Patients will demand the government gives its guaranteed hours gamble a tougher health check - REC

The Recruitment and Employment Confederation (REC) has warned that guaranteed hours reforms could make it harder for health and social care providers to fill staffing gaps at short notice, threatening service resilience, continuity of care and ultimately patient outcomes.

The proposals requiring employers to offer eligible zero- or low-hour workers a contract reflecting the regular hours they worked over a specific reference period could be a hammer blow to the two-way flexibility needed in the health and social care sectors. The worker shortages in both sectors, combined with short-notice needs for additional staff, are a mainstay of how the health and social care sectors manage their workforce needs.

This makes REC the latest organisation to raise concerns about the proposals, after warnings from NHS Employers and the NHS Alliance.

The REC argues that requiring guaranteed hours and compensation for cancelled shifts at short notice could discourage agencies and temporary workers from accepting flexible assignments, reducing the pool of staff available to cover sickness, vacancies and unexpected surges in demand.

Neil Carberry, REC Chief Executive, said:

“These sweeping curbs on flexible work risk making agency roles less available and less attractive, deepening the recruitment and retention crisis across health and social care. Guaranteed hours add costs, bureaucracy and legal risks that make it harder to deploy temporary staff at short notice. When health and social care providers cannot fill gaps quickly, patients pay the price through reduced access to safe and timely care. At a time when services are already under intense pressure, reducing workforce flexibility risks leaving patients to bear the consequences.”

This is leading the REC to urge the government to rethink its plans, taking a simpler and more targeted approach. This includes exempting genuinely temporary workers from the proposals to avoid loss of opportunities and a boom in false self-employment.

Neil Carberry said:

“The government keeps threatening to end agency use in the NHS in a misguided effort to save costs despite limited evidence that the consequences around access to a skilled workforce have been properly considered. Yet its guaranteed hours gamble could do far more to drive up costs, making agency work less viable and stripping services of the emergency cover they rely on to keep patients safe.

“The guaranteed hours changes could significantly limit the choice and flexibility that health and social care workers seek when working through agencies. If a nurse does a regular shift at a hospital once or twice a week over a few months that does not mean they want that to continue indefinitely or that their own preferences around when and how much they work won’t vary over time. Many workers may decide agency work is no longer worth the hassle and leave the sector altogether. Despite the need for agency workers, the result is potentially fewer agencies, fewer temporary workers and fewer options for services struggling to fill gaps at short notice.”

Interestingly, NHS Employers has also warned that, if not carefully designed, the reforms could make NHS Bank work less attractive and further reduce workforce availability. This is particularly significant because successive governments have promoted NHS staff Banks as an alternative to agency staffing.

In its submission to a government consultation on the proposals this week, the REC argues that temporary work helps employers respond to seasonal spikes, short-term pressures and unpredictable demand. When a permanent hire does not make sense, flexible staffing helps the end hirer to stay effective and productive, and create opportunities, particularly for young people starting their careers. The REC argues that the proposals risk closing off opportunities for people who value flexibility, shrinking the supply of regulated jobs and pushing more workers towards less secure arrangements, including bogus self-employment.

Notes to editors

1.     Pause zero-hours reforms over cost risk, warns NHS Employers, NHS Employers. NHS organisations in England could face unbudgeted costs of close to £1 billion a year because of a government crackdown on zero hour contracts. NHS Employers (part of the NHS Alliance) is calling on the government to pause its plans due to the potential impact they would have on patient care and the additional cost to the NHS.

2.     Over the past decade, NHS turnover figures for England tend to show more people joining than leaving the NHS. Despite this, the level of vacancies in the NHS in England has increased in recent years, because the total number of roles has grown. The NHS uses internal “banks” of staff and external agencies to fill vacancies.

3.     Vacancy levels in adult social care remain around three times higher than the wider economy, underlining the continued challenge of recruitment and retention within the sector, according to Skills for Care in June 2026.