The statistics show that the use of agency nursing and midwifery staff has continued to decrease, following the Scottish government restricting this to exceptional circumstances only. In 2025-26, the cost of agency staff was £34.5m. 

However, the cost of bank nursing and midwifery staff has continued to spiral - £391m in 2025-26, up 11% compared to the year before (£353m).   

When bank nursing and midwifery is combined with agency use, the equivalent of 7,320 WTE were used in NHS Scotland in 2025-26. Agency and bank use in 2025-26 cost £425m, an increase of £15m in a year.  

Each individual health board in Scotland has less than 7,000 WTE nursing and midwifery staff in post, except for the two largest health boards. Therefore, the WTE figure for bank and agency use across Scotland is bigger than the permanent workforce in most boards. 

This data demonstrates the scale of gaps in the nursing workforce, and the significant reliance on supplementary staffing required to fill them. With the data only covering shifts that have been filled by bank and agency staff, this does not give the complete picture of demand for supplementary staffing. There will be a proportion of requested shifts left unfilled or filled by existing staff doing additional hours or overtime. 

Colin Poolman, RCN Scotland Executive Director, commented: 

“These figures reveal the continued scale of supplementary staffing that is required to fill gaps in the nursing workforce across Scotland. Bank and agency nursing and midwifery use equated to over 7,000 WTE staff last year – this is equivalent to the nursing workforce of an extra medium sized health board.  

“The first debate of the parliamentary session on Scotland’s NHS takes place today and Scottish government must acknowledge that the scale of this need for supplementary staffing demonstrates that nursing workforce planning tools are not fit for purpose.  

“Managers will always have a need to fill gaps in the workforce and minimise the risk to patient care caused by unexpected absences or vacancies or to bolster teams at times of high workloads or increased patient need. Undoubtedly, NHS banks or external agencies have a role to play in supplying supplementary or temporary staff on a short-term basis. However, an overreliance on supplementary staffing is not sustainable and can affect quality of care and patient safety. 

“This is why we need to see investment in workforce planning, a renewed focus on delivering safe staffing and action to secure a sustainable nursing workforce to meet current and future demand.”