NHS bank staff cost ‘as much as minimum’ agency use
Freedom of information requests have revealed that some NHS trusts are paying much more for ‘bank’ staff than for agency workers, despite government assertions that limiting agency use would save money.
An NHS “bank” is a pool of healthcare workers (nurses, physicians, admin, etc) that work for the NHS to plug gaps as and when they happen, on flexible shifts.
The Recruitment and Employment Confederation, which authored the letter, has written to the House of Commons Health and Social Care Committee to call on MPs to probe what it called a “politicised debate” on temporary staffing in the NHS. The intervention comes as ministers construct the NHS 10-Year Workforce Plan, and seek to defend limitations on agency personnel enacted last year.
Caps on the hourly rates paid for all agency staff in the English NHS have been in place since 2015, to ensure the pay for agency workers is aligned with equivalent, directly hired NHS staff. The rules include a “break glass” clause allowing the caps to be bypassed on patient safety concerns.
But a House of Commons research report from 2024 said spending on bank workers jumped 51% to £5.2 billion between 2018-19 and 2021-22, and spending on agency people increased 23% to £2.96 billion.
The briefing added that NHS providers spent £3.46bn on agency staff in 2022-23. The NHS workforce plan intends to reduce agency spend by building capacity and using bank personnel more to fill vacancies.
The government said in June that the NHS had saved £1bn in 2024-25 by hiring bank workers instead of agency staff. It stated it was taking a stand against “rip-off temporary staffing agencies”.
But the REC in its letter used numbers from NHS trusts it said undermined the Department of Health and Social Care (DHSC) drive to cut agency use. Its review of FOI replies for 2024-25 and 2025-26 indicated some of the greatest cost shifts were actually covered by bank arrangements, even in trusts that do not utilise off-framework agencies, which are commonly accused for excessive spending.
Nottingham University Hospitals NHS Trust reported no off-framework agency use, and the average cost of the five most expensive bank shifts was £5,723 in 2024-25 and £5,622 in 2025-26. The five most expensive agency moves were £4,491 and £4,642 respectively by contrast.
The difference was even more stark at Imperial College Healthcare NHS Trust in London in 2025-26. The average cost of its five most expensive bank shifts was £5,509, vs £2,116 for agency shifts, the REC claimed in the FOI research.
The most expensive bank shifts at Newcastle upon Tyne Hospitals NHS Foundation Trust cost an average of £1,365 in 2024-25, compared with £372 for agency shifts. The trust also reported no spending on agencies outside the framework during the period.
Staffing shortages were responsible for excessive costs across the NHS, rather than the staffing strategy itself, the REC stated.
Neil Carberry, chief executive of REC, said: “The idea that bank staff are always cheaper is just wrong. The data we have in some situations demonstrates the opposite and that should be a wake-up call for Ministers.”
“This shows that staffing models aren’t the driver of cost, workforce shortages are. “The answer is not to pick one staffing route over another, but to fix the root problem.”
The REC said the figures raised questions about the assumption that a reduction in agency utilisation automatically brought savings for taxpayers. It also warned that the government’s strategy could create workforce shortages by alienating temporary healthcare workers who increasingly favour flexible working arrangements. It said NHS trusts needed a larger and more flexible workforce, more long-term planning and pay structures that better represented staffing need.
The concerns come after earlier this year when the National Guardian’s Speak Up Review found that many temporary NHS workers felt devalued within healthcare teams. The study advocated more collaboration between the NHS and staffing agencies.
Carberry said the NHS needs to recognise that the demand from staff to work flexibly was “only increasing”.
This meant DHSC had to “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 has a much greater potential than a stand-off over ill-informed assertions on ‘rip-off’ agency cost from Wes Streeting. We’re eager to collaborate with the NHS on sustainable solutions for compliant, well regulated, care-focused agencies.”