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The eye-watering amount the Welsh NHS spends on agency staff

The eye-watering amount the Welsh NHS spends on agency staff thumbnail

The Welsh NHS spent a colossal £260m on agency and bank staff in the last year to help fill gaps in rotas, new figures have shown. The Royal College of Physicians (RCP) in Wales claims the spend for 2021-22, which is up 36% when compared to the previous financial year (£191.5m), highlights chronic and serious shortages in the workforce.

Aneurin Bevan University Health Board, which covers south-east Wales, spent the most on agency and bank staff in 2021-22 with £57.5m followed by Betsi Cadwaladr UHB (£48.8m), Cwm Taf Morgannwg UHB (£48m), Hywel Dda UHB (£37.5m), Swansea Bay UHB (£34.6m), Cardiff and Vale UHB (£23.7m), and Powys Teaching (£10m). In the past five years agency spend has almost doubled with the total increasing by 98% since 2017-18.

Agency nurses, who are often paid substantially more than permanent NHS staff, are typically brought in by health boards across Wales due to high vacancy rates or sickness levels. Meanwhile bank staff are used as a less expensive alternative mode of flexible workers who want to work in the NHS when there is a need for temporary workers. The Royal College of Nursing estimates there are around 3,000 nursing vacancies at present.

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Dr Olwen Williams, RCP vice president for Wales, said without “root-and-branch reform” of social care and a new approach to long-term workforce planning across the whole sector the system will “continue to collapse in on itself slowly but surely”. She said: “Staffing shortages are the biggest challenge we face right now. No amount of financial investment in the NHS can make up for the fact that we simply don’t have enough doctors, nurses, and social care workers to keep up with patient demand.

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“While agency workers can help the NHS to maintain staffing levels in an emergency becoming overly reliant on locums can have a negative effect on continuity of care, patient safety, and team morale. NHS staff are working flat out but there simply aren’t enough of us. Ultimately we need to know how many staff are needed to keep pace with patient demand but at the moment we just don’t know the scale of the problem. We’re flying blind.

“We are expecting a funded, detailed workforce plan from the Welsh Government in the coming weeks and we are keen to work with our colleagues across government and the NHS to make sure it makes a difference to people’s lives. Yes, having a plan is the start of the process, and clearly there’s a lot of work ahead of us to implement it, but knowing where we’re going and how we’re going to get there is a vital first step towards coordinated system-wide action.



Dr Olwen Williams, a consultant physician at Besti Cadwaladr University Health Board and vice president of the Royal College of Physicians (RCP)

She added: “Many doctors in the Welsh NHS want to work more flexibly, with increased control over their own hours and work–life balance and the ability to choose where they live and what they do at work. And why not? Rates of burnout and exhaustion are at a record high among NHS staff. Giving people more autonomy about where, how and when they work could stop people from leaving the health and care sector entirely.”

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The total cost of using agency staff and bank staff in each of the last five financial years, broken down by health board (in millions):

Agency costs Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Morgannwg Hywel Dda Powys Teaching Swansea Bay Wales total
2017-18 18,170 34,162 8,776 21,387 24,821 4,661 19,518 131,495
2018-19 21,103 31,636 11,340 23,393 20,541 5,177 26,282 139,472
2019-20 27,039 38,128 12,008 41,843 22,891 5,449 23,423 170,781
2020-21 40,823 40,841 14,238 41,482 22,516 6,161 25,436 191,497
2021-22 57,508 48,791 23,749 48,014 37,488 10,036 34,629 260,215

RCP Wales has launched a new briefing paper that calls on health boards to further develop and recognise the skills, expertise, and contribution of specialist and specialty (SAS) doctors in Wales. On Thursday the Welsh Government will meet leading health unions to discuss, among other things, how to reduce the NHS’ over-reliance on agency staff. The spend on agency staff represents less than 6% of NHS Wales’ pay bill.

A Welsh Government spokesman said: “We would be pleased to work with the Royal College of Physicians in Wales to consider how we could develop new ways of working as we implement the National Workforce Implementation Plan to deal with current pressures. 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. The increase in the costs of agency staffing in both 2020-21 and 2021-22 reflects the impact of the pandemic.

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“We recognise the role of specialty and associate specialist (SAS) doctors as a highly valued and vital part of the medical workforce in Wales. NHS Wales Employers are working in social partnership with the SAS committee to revisit the SAS charter which demonstrates a commitment to supporting and developing the role. The Workforce Strategy, published by Health Education and Improvement Wales and Social Care Wales, sets out a long-term vision for the health and social care workforce.”

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