For NHS trust finance directors, a now-routine dilemma looms: how can they balance their budgets when staffing consumes the largest share of expenditure and reliance on temporary cover absorbs what remains? Growing demand, ongoing vacancies and immediate operational pressures are driving many trusts to rely heavily on agency staff, a tactic that fills shifts but drains budgets and undermines long-term stability.
Rising Agency Reliance Exposes Deep Workforce Gaps and Financial Strain Across the NHS
Temporary staffing is hardly a new feature of the NHS, which has always used agency and bank workers to cover gaps, but the current scale and unpredictability are increasingly concerning. NHS England’s latest accounts show that agency spending fell in 2024/25 after a strong national drive to reduce rates and enforce tighter controls, yet the overall temporary-staff bill remains substantial. The fall in spending is positive, but trusts warn that deep workforce shortages persist, and sudden pressures such as industrial action, seasonal demand or unexpected local gaps can rapidly drive agency costs back up.
Vacancies continue to persist in nursing, emergency medicine and other frontline roles, as recruitment pipelines have not kept pace with retirements and ongoing attrition. Short-term pressures such as strikes, sudden demand surges and urgent requirements for specialist skills push trusts to rely on agency shifts to keep services safe. Pay dynamics also play a role, as high agency rates and the premiums agencies can charge often make agency work more appealing than bank shifts, making it harder for trusts to stabilise their permanent workforce.
Money directed towards agency staffing diverts funding from permanent recruitment, training, community provision and essential maintenance. Several trusts have already cautioned that they may reduce services or pursue further efficiencies to meet financial targets, a short-term response that could undermine capacity in the years ahead. Patient continuity also suffers when care is delivered by rotating agency staff rather than stable teams, and substantive staff report increased pressure and burnout when rota gaps persist.
Policy responses are in motion. NHS England has published clearer rules on agency use, price caps and planning guidance that ask trusts to cut agency bills (short-term reduction targets of around 30 per cent were set for 2024/25 and remain a system priority) while expanding bank capacity and substantive recruitment.
Stabilising the Workforce: Why Lasting Solutions Must Replace Short-Term Agency Dependence
Local leaders face stark choices as they try to sustain services without weakening core capacity. The priorities are well known yet increasingly urgent. Boards need transparent, specialty-level data on agency spending so they can identify the areas with the greatest dependency. Retention must be strengthened through flexible roles, development opportunities and genuine support for staff wellbeing. Bank work should offer clear financial advantages, and procurement teams must apply tighter controls to prevent agency rates rising. At a national level, expanding training places, maintaining international recruitment pipelines and funding a credible long-term retention plan remain essential to stabilise the workforce.
In the end, agency staff will remain part of the toolkit. However, treating agency as the solution rather than the symptom risks a cycle in which short-term cover becomes the long-term cost driver. If the NHS wants to steady services and safeguard patient care, it must confront the underlying problems of persistent vacancies, declining morale and an inadequate workforce pipeline rather than focusing only on the costly consequences of leaving these issues unresolved.
