New data from freedom of information (FOI) requests has ignited a fresh debate over temporary staffing costs within the National Health Service (NHS), revealing that some trusts are paying substantially more for ‘bank’ staff than for agency workers. This finding directly challenges long-standing government claims that reducing reliance on external agencies would yield significant financial savings for the health service. The Recruitment and Employment Confederation (REC), representing the recruitment industry, has formally urged the House of Commons Health and Social Care Committee to launch an investigation into what it describes as a "politicised debate" surrounding temporary staffing. This intervention comes at a critical juncture, as ministers finalize the ambitious NHS 10-Year Workforce Plan and continue to defend stringent restrictions on agency staffing introduced last year.
The "Bank vs. Agency" Conundrum
Understanding the distinction between "bank" and "agency" staff is crucial to grasping the complexities of NHS temporary resourcing. An NHS "bank" refers to an internal pool of healthcare professionals – including nurses, doctors, allied health professionals, and administrative staff – directly employed by a trust on flexible contracts. These individuals pick up shifts as needed to cover shortfalls, sick leave, or periods of high demand. Agency workers, conversely, are supplied by external recruitment companies and are typically employed by the agency, not directly by the NHS trust. Both models aim to provide essential flexibility, ensuring hospitals and clinics can maintain safe staffing levels and continuity of care amidst unpredictable patient flows and persistent workforce shortages.
The government’s long-standing policy has favoured the use of internal bank staff, primarily on the premise that it is a more cost-effective and sustainable solution than engaging external agencies. This preference is rooted in the belief that agencies charge premium rates, adding an unnecessary financial burden to already stretched NHS budgets. The narrative often frames agency use as a last resort, to be minimized wherever possible.
A Decade of Cost-Cutting Measures and Rising Expenditure
The push to control agency spending is not new. Since 2015, the English NHS has implemented caps on the hourly rates payable to all agency staff. These measures were designed to align agency pay more closely with that of equivalent directly employed NHS staff, thereby curbing perceived excessive costs. A "break glass" provision exists, allowing these caps to be overridden in exceptional circumstances, typically on urgent patient safety grounds when no other staffing options are available.
Despite these regulatory efforts, overall expenditure on temporary staffing has continued its upward trajectory. A 2024 House of Commons research briefing highlighted significant increases: between 2018-19 and 2021-22, spending on bank staff surged by 51% to £5.2 billion, while agency staff spending rose by 23% to £2.96 billion. The briefing further detailed that in 2022-23 alone, NHS providers spent a substantial £3.46 billion on agency staff. This persistent increase, even with caps in place, underscores the profound and escalating challenge of workforce shortages across the health service. The NHS workforce plan explicitly aims to reduce agency spending by boosting internal capacity and enhancing the utilization of bank staff to fill persistent vacancies.
Adding to the complexity, last June, the government publicly declared that the NHS had saved an estimated £1 billion in 2024-25 by prioritizing bank staff over agency alternatives. This announcement was accompanied by strong rhetoric, with ministers stating their intention to move away from what they termed "rip-off temporary staffing agencies," reinforcing the perception that agencies are inherently more expensive and contribute to wasteful spending.
Freedom of Information Reveals Discrepancies
The REC’s recent intervention directly challenges this governmental narrative. Its analysis of FOI responses from NHS trusts for the 2024-25 and 2025-26 financial years presents compelling evidence suggesting that the highest-cost shifts are, in fact, often filled through bank arrangements, even at trusts that reported no use of "off-framework" agencies – a category frequently blamed for inflated costs.
Detailed examples from specific trusts illustrate these findings:
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Nottingham University Hospitals NHS Trust: This trust reported no use of off-framework agencies. Yet, its average cost for the five most expensive bank shifts was £5,723 in 2024-25, slightly decreasing to £5,622 in 2025-26. In stark contrast, the average cost for its five most expensive agency shifts was significantly lower, at £4,491 and £4,642 for the respective periods. This suggests a premium being paid for internal temporary staff in critical, high-demand scenarios.
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Imperial College Healthcare NHS Trust (London): The disparity was even more pronounced at this major London trust in 2025-26. The REC’s FOI analysis revealed an average cost of £5,509 for its five most expensive bank shifts, compared to a remarkably lower £2,116 for agency shifts. Such a wide gap directly contradicts the assumption that bank staff consistently represent the more economical choice.
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Newcastle upon Tyne Hospitals NHS Foundation Trust: This trust also reported no off-framework agency spending during the specified period. However, its average cost for the most expensive bank shifts reached £1,365 in 2024-25, dramatically exceeding the £372 average for agency shifts.
