Support our Nation today - please donate here

NHS Wales’ increasing dependency on agency staff is ‘dangerous’ according to new report

04 Dec 2022 4 minute read
Staff on a NHS hospital ward. PA Images, Peter Byrne

Over five thousand nurses could be employed in the NHS in Wales with the amount of money spent on agency staff, according to a new report by the leading nursing union.

The Royal College of Nursing (RCN) has warned that the levels of dependency on agency staff in the NHS in Wales could lead to a situation where ‘most or all’ nursing care could be outsourced to private companies, and that the service risks moving to a situation in which it no longer employs staff to care for patients directly.

Responses to a number of Freedom of Information (FOI) requests suggest that NHS Wales spent between £133m and £140m on agency nursing during 2021-22, and if accurate, this figure could fund the employment of 5,167 full time nurses.

According to two separate FOI requests, three health boards each spent over £20m on agency nursing staff during 2021-22, with Swansea Bay Health Board spending between £24m and £23.6m, Aneurin Bevan Health Board spending £22.8m and Cwm Taf Morgannwg spending between £21.8m and £22m.

It is thought that Betsi Cadwaladr Health Board spent between £21m and £17.2m, while Cardiff and the Vale Health Board spent £17.6m and £15.2m.

The lowest level of spend, based on the FOI requests, was by Powys Teaching Health, with both FOI responses suggesting that the board spent just £3.7m.


The report aimed to discover what made agency working attractive to nursing staff and found that “Agency nursing staff have better pay, more freedom over location and hours and there is generally less responsibility to address staffing shortages and internal challenges.”

Many agencies offer additional benefits like significant ‘refer a friend’ bonuses, joining incentives, revalidation support and out of hours support.

RCN Wales said the NHS was now “displaying a dangerous and growing reliance on agency nursing over its own workforce”.

The report, which was published on Friday, stated “If this trend continues, Wales will move to a situation where NHS Wales no longer directly employs staff to provide patient care and instead moves to a model in which most or all nursing care is outsourced to private companies.

“This is not a shift that should take place without a conscious government policy decision,”.

The report comes as the college prepares for strike action over nurse pay later this month in Wales, England and Northern Ireland, with all but one of the NHS employers across Wales currently have a mandate for RCN members to take strike action in the coming months.

Earlier this year the Welsh Government handed NHS nurses on Agenda for Change contracts a £1,400 uplift, in line with recommendations from the NHS Pay Review Body.

However, the RCN has been calling for a pay uplift at 5% above inflation for nurses across the whole of the UK.

Good employer

Commenting in the Nursing Times, Sandy Harding, associate director of nursing for professional practice, said: “Agency nursing is becoming increasingly popular as an option for our members as an alternative to working for the NHS.

“Agency nursing can provide more flexibility in hours, better pay, greater choice over work location and support with professional development,” she said.

“Agency nursing is providing our nurses a better work-life balance,” she said. “The NHS struggles without enough nurses.”

She added: “The Welsh Labour government needs to step up and be as good an employer as the nursing agencies.”

A Welsh Government spokesperson said: “Our NHS workers are under considerable pressure.  We greatly value their tireless commitment to serving the public and understand their frustrations.

“We believe they should be fairly rewarded but our current financial settlement falls far short of what is needed to meet the very significant challenges faced by our public services and workers across Wales.”

They added: “There are more staff working in NHS Wales than ever before, and this year we are investing record levels in training and professional education, £262m, including more training places than ever before.

Support our Nation today

For the price of a cup of coffee a month you can help us create an independent, not-for-profit, national news service for the people of Wales, by the people of Wales.

Notify of
Newest Most Voted
Inline Feedbacks
View all comments
1 year ago

Yet another statement of the obvious. NHS knew 10 or more years ago that they had a manpower crisis that would only escalate with time. Management is clearly not fit for purpose when it can’t or won’t respond to evidence. As for the statement – “The Welsh Labour government needs to step up and be as good an employer as the nursing agencies.” it must come straight out of the Alice in Wonderland text book on funding public services. The RCN is becoming dangerously close to advocating a market led approach to health which puts it squarely in the JRM… Read more »

Mab Meirion
Mab Meirion
1 year ago


1 year ago
Reply to  Mab Meirion

It’s getting like that. There are stories around about nurses being withdrawn from one job so they could be moved to another better paying number elsewhere. And better paying means more commission for the agent and probably better rates for the temp nurse. Grotesque.

Our Supporters

All information provided to Nation.Cymru will be handled sensitively and within the boundaries of the Data Protection Act 2018.