Spending on agency staff in NHS hospitals is predicted to climb as frontline pressures intensify, according to a report shared with Health Service Journal.

The report, by healthcare market analysts Laing and Buisson, demonstrates the service’s reliance on agency staff, with £2.1bn spent on them in 2012.

Agency staff spending by NHS hospitals and community services rose by 42 per cent in real terms over the five years between 2008 and 2012.

According to the report this was driven by a “sharp jump” in dependency on overseas staff in the last three years of the Labour government, due to “substantive staffing shortages” and the NHS seeking to meet targets.

It said the coalition government had “clipped” agency use as part of its NHS efficiency drive, which included a demand to shave £300m from agency spending – but warned this represented only a temporary success.

NHS agency spend fell by 10 per cent and 16 per cent during 2010-11 and 2011-12, respectively, although it still represented 4 per cent of total health service workforce spending. Nursing staff accounted for almost a quarter of total agency spend cent during 2011-12.

But Laing and Buisson predicted figures for 2012-13 would show an increase, and that was likely to have continued into the present financial year.

An analysis by HSJ in March, based on information from 100 trusts, supported this prediction. It found payments for agency and bank staff were likely to be 20 per cent higher in 2012-13 than in 2011-12.

The expected increase, Lang & Buisson said, was being driven by heightened pressures on frontline services, which separate evidence shows are now reaching record levels. These pressures will be exacerbated by growing shortages in nursing, the report warned.

Report author and economist Philip Blackburn said: “Pressures on the system are likely to encourage greater use of flexible staffing resources to offer short-term solutions, providing there is necessary funding to meet these demands.”

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Agency nurses provide a vital service in the NHS, covering unplanned absences at short notice.”

However he added: “They should not be used as a solution to short-sighted, boom and bust workforce planning.

“This [report] is a clear example of short-term cuts to staffing levels actually proving more expensive in the long run, as hospitals are forced to use expensive agency staff to fill gaps in their workforce that they created.”

The Laing and Buisson report highlighted “cyclical” trends in agency spending, with peaks and troughs over the past 25 years depending on the growth of NHS budgets, the wider economy and level of directly employed staff.

There also appeared to be a north-south divide in agency spending levels. London and the surrounding home counties dominated the market with 45% of all agency spend in 2011-12, compared to other parts of the UK (see table below).

Jacqui Skinner, interim managing director of HCL Nursing, which supplies agency staff to the NHS said: “We cannot emphasise enough the critical importance of agency staffing to the NHS. We believe this staff group is an essential part of the solution to the impending nursing crisis facing the UK.

She said: “We are constantly investing in our nurses to maintain the highest levels of customer service, compliance and in-depth quality management.”

She added: “As a minimum requirement, we ensure every one of our candidates is fully vetted as outlined within the NHS Employers standards for the recruitment of healthcare workers.”


Share of NHS UK agency spending  in 2011-12%
Southern Home Counties10.3
North West10.2
West Midlands9.5
Northern Home Counties9.3
Yorkshire & The Humber6.7
East Midlands6.2
South West5.3
East of England4.1
The North3.4
Northern Ireland3.0
United Kingdom100