Your web browser is outdated and may be insecure

The RCN recommends using an updated browser such as Microsoft Edge or Google Chrome

NHS has squandered billions on agencies that could have been used to hire over 31,000 nurses

Press Release 06/12/2023

New analysis of findings from a Freedom of Information (FOI) request to NHS trusts across England, which received 182 responses from 202 trusts, exposes a £3bn spend on agency staff by hospitals in England to plug chronic staff shortages. Poor government planning and underfunding of the NHS has forced trusts in each region to spend millions that could have paid the salaries of almost 31,000 full-time nurses.

The analysis by the Royal College of Nursing found hospitals spent a total of £3.2bn between 2020 - 2022 to cover gaps in rotas and keep wards open.

Three-quarters of the vacancies in the NHS could be filled if the money had been redirected to hiring permanent staff. The money spent on agencies could have covered the salaries of 30,956 permanent full-time equivalent nurses (FTE) paid at the top of a Band 5 salary (£34,581).

Instead, the recruitment crisis in the NHS is forcing hospitals to spend vast sums on agency staff as services run under the strain of over 40,000 vacant nursing posts. 

Alternatively, analysis by the RCN reveals the money spent on agencies could have trained over 86,000 new nurses. Research by London Economics for the RCN estimates the cost of training a nurse is £37,287.

Every year trusts are spending more on agency staff, and the findings demonstrate costs spiralling by 63% from £800m in 2020 to £1.3bn in 2022. 

Costs were highest in London, where hospitals spent £630m on agency staff, while in the North of England, hospitals paid out £109m for staff working temporary shifts across the three years. 

Whilst vast sums are being spent to plug holes in rotas in the short term, the RCN is asking how the NHS Long Term Workforce Plan will be funded.  To grow the profession, the government needs to demonstrate it is committed to making nursing more attractive, starting with fair pay.

Alarmingly, despite the need to increase nursing student numbers to achieve the plan’s targets, the most recent figures show a 12% drop in the number of people accepted onto courses to study nursing.  An average nursing student takes on a debt burden of £50,000.  The RCN is calling on the government to abolish tuition fees for prospective nursing students and provide loan forgiveness for those who have already paid for their education.

Royal College of Nursing Chief Nurse Professor Nicola Ranger, said:

“Ministers have got their priorities wrong – forcing trusts to squander billions on agency staff while they provide miserly funding for fair pay and nurse education.

“With cuts to nurse education and maintaining unfair pay levels, ministers are choosing to spend the money on much higher private agency bills instead, this is yet another false economy when it comes to NHS spending.

“This should act as a wake-up call. The government must give nursing staff and patients the investment and respect they deserve. Not acting now will mean even more patients on waiting lists and the crisis in the nursing workforce deepening further.”


Notes to Editors  

The RCN submitted a Freedom of Information request to NHS trusts in England on spending on agency nursing staff between 2020 and 2022. A total of 182 trusts provided usable data that showed £3,211,438,575 was spent on agency staff to plug gaps in nursing rotas. 

Full regional data for spending on agency staff is available on request from the RCN. 

Spending on agency staff by region 

RCN region (no. of trusts included / out of total no. trusts contacted)





London (32/34)





South-East (27/28)





South-West (18/19)





North-West (26/30)





West-Midlands (19/23)





Yorkshire & the Humber (20/21)





East Midlands (13/15)





Eastern (16/20)





Northern (11/12)






The average agency spend each year (£1,070,479,525), would pay the salaries for 30,956 permanent full-Time Equivalent Nurses (FTE) on the top of a Band 5 salary (£34,581) at the 2023/24 NHS pay scales.  

While some in the nursing profession prefer the flexibility of working as agency nurses, massive spending on regularly staffing shifts points to a need for the government to do more to attract people into working in the NHS. This must start with fair pay. 

Press Office Contacts

Tom Colclough, Head of Media
07891 109 146

Nick Spears, Senior Media Officer
020 7647 3696

Claire Nelson, Senior Media Officer
029 2054 6401

Michael Finlayson, Media Officer
020 7647 3459

Out of hours duty press officer
020 7647 3633