How Much Is the NHS Paying for Temporary Staff?

The NHS spent £3.7 billion on agency and locum workers in 2023/24, representing 8.2% of the total pay bill — more than double the NHS Improvement target of 3.5% and up from a low of 4.3% in 2020.^[1] An agency nurse costs £47 per hour against roughly £18 for a contracted equivalent — a 2.6-times premium funding agency margins rather than patient care.^[2] Agency spend fell between 2016 and 2020 after rate caps were introduced in 2015–16, but the pandemic reversed that progress: extraordinary staffing demands, followed by burnout-driven attrition as the emergency subsided, drove agency use back upward. Industrial action in 2022–23 further increased reliance on temporary cover. The cycle is self-reinforcing: burnt-out staff leave for agency work where they earn more with greater flexibility; trusts pay a premium to bring them back; remaining substantive staff face higher workloads and burn out in turn.

The £3.7 billion annual premium over what the same hours of care would cost from a substantive workforce represents money not spent on additional permanent posts, training, or patient-facing services.^[1] The burden falls disproportionately on the trusts with the highest vacancy rates and the most acute recruitment difficulties — typically those in areas with higher living costs or less attractive working environments — creating a fiscal inequality between well-staffed trusts that can contain agency costs and struggling trusts that cannot. The NHS Long Term Workforce Plan commits to training more staff over the long term; training pipelines take years to fill, leaving the immediate cycle of churn and premium payments largely unaddressed.^[3]