REC response to new era for NHS with its health plan: ‘success depends on staffing’

The Department of Health and Social Care (DHSC) has this week outlined parts of its 10 Year Health plan. The Recruitment and Employment Confederation (REC) Deputy Chief Executive Kate Shoesmith said:

“The 10-year plan sounds encouraging for patients, such as a shift to Neighbourhood Health Services, but ultimately its success hinges on having the staff necessary to deliver the ambitious service improvements – and that is not yet the case. To break from the status quo, any long-term plan must emphasise reform of current staffing arrangements to ensure Trusts have access to flexible and contingent workforces to fill people gaps in the system, and in recognition of how people want to work. Instead, the government often chooses to scapegoat agencies while staffing bank costs creep up. If Wes Streeting stopped focusing on political point scoring and instead engaged with our industry to form a proper partnership, NHS Trusts, patients, NHS workers and the government would all win.

“The NHS badly needs a balanced workforce strategy, that protects the choice to work flexibly. People across the labour market are drawn to agency work because it offers choice and helps those with personal commitments such as childcare, their own health conditions, semi-retirement, or other caring responsibilities. And the agencies themselves provide a flexible, responsive solution to meet the immediate needs of the NHS, cost effectively, because even with the best technology, you will always need people to cover when someone cannot work a shift. This makes flexible, value for money recruitment strategies key for the NHS to deliver improved services and create a resilient workforce.

“The government repeatedly refuses to work with the agency sector on that plan. Without a good working relationship with the agency sector, long term plans for the NHS risk falling short. We are ready to work with the government to develop an in-depth NHS workforce plan and we challenge them to explain why they will not accept this offer that will improve patient care and offer talented people the ability to remain working in the NHS.”

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’ve 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. 

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