NHS Bank shifts often cost more than agency cover in trusts, contrary to DHSC claims, according to new FOI data – REC

• Some NHS Bank shifts now cost more than twice agency cover which is pay-capped, new FOI data shows.
• Crackdown on agency use failing to cut costs as Bank spending surges in major trusts.
• Ministers risk deepening staffing crisis as temporary workers feel pushed out.

The Recruitment and Employment Confederation (REC) has written to the House of Commons Health and Social Care Committee requesting an inquiry after new Freedom of Information (FOI) data revealed that some NHS trusts are paying significantly more for Bank staff than agency workers. The findings raise serious questions about the government’s crackdown on using agency staff and whether it is driving up costs rather than reducing them.

The findings come as ministers prepare the NHS 10 Year Workforce Plan and defend restrictions on agency use, almost a year after the Health Secretary told trusts to cut back sharply on agency staffing and move towards relying on Bank workers instead.

REC is calling for an urgent review of NHS staffing policy, including greater engagement with regulated agency providers.

Neil Carberry, REC Chief Executive, said:

“The idea that Bank staff are always cheaper is simply wrong. Our data shows the opposite in some cases and that should ring alarm bells for ministers. This shows that workforce shortages, not staffing models, drive cost. The answer is not to favour one staffing route over another, but to fix the underlying problem. Even with capped agency rates and no off-framework use, some of the highest cost shifts are still filled through Bank. Trusts need a larger, more flexible workforce, better long-term planning and pay frameworks that reflect real world demand. Until then, costs will rise wherever shortages persist. This means talking with healthcare staffing providers not sidelining them as has been the case for too long.

“We hope that MPs on the Health and Social Care Committee can investigate further and bring clarity and calm to this politicised debate which doesn’t serve the interests of taxpayers or patients.”

Successive governments have portrayed agency staff as more expensive and less efficient, encouraging NHS trusts to move away from using agency staff and instead shift demand toward Bank staff. But REC’s analysis of FOI data from major NHS trusts shows that at the shift level, particularly in high-demand or hard-to-fill roles, Bank staffing is often more expensive than agency provision. Crucially, Bank shifts can cost more than agency cover even in trusts that do not use off‑framework agencies, undermining the central justification for the crackdown on agency staffing.

REC has received responses to FOI requests made in early 2026 to some of the biggest NHS Trusts in the UK. These FOIs asked for a comparison of the top five most expensive Bank shifts in 2024/5 and 2025/6 compared to the top five most expensive agency shifts in those same time periods.

By way of illustration, off-framework agencies are frequently blamed for escalating costs, yet some large Trusts do not use that form of agency cover:

• Nottingham University Hospitals NHS Trust, which does not use off-framework agencies. The average cost of the top five most expensive Bank Shifts was £5,723 in 2024/25 and £5,622 in 2025/26. This compares to £4,491 in 2024/25 and £4,642 in 2025/26 for the top five most expensive agency shifts
• In addition, the average cost of the five most expensive Bank shifts in 2025/26 paid by Imperial College Healthcare NHS Trust London was £5,509, compared with £2,116 for the five most expensive agency shifts. It did not use off framework agencies that year.
• Another example is Manchester University NHS Trust. At that trust the average cost of the top five most expensive Bank shifts in 2024 was £2,895 and the average cost of the top five most expensive agency shifts in 2024 was about the same at £2,888. It did not use off framework agencies in that time period. And that the total overall cost of Bank at all levels at this trust in 2024/25 was £114.3 million – nearly double that in 2020/21 (£60.2 million) – while overall agency staffing spending at all levels was £12.1 million in 2024/25 – which is around £2.7 million less than in 2020/1. 
• At Newcastle upon Tyne Hospitals NHS Foundation Trust, the average cost of the five most expensive shifts was: Bank - £1,365 in 2024/25 and £1,193 in 2025/26; Agency - £372 in 2024/25 and £574.23 in 2025/26. Again, there was no off-framework spend by that trust in these time periods.

In addition

• Data from Barts Health NHS Trust in London indicate that the average cost of the five most expensive Bank shifts in 2024/5 was £3,077, which compares to £2,478 average for the top five most expensive framework agency shifts in 2024/5 and £697 average for off framework in 2024.

The letter to the Health and Social Care Committee from the REC is after months of mounting concern about the Department of Health and Social Care’s management of NHS staffing. This raises serious questions about taxpayer value, patient safety and whether current NHS staffing policy is simply not working.

REC warns that the current approach reflects a ‘cut now, think later’ strategy to agency staffing. Despite DHSC claims that reducing agency spend would deliver significant savings for NHS trusts, the evidence does not show this consistently in practice. REC analysis published in January 2026 shows that spending on Bank staff exceeded agency costs overall between 2020 and 2025, in some cases by a significant margin. This pattern was evident across several London NHS trusts surveyed through FOI requests which REC conducted last year.

And the DHSC’s limited understanding of temporary work was exposed in the National Guardian’s Speak Up Review published earlier this year. The report found that many temporary NHS workers feel undervalued, unsupported and uncertain about their job security, with these issues worsened by poor integration and inclusion within teams. The National Guardian’s call for the NHS to work more closely with healthcare staffing agencies is therefore both significant and welcome.

Neil Carberry said:

“Employers such as the NHS must understand that demand from workers to work flexibly is only increasing. This means the DHSC must grasp the nettle on temporary staffing in the NHS by working with rather than against agencies to control spending, improve care and engage staff. This approach has a far bigger upside than a standoff with ill-informed statements about ‘rip-off’ agency cost from the Secretary of State Wes Streeting. We are ready to work with the NHS and the Department of Health on sustainable solutions on behalf of compliant, well-regulated and care-focused agencies.”

Notes to editors

1. Download the letter to the House of Commons.

2.     In the NHS, staff Bank workers are directly employed by the NHS trust to take on flexible shifts when needed, while agency workers are employed and supplied by external recruitment agencies.

3.     ‘Patient safety taken for granted: Trusts admit failing to assess impact on patients and staff of Department of Health diktat to cut agency staff’, REC, January 2026

Despite a looming winter crisis, NHS Trusts have admitted they did not specifically assess the impact on care of the government’s directive for them to massively cut their use of agency staff in the last quarter of 2025. Our data and research tell us that Bank spend outweighs agency spend overall for the period 2020- 2025 – and in some cases massively - in many of the London NHS trust we surveyed with FOIs.

4.     Let the Speak Up review of temporary workers serve as a wake-up call for the NHS – REC, March 2026

The report shows that many temporary NHS workers feel undervalued, unsupported and uncertain about their job security, issues made worse by poor integration and team inclusion. This is a major criticism of the NHS given the increasing demand from healthcare workers to work flexibility.

5.     Letter: Further action to reduce NHS spending on temporary agency staffing, Secretary of State for Health and Social Care, DHSC, June 2025.

6.     Secretary of State pledges to contain NHS agency spend, DHSC, 11 November 2024. Health and Social Care Secretary Wes Streeting, said: “For too long desperate hospitals have been forced to pay eye-watering sums of money on temporary staff, costing the taxpayer billions, and pulling experienced staff out of the NHS. We’re not going to let the NHS get ripped off anymore.”

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