These case studies, drawn from across the country and from trusts with varying operational profiles, indicate a systemic issue that warrants deeper investigation. The data suggests that the cost implications of temporary staffing are far more nuanced than the simplistic "agency equals expensive" narrative often propagated.
The Underlying Crisis: Workforce Shortages
Neil Carberry, Chief Executive of the REC, articulated the core conclusion drawn from these figures: "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." He emphasized, "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."
This perspective aligns with broader concerns about the sustained and critical shortage of healthcare professionals across the NHS. Vacancy rates remain stubbornly high across numerous specialisms, exacerbated by factors such as an aging workforce, post-Brexit reductions in international recruitment, and increased burnout rates among existing staff. The COVID-19 pandemic further intensified these pressures, leading to a backlog of elective care and an even greater reliance on temporary staffing solutions to keep services running. When demand for staff significantly outstrips supply, the market dictates higher prices, regardless of whether the staff are sourced internally via a bank or externally via an agency. Trusts, facing critical staffing gaps that could compromise patient safety, are often compelled to pay premium rates to secure the necessary cover, irrespective of the source.
The REC’s concerns are also echoed in findings from the National Guardian’s Speak Up Review earlier this year. The review highlighted that many temporary NHS workers, whether bank or agency, often felt undervalued and marginalized within healthcare teams. This sentiment of not being fully integrated or appreciated can deter individuals from continuing to offer their services, further exacerbating staffing challenges. The review specifically recommended closer collaboration between the NHS and staffing agencies, recognizing their vital role in providing flexible workforce solutions. Carberry reiterated this, stating that the NHS needs to acknowledge that demand from workers for flexible arrangements is "only increasing."
Implications for NHS, Staff, and Patients
The findings presented by the REC carry significant implications across several dimensions:
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Financial Strain and Budgetary Pressures: If bank staff are indeed costing more in high-demand scenarios, the government’s strategy of pushing trusts towards greater bank usage as a primary cost-saving measure may be flawed. This could mean that the projected £1 billion in savings might not fully materialize or could be offset by increased spending elsewhere, putting continued strain on the NHS’s already tight budget. It also raises questions about the transparency and accuracy of reported savings.
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Impact on Workforce Morale and Retention: The government’s strong anti-agency rhetoric, exemplified by phrases like "rip-off agencies," risks alienating a significant portion of the temporary healthcare workforce. Many professionals, particularly younger generations, increasingly value the flexibility offered by both bank and agency work. If perceived as undervalued or unfairly criticized, these skilled workers might choose to leave the NHS entirely, move to other sectors, or seek opportunities abroad, further intensifying staffing shortages. A demoralized workforce, whether permanent or temporary, is less productive and more prone to attrition.
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Potential Consequences for Patient Safety and Care Quality: Persistent and unaddressed workforce shortages, regardless of their source, pose a direct threat to patient safety and the quality of care. When shifts are left unfilled or covered by staff working under extreme pressure, the risk of errors increases, and the ability to deliver timely and comprehensive care is compromised. A policy that inadvertently discourages flexible workers from contributing could worsen this critical situation, potentially leading to longer waiting lists, delayed treatments, and reduced service availability.
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The Path Forward: A Call for Collaborative Policy: The REC argues that a more nuanced and collaborative approach is urgently needed. Rather than viewing agencies as adversaries, the Department of Health and Social Care (DHSC) should "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, Carberry suggests, has a "far bigger upside than a standoff with ill-informed statements about ‘rip-off’ agency cost." The REC advocates for a larger and more flexible workforce, improved long-term planning, and pay systems that genuinely reflect staffing demand, rather than arbitrary caps.
Official Responses and Future Outlook
While the Department of Health and Social Care has been contacted for an official response to these specific findings, their overarching policy framework remains clear: a commitment to building a sustainable, permanent NHS workforce and reducing reliance on external temporary staffing to save money. The upcoming NHS 10-Year Workforce Plan is expected to outline strategies to achieve this, focusing on increasing training places, improving retention, and optimizing the use of internal bank staff. However, the REC’s data suggests that the implementation of this strategy needs careful re-evaluation to avoid unintended consequences.
The challenge for policymakers is to move beyond the "politicised debate" and adopt a pragmatic approach that acknowledges the complex realities of modern healthcare staffing. This includes recognizing the legitimate role of both internal bank and external agency staff in maintaining operational resilience, understanding the true drivers of high costs (which appear to be underlying workforce shortages), and fostering an environment where all healthcare professionals feel valued. A truly sustainable solution will likely require a multi-faceted approach, encompassing robust long-term workforce planning, competitive remuneration, flexible working options, and genuine collaboration with all partners in the recruitment ecosystem. The current findings underscore the urgency of such a holistic strategy to ensure the NHS can meet the ever-growing demands placed upon it.
