Trusts Report Rising Agency Costs Amid Mounting Workforce Pressures

NHS trusts are warning that increasing workforce gaps and sustained operational pressures are driving higher spending on agency staff. Finance directors say the reliance on temporary staffing continues to strain budgets at a time when many organisations are already struggling to meet financial targets.

Temporary Staffing Remains High Despite National Efforts to Reduce Costs

Agency and bank staff have long formed part of the NHS workforce, but the current scale of use has raised concerns among trust leaders. NHS England’s most recent accounts show a fall in agency spending in 2024 and 2025 following national efforts to tighten controls and reduce rates. However, the overall bill for temporary staffing remains significant, and trusts say it can rise sharply when demand spikes or rotas become unstable.

Vacancies remain persistent in key roles such as nursing, emergency medicine and specialist clinical areas. Recruitment pipelines have not kept pace with retirements and ongoing staff turnover, which means many trusts continue to rely on agency cover to maintain safe staffing levels. Industrial action, winter pressures and sudden demand surges also drive short term increases in agency use.

In some areas, high market rates for agency shifts are outpacing bank pay, making it more difficult for trusts to attract staff through internal staffing pools. Leaders say this dynamic contributes to rota gaps and can undermine attempts to build more stable teams.

Financial and Operational Consequences for Trusts

The cost of agency staffing continues to divert money away from permanent recruitment, training and service development. Several organisations have warned that rising temporary staffing bills may require reductions in local services or further efficiency programmes to stay within budget.

Patient continuity can also be affected when care is delivered by rotating agency staff rather than consistent teams. Substantive staff report increasing pressure when rota gaps persist, contributing to higher levels of burnout and turnover.

National and Local Measures Underway

NHS England has introduced tighter rules on agency use, including price caps and guidance that asks trusts to reduce their agency spending. Reduction targets of around 30 per cent were set for 2024 and 2025, and increasing bank capacity remains a priority across the system.

Trusts are being encouraged to improve retention, expand flexible roles and strengthen wellbeing support as part of wider efforts to stabilise the workforce. Procurement teams have also been asked to ensure greater discipline in the use of agency agencies and to monitor specialty-level spending.

Long-Term Workforce Planning Remains Essential

Health leaders say that agency staffing will remain necessary in some situations, but they stress that long-term workforce investment is the only sustainable solution. Expanding training places, maintaining international recruitment and developing a credible retention plan are key areas of focus at national level.

Trusts argue that without action to address persistent vacancies and workforce morale, reliance on temporary staffing will continue to act as a significant financial pressure. They emphasise that agency use is a symptom of wider shortages, and that stabilising the workforce will be critical for improving capacity and maintaining safe, reliable patient care.