NHS stats highlight the costly impact of its over reliance on Banks

Dive into the latest insights on NHS staffing rates and trends, based on newly released data from NHS. This essential overview is an excellent go-to resource for engaging with Trusts and the wider health ecosystem, as well as responding to current and upcoming NHS consultations. It makes it clear that there is much more to getting NHS staffing right than demonising agency spend. 

The extent of the mismanagement of temporary staffing in the NHS is evident in a set of new statistics that shows that cuts on agency spend are more than offset by extra spending on staff banks. This is why next year’s NHS 10 year-plan needs a more sophisticated and nuanced approach to control staffing costs rather than today’s ‘Bank is good, agency is bad’ DHSC diagnosis.

The switch to bank rather than agency was supposed to give NHS more control over staff spends over recent years, yet the NHS has admitted that it has instead upped the overall cost of contingent staffing.

But a release of NHS statistics has shown the folly of that move. In 2023/24, total expenditure on medical temporary staffing increased by 18% (£470 million) compared to 2022/23, largely due to an increase in spending on bank staff. Medical and dental bank spending in 2023-24 was £1.9 billion, up from £1.4 billion the previous year, and up 114 per cent from £902 million in 2019-20.

Yet agency medical spending fell slightly, from £1.15bn in 2022-23 to £1.13bn, according to NHS England this week. 

NHS agency price caps and controls were introduced with an aim to reduce NHS spend on the temporary workforce, while encouraging workers to take up substantive roles. Yet these new NHS statistics will form part of our ongoing message to the NHS that caps and controls have not seen staff moving into substantive roles, but it has instead swelled expenditure on temporary labour via staffing banks.

There is a write up of these newly released statistics in Health Service Journal (HSJ) today.

A separate paper ‘Submission to the NHS Pay Review Body – evidence for the 2025/26 pay round, was published this week and also provides a further snapshot of challenges relating to the NHS workforce that may impact on our members’ work. This includes use of levy funding for apprenticeships, flexible working arrangements and everyday workforce issues. 

The paper makes clear that workforce issues have posed long-term challenges for the NHS – ‘too few staff have resulted in burnout and a demoralised workforce which further exasperate recruitment challenges’.

Agenda for Change (AfC) in 2004 was the biggest reform of NHS since it began, and broadly harmonised and modernised pay and conditions, terms of employment and HR policies across the NHS. AfC staff is now a catch all phrase for all NHS staff (except doctors, dentists and very senior managers). The new NHS paper praises the increased number of AfC staff over the last few years by 22% (22,106 FTE), ‘supported by successful international recruitment activity’, although it accepts that the post-covid interest in career and training opportunities in the NHS is dropping-off. The AfC leaver rate for most staff groups has steadily returned from its peak of 9.2% in April 2022 to pre-pandemic levels. Nursing leaver rates dropped to 5.5% in June 2024, below the pre-pandemic average of 6.8%.

The NHS paper is clear that the size of the NHS workforce has grown significantly in recent years and it is too early to confirm exactly how the 10-year Health Plan might alter the projected workforce number.

Recruitment overview

• London continued to have the highest vacancy rate for AfC staff at 9.8%, and the North East and Yorkshire region had the lowest at 5.1%. 
• A total of 5,387 (23.9%) of 22,511 job adverts on NHS Jobs in June 2024 offered flexible working opportunities, with the total doing so increasing by 0.7 percentage points month on month and decreasing by 1.8 percentage points year on year. 
• Since 2021, the lowest-scoring question in the yearly NHS Staff Survey has been that relating to the organisation’s commitment to flexible working. 
• NHS has significantly reduced investment in international recruitment in 2024/25 ‘following successful growth over the last two to three years in substantive staffing’. 
• There has been a noticeable decline in the number of newly qualified workers (nursing, midwifery and AHPs) entering the NHS workforce. 
• NHS’ best estimate of productivity in 2024/25 from acute sector data is that it is still lower than pre-pandemic but is recovering by between 1.6% and 2.8% a year. 
• Pay is around 65% of total operating costs. NHS propose to set allocations for NHS planning on the basis of a 2.8% pay settlement.

Nursing 

Between September 2019 and June 2024, the monthly use of temporary nursing workforce increased by around 3,800 FTE (+10.8%), which is attributed to an increase in monthly bank nurse use (+c6,800 FTE). The number of substantive nursing vacancies decreased by 11,057 FTE between September 2019 and June 2024, to 31,049 FTE, and as a result, the nursing vacancy rate has decreased from 12.5% to 7.9%. 

Midwifery 

As of June 2024, the total number of midwives in substantive employment is 23,562 FTE, a record number for this point in the year, says the paper. Midwives leaving the profession has reduced to 4.6% as of June 2024, from their peak of 7.3% in August 2022. 

Allied health professions (AHPs) 

Vacancy rates for many AHPs remain high in the NHS, particularly at early-stage career. For example, from June 2023 to June 2024, the paramedic workforce vacancy rate decreased from 6.8% to 5.7%, and FTE vacancies reduced from 1,407 to 1,288. 

Estates and facilities 

This is 6% of the total NHS workforce, with vacancy rates varied from 3% to 22%, depending on role. NHS Jobs data shows recruitment difficulties, with a re-advertisement rate of 57.6% for estates and facilities management roles. Recruitment and attraction challenges are most acute at Bands 2 to 4, which represent 81% of estates and facilities roles. 

Apprenticeships 

Since implementation of the apprenticeship reforms and inception of the levy in 2016, over 131,000 people have started apprenticeships in the NHS. Higher and degree-level apprenticeships for staff continue to increase, with 66% of apprenticeships in the 2022/23 academic year at level 4 or above compared to 27% in 2017/18. 

Staff experience 

The 2023 NHS Staff Survey found perceived presenteeism (55.6%), experiences of burnout (30.38%), stress (41.71%) and musculoskeletal (MSK) issues (28.69%) remained high but did decline slightly. Ambulance and registered nurses continue to report the highest perceived levels of stress.  

The spring months of 2024 showed a slight increase in sickness absence rates compared to the previous year – before falling to 4.9% in June 2024, but this is still higher than the rate before the pandemic (4.4% in June 2019). Outside seasonal variations, mental health (27.2%) and MSK issues (13.3%) continue to be prominent reasons for sickness. 

The paper accepts that both race and disability pay gap reporting lack sufficient robust data, which it said will get addressed with ‘urgency in light of proposed future legislative changes’.