As outlined in the NHS Planning Guidance 2025/26, all trusts are required to reduce agency spend by at least 30%, with an additional focus on achieving a 10% reduction in spend on bank staff. This aims to transition away from a reliance on costly temporary staff and to promote investment in permanent roles.

While this specific assessment has not been made, fill rates on temporary staff, including nurses, are monitored monthly. It is essential that patient safety considerations continue to be the most important priority.

Spend on agency increased significantly in 2021/22 to £2.96 billion and to £3.46 billion in 2022/2023. However, spend appears to have peaked as 2023/24 spend was £3 billion and it has decreased further in 2024/25.

My Rt. Hon. Friend, the Secretary of State for Health and Social Care, and Jim Mackey, Chief Executive of NHS England, wrote to trusts and integrated care boards in early June 2025 to reinforce the message in the Planning Guidance and set the ambition to eliminate agency spend in this parliament as part of optimising costs and productivity. The expectation is that staff will move to bank and substantive roles.

The Department does not hold the data requested.

The Government is committed to reducing off-framework agency use, the cost of which is at a premium, above the agreed framework rates. Additionally, staff hired through off-framework agencies are not subject to the same pre-employment checks as those carried out by on-framework agencies. Off-framework use is actively monitored through NHS England’s governance mechanisms, with additional oversight applied to trusts with recurring non-compliance.

The NHS Planning Guidance 2025/26 states that trusts should reduce their agency spend by a minimum of 30%, and the accompanying Revenue Finance and Contracting Guidance sets the ambition that agency spend should be eliminated in the coming years.

The Department does not hold the data requested.

The Government is committed to reducing off-framework agency use, the cost of which is at a premium, above the agreed framework rates. Additionally, staff hired through off-framework agencies are not subject to the same pre-employment checks as those carried out by on-framework agencies. Off-framework use is actively monitored through NHS England’s governance mechanisms, with additional oversight applied to trusts with recurring non-compliance.

The NHS Planning Guidance 2025/26 states that trusts should reduce their agency spend by a minimum of 30%, and the accompanying Revenue Finance and Contracting Guidance sets the ambition that agency spend should be eliminated in the coming years.

Trusts manage their own procurement processes and must align with framework and procurement regulations, to uphold fairness and deliver value for money. Any breaches of framework rules, including price cap violations, are closely monitored by NHS England through the Temporary Staffing Efficiency Programme.

NHS England will continue to review framework applications as they are submitted, and will continue to communicate outcomes to framework operators and providers, including any updates to the list of approved framework agreements. A list of approved framework agreements can be found on NHS England’s website, at the following link:

https://www.england.nhs.uk/reducing-expenditure-on-nhs-agency-staff-rules-and-price-caps/agency-rules-list-of-approved-framework-agreements-for-all-staff/

The Department does not hold the information requested.

The information requested is not available.

The amount spent on agency nurses by year for each of the last five years is set out in the table below.

The Long Term Workforce Plan sets out a path to reduce the National Health Service’s reliance on agency. We estimate that the reliance on temporary staffing in FTE terms will reduce from 9% in 2021/22 to around 5% from 2032/33 onwards, with mostly bank staff fulfilling the requirement for temporary staffing.

Due to local audit processes which are variable and not within the control of NHS England, we cannot currently confirm the date when off-framework spend for 2022/23 will be finalised and publicly available.

The information requested is not held centrally.

Agency spend on nurses for 2021/22 is not yet available. While the NHS Consolidated Accounts have been published, this does not include an explicit figure for agency spend as it is bundled together with other spend items. We expect the agency data for 2021/22 to be published this spring.

In 2015, we introduced measures to reduce spending on agency staff, including price caps, procurement frameworks and expenditure ceilings. This has contributed to the National Health Service reducing expenditure from £3.6 billion in 2015/16 to £2.4 billion in 2020/21. In September 2022, NHS England re-established such measures, including a system agency expenditure limit and we have worked with NHS trusts to develop staff banks.

The information requested is shown in the following table.

NHS England and NHS Improvement do not hold information on the number of agency nurses employed in hospital trusts. Since April 2020, agency nurses have represented an average of 3% of full-time equivalent nursing staff.

The information is not held in the format requested. However, the average daily cost of an agency nurse calculated in October 2021/22 was £194.28 and £204.69 in October 2020/21. A comparative average cost of substantive staff is not available as the cost of agency staff includes all training, development and other costs, whereas average salary information for substantive National Health Service staff will not incorporate this.

All National Health Service and social care staff, including nurses, can apply for a test if they are experiencing symptoms using digital portal. The employer referral portal allows employers to refer essential workers who are self-isolating either because they or member(s) of their household have COVID-19 symptoms, for testing.

Asymptomatic care home staff are now eligible for testing through the ‘whole home’ testing portal.

NHS Providers do not directly pay sick pay to agency workers as they are not employed by the trust. Agency workers are entitled to statutory sick pay (SSP), with responsibility falling to the employing agency. When a rate is agreed with an agency, it includes sick pay entitlement within the total charge rate being invoiced to the trust.

The Department is working closely with the agency sector to ensure that these requirements are understood and honoured, and to ensure that no National Health Service workers are put at any disadvantage at this time.

Individual agency workers should contact their respective agencies or follow the guidance on the Government website for more information on the rules and guidance on statutory sick pay.

In March 2018 the Government backed the Future Fit proposals with £312 million. Release of this funding is subject to the usual business case approvals process, which includes approval by Departmental Ministers and HM Treasury.

The Secretary of State for Health and Social Care has formal decision-making powers relating to service change under Regulation 23(9) of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny Regulations) 2013. Where a local authority has referred a reconfiguration to him, the Secretary of State may make a final decision on the proposals and give directions to NHS England and NHS Improvement. On 2 October 2019 the Secretary of State communicated his decision that the Future Fit proposals should proceed, whilst keeping the accident and emergency (A&E) at the Princess Royal Hospital open as an A&E Local. On 6 January 2020, he also directed NHS England to work with the clinical commissioning groups and Shrewsbury and Telford Hospital NHS Trust (SaTH) to implement the A&E Local model.

The National Health Service has made recommendations on the legislation changes it would like to see and the Department is considering those proposals.

Shrewsbury and Telford Hospitals NHS Trust has faced staffing challenges in A&E departments and critical care services. Both this and an increase in attendances at the Emergency Department has resulted in doctors being on-call more frequently and working extra hours across two hospital sites. It has also been necessary to recruit temporary staff.

For the month of December 2019, 14.38% of nursing hours worked across both the Royal Shrewsbury Hospital and Princess Royal Hospital, were staffed from agency.

The reconfiguration will address staffing challenges, by consolidating some emergency services onto one site and reducing duplication. The Future Fit proposals aim to deliver high quality, safe services for all patients for the long term. Achieving this will support the recruitment of the right level of highly skilled doctors, nurses and other healthcare staff.