- Concern at ‘cut now, think about it later’ approach to patient care.
- Dismay at impacts of draconian cuts to agency use.
- Department of Health’s claim that curbing agency spend will save significant money for NHS Trusts is proved false.
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. There have been fewer staff dealing with patients at the busiest time of year while corridor care is still rampant.
A freedom of information request sent to NHS Trusts in London by the REC has uncovered that half of respondents had done no specific impact assessment of patient outcomes relating to the Department of Health’s directive to cut use of agency staff by ‘30% in the short term’.
The number of Trusts not knowing the impact of these cuts could be even higher because responses from certain Trusts were unclear about whether an impact assessment was done or not.
Given the relative scale of Trusts in London, this outcome is likely to be the case across much of England.
REC is urging DHSC to rethink this careless ‘Cut first, consider later’ approach to shedding thousands of agency staff from within its ranks and instead, work in partnership with healthcare staffing firms on a safer and more sustainable NHS staffing workforce plan. During the winter, Bank staffing can get overwhelmed with demand for staff and by reducing the capacity of compliant, price-controlled on-framework agencies to support staffing needs, DHSC will leave Trusts with a choice between cancelling care or delivering it via exactly the sort of expensive off-framework provision the government rails against.
REC Chief Executive Neil Carberry said:
“The Department of Health’s misleading statements about temporary work costs hide the truth – while agency costs have been going down, temporary shift spending is rising as bureaucrats put ideology before the best outcomes for patients. Having run down the firms who did what government needed by delivering great care at controlled rates by pushing work to more expensive Bank shifts, the Department is therefore left with little or no compliant and effective safety valve for winter crises.
“It is time to look more practically and less ideologically at ways to fix the NHS’ long-standing recruitment and retention problems. As the government prepares to publish its Ten-Year NHS Workforce Plan, they should consult with agencies and the REC about how to make agency staffing work best for Trusts, patients and the exchequer.
“It should concern us all that the impact of this meaningless crusade is on more than costs. The lack of proper impact assessments by so many NHS Trusts reflects the pace of change as policy making is rushed and agencies scapegoated. How can the government ask NHS Trusts to cut 30% of agency staff use without making sure they assess the impact of this significant cut on patient care. Such assessments should be mandatory and publicly available so the Secretary of State can be held accountable for the consequences of this policy.
“On behalf of compliant, well-regulated, and care-focused agencies, the REC stands where it always has – ready to work with the NHS and the Department of Health on sustainable solutions. Scapegoating of agencies has run out of road and has solved no problems. The system did need and does need to change, and working with rather than against agencies to control spending, improve care and engage staff has a far bigger upside. We hope the government finally sees this in 2026.”
Facts versus DHSC anti agency staffing rhetoric
The REC represents healthcare staffing agencies which provide temporary workers to NHS Trusts. These agencies are experts in staffing in healthcare and have first-hand experience of the impact on NHS Trusts. This is the impact of the government’s decision to axe 30% of agency use without any idea about what it would mean in practice for service delivery.
Healthcare staffing agencies are reporting to the REC:
- Bank assignments routinely cost more than agency assignments.
- Banks take longer to fill placements – risking unsafe staffing levels for longer periods.
- Because Trusts are worried about using an agency to fill permanent vacancies hiring processes are taking much longer – all while corridor care has become the norm.
- You also cannot use an agency to do the turnaround jobs that many NHS Trusts need – for example we have heard about delays in hiring interims in finance / HR / projects.
- Because the NHS cannot use an agency to fill a nursing shift, they are having to find alternatives to keep patients safe. In one case that involved a security guard on a mental health ward.
Neil Carberry said:
“Quashing the ability of people to work flexibly through agencies will exacerbate the recruitment crisis in healthcare – immediately and in the long term. Treating staff with respect and listening to their choices matters.
“Sustainable NHS staffing requires deep expertise and a clear understanding of the service’s complex needs, not political grandstanding. The government keeps misleading the public about temporary staffing while relying on bullying tactics and favouritism.
“Banks cost more than on-framework agencies. The best agencies deliver stronger compliance, better safety and tighter cost control.
“Trust leaders know agencies must be a controlled part of the mix. It is time for the government to face facts and listen to what Trusts are telling them.”
Curbing agency spend is not saving NHS significant money
NHS Trusts were directed to rely more on internal Bank staff rather than what they see as expensive agency staff, even before this new government came to power. But 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.
Examples below of where swapping agency for Bank staff is a false economy.
Policy failing at the top-end: The expenditure on Bank staffing at Imperial College Healthcare NHS Trust has gone up nearly every year since FY 2019/20 when it was £55.7m (19/20) to £54.4m (20/21), £63.7m (21/22), £75m (22/23), £95.5m (23/24) and £95.9m (24/25). Yet the fall in agency spend seems to hardly compensate the NHS Trust for the increase in Bank spend across that period. Agency spend at that trust: £16.1m (2019/20), £15.2m (20/21), £23.3m (21/22), £27.4 (22/23), £17m (23/24) and £14.4m (24/25). In fact, for the period financial year 2019/20 to financial year 2024/5, Bank spend at that trust was around £440m. This is more than three times the money spent on agency staff, which was £113m in that same time frame.
Like Imperial College NHS Trust, the Royal Free London NHS Foundation Trust is also one of the biggest hospital trusts in the UK. Again, the increase in Bank cost is far more than savings on reducing agency use. Agency pay went up every year between 2020 and 2023. But in 2024 agency spend was £41m, down on the near £44m in 2023 – a saving of about £3m. Yet Bank spend went up in 2020-2023. In 2024, Bank spend was £116.5m, up on the £109.2m in 2023.
Policy failing at the mid-level: It is the similar story at middle tier West London NHS Trust, where there seems no real savings from using Bank over agency. Bank spend at that trust was £24.7m in 2020, £27.7m in 2021, £28m in 2022, £30.8 in 2023 and £36.4m in 2024. Yet the fall in agency spend does not seem to cover the extra spend on Bank at all. Agency spend was £18.3m in 2020, £17m in 2021, £20.6m in 2022, £18.9m in 2023 and £16.4m in 2024.
Policy failing at the bottom-end: At the other end of the size scale is Whittington Health NHS Trust, where again, there appears no apparent real savings to it by using Bank instead of agency as both have gone up. Bank spend in 2020 was 10.7m, £16.4m in 2021, £17.1m in 2022, £20.8m in 2023, £21.9m in 2024. Yet agency spend was £5.2m in 2020, £7.4m in 2021, £12.1m in 2022, £8.9m in 2023 and £9.7m in 2024.
