they would leave the UK health system entirely if agency work was no longer an option - with many indicating they’d move abroad to continue their clinical careers.

“If we want to protect NHS capacity and avoid further workforce loss, policymakers must stop treating agency staffing as a problem to eliminate and start recognising the value it offers in terms of flexibility, retention and service continuity.”

A UK health care staffing agency said:

“People come to us because they want flexible working, work around school term time or that better fits their lifestyle such as semi-retirement and/or caring responsibilities. But in the past year or two, we’ve seen a number of doctors who have made a career choice to take up permanent work outside of the UK. We’ve also seen a large move to NHS Staff Banks where they will often get higher rates than if they were working agency. With our nurses, the rates sometimes mean that they can work in retail or hospitality for better rates, flexible working patterns and less stress; this is of particular concern to us. NHS Budgets are set relatively short term and that combined with continuous change amongst the workforce such as maternity and paternity; it makes workforce planning in the NHS challenging. Rather than maintain a level of over-staffing to manage these variables, agency workers can support a more responsive, safe and efficient NHS. We have also been encouraged by some NHS organisations taking a pragmatic and best value approach; they recognise that their own internal workforce can sometimes be more expensive than agency workers and will source the best option for the department while ensuring patient safety and best use of the taxpayers’ money. Agencies provide a trusted shorter and faster solution because recruitment in the NHS can take a significantly long time, with consultant doctor positions anywhere between six and 12 months and while other roles including nursing, can be shorter, these are often inefficient unless done in bulk, leading to delays in start dates for individual roles.”

Hannah Ahmed, Group CEO, HG Group, said:                         

“Many of our candidates choose agency work because of the flexibility and control it offers over their working patterns, which is especially valuable when balancing childcare, family commitments, or further education. Financially, many feel that agency work better reflects the value of their time and skills, particularly given the increasing pressures of the cost of living. Agency work also gives them access to a variety of clinical settings and experiences, which they find both professionally stimulating and personally rewarding.

“When we speak to our candidates about the growing restrictions on agency work, many express real concern. Some might reluctantly return to substantive NHS posts, but a large proportion is clear that if further curbs are introduced, they would reduce their hours, seek opportunities in private healthcare, consider working abroad, or potentially leave the profession altogether. The unintended consequence is that highly skilled clinicians could be lost from the system entirely, which would place even more strain on an already stretched workforce.

“Over the past 12 months, working with NHS Trusts has become increasingly difficult. Despite our willingness to be flexible on rates and to respond rapidly to urgent staffing gaps, it has often felt like agencies are being unfairly scapegoated by government narratives. This is particularly disappointing given that many of us have gone through the rigorous procurement, compliance, and audit processes required to become approved NHS framework agencies. We have operated within the capped rates and met every condition asked of us, yet there has been little acknowledgement or support for the critical role we continue to play in keeping services running safely.

“While the intention to reduce agency spend is understandable, the approach has often felt heavy-handed and has rarely considered the reality on the ground. Some trusts, despite the de facto restrictions, continue to rely on agencies because alternative staffing routes simply cannot fill gaps quickly enough. Internal hiring and bank recruitment can take weeks or months due to administrative bottlenecks and the well-known challenges of attracting permanent staff, whereas agencies can often cover shifts within hours or days.”

2.     The following are recent examples of the cost of a framework agency compared to hiring from a staff bank, gathered from our members. These examples are taken from before the changes to NMW and NICs that were introduced in April 2025. 

At a Trust in the East of England, the hospital approached a locum directly in September 2024. These were the comparative costs: 

A Trust in London - Locum Senior House Officer - an additional £30,850 per year 

* This is an estimate based on averages for onboarding, training, revalidation, attrition, sickness, payroll and the Apprenticeship Levy.