Annual expenditure on agency nursing staff in Northern Ireland has
tripled in six years, reaching £162 million in 2024-25, with some hourly
rates paid to nurses exceeding those paid in London. These are among
the findings of a report published today (Wednesday 27 May 2026) by
Northern Ireland’s Comptroller and Auditor General.
Dorinnia Carville’s report on “The Use of Temporary Nursing Staff in
Northern Ireland” follows a 2020 Northern Ireland Audit Office publication
on “Workforce Planning for Nurses and Midwives”. Today’s report notes
that annual permanent nursing and midwifery staff costs reached a total
of £1.1 billion in 2024-25 (the vast majority of these posts are nursing
staff). The registered nursing workforce has increased since the 2020
NIAO review (from around 14,000 whole time equivalent nurses in March
2019 to around 17,000 at March 2025). Reported nurse vacancies have
decreased by 45 per cent over the same period.
However, the report finds that major issues and challenges persist. It
highlights that, in 2024-25, Health and Social Care Trusts spent £258
million on temporary nursing (and midwifery) staff, with more than eight
million hours of temporary cover commissioned.Particular concerns are
highlighted around a growing and costly reliance on agency staff. Over
£160 million was spent on agency nursing staff in 2024-25, with
expenditure levels having tripled since 2018-19. An agency nursing
framework, introduced in 2023, has helped to largely eliminate the use of
very expensive off-contract nursing agencies, a practice previously
prevalent across Trusts. However, agency rates, introduced as part of this
new framework, are substantially higher than in England, including
London. For example, maximum hourly rates for Band 5 agency nurses
are at least 35 per cent higher than in most of England, and can be up to
64 per cent higher in some cases.
Agency nursing remains significantly more expensive than other
temporary nursing solutions. The report notes that, on average, agency
nursing staff cost £11 per hour more than staff employed through Trusts’
internal bank system (these staff are employed directly by Trusts). It
estimates that, had agency staff had been engaged at equivalent bank
rates, the system could have saved up to £186 million over the last four
years.
Weaknesses in workforce planning are also identified. While reported
registered nursing vacancies have reduced in recent years, the report
finds that vacancy data does not fully reflect workforce need. The number
of reported registered nursing vacancies at March 2025 (1,178) reflects
the number of funded job roles being actively recruited. However, the
Department of Health estimates that an additional 2,195 nurses would be
required to ensure safe and effective staffing levels. The report also found
limited evidence underpinning decisions on the number of nursing training
places commissioned, with adequate workforce planning absent.
Commenting on the report’s findings, Dorinnia Carville said:
“Nurses clearly play a pivotal role in our health and social care system,
both in terms of their range and volume of direct contact with patients,
and because they represent around a quarter of the system’s overall
workforce. While the use of temporary staff to fill short term workforce
gaps is inevitable to some degree, this must be planned and managed
effectively to ensure the long-term sustainability of services. “
“The introduction of a new agency framework has delivered some
important improvements, but agency costs remain high and better value
for money could be achieved. Today’s report recommends that clear and
targeted action is taken by the Department to reduce agency nursing
usage and expenditure. Improved workforce planning is also required to
identify workforce needs and establish a sufficient pipeline of
appropriately skilled staff. This should entail greater use of more cost effective solutions such as internal bank staff, as well as more accurate
and complete workforce data. We have also recommended that the
Department considers actions and approaches taken to tackle these
issues in other UK jurisdictions such as Scotland and Wales, which have
both reported significantly lower levels of expenditure on agency staff
despite their larger populations.”
ENDS
