Expert advice

The extent of reliance on agency nurses points to the depth of the malaise in the NHS

Temporary staff now have to cover chronic nursing shortages, not just unplanned absence 

Temporary staff now have to cover chronic nursing shortages, not just unplanned absence 


The canaries in the NHS coal mine. Picture: iStock

Agency nurses are the canaries of the NHS coal mine. The more you see, the more you know there is a problem of nursing shortages in that locality. 

This was not always the case. The traditional use of agency nurses was to provide short-term cover for a few days' unplanned sickness absence or study day leave. Now, some are being deployed for longer periods as a response to system-wide staff vacancies.

A recent Labour party survey covering 129 NHS trusts in England reported that the longest continuous agency nurse contract was 95 months at a trust in the north east of England, followed by 79 months at a mental health trust in London.

These are extreme examples but they flag a growing problem; the irresistible force of staff shortages is meeting the immovable rock of NHS funding constraints.

Despite reliance on agency staff, there has been a nationally-led attempt to cut agency costs. Latest figures from NHS Improvement put agency spend for the NHS in England in 2017-18 at £2.4 billion. This is down from £3.6 billion in 2015-16, when a cap was introduced on agency costs.

A morale issue

To complicate matters, health and social care secretary Matt Hancock recently described the use of agency staff as ‘demoralising’ for NHS staff. In an interview shown at the NHS Providers conference in October, he vowed to further reduce agency use in the NHS in England which he said can affect morale among nurses on permanent contracts.

He has a point. Compared to a permanent nurse, an agency nurse is likely to require more supervision and may be less effective, but the current endemic level of use of agency nurses means Mr Hancock is not making the right connection. 

The realistic option in many care environments is not agency nurse or permanent nurse, it is agency nurse or no nurse.


James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh

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