The NHS’s reliance on agency staff is often framed as a financial or logistical problem. But it’s more than that—it’s a symptom of deeper systemic failures, including the lack of coherent workforce planning and an inability to adapt to societal shifts in working patterns. Recent proposals to ban certain types of agency spend may appear cost-effective, but they risk creating further instability in the short term, prioritising savings over patient care.

If we want a sustainable solution, we need to stop pointing fingers and start addressing the root causes of why agency workers are needed in the first place.

The Workforce Planning Crisis: Not Short-Term, Not Long-Term, Just Reactive

Workforce planning in the NHS is neither proactive nor adequately responsive. Instead, it operates in a day-by-day, week-by-week reactive cycle, where decisions are made to patch immediate gaps rather than addressing underlying issues.

This reactive approach leads to:

• Chronic understaffing in key areas, leaving trusts scrambling to fill shifts.
• A lack of foresight about predictable patterns, such as seasonal demand or retirements.
• Missed opportunities to align resources with actual patient needs.

This constant firefighting isn’t just inefficient—it’s harmful. Patients face delays, staff experience burnout, and agency workers become the default solution, not because they’re ideal but because they’re available.

What’s needed:

1. A workforce planning framework that anticipates future demands while addressing today’s gaps.
2. Regional collaboration to reduce competition between trusts for the same limited talent pool.
3. Planning tools that allow meaningful data on capacity and demand to inform decisions beyond the crisis of the moment.

Wes Streeting’s Proposal: A Dangerous Shortcut

The health secretary’s suggestion to ban agency spend for certain entry-level roles risks compounding the very problems it aims to solve. Yes, agency reliance is costly, but these workers currently keep wards open, services running, and patients cared for.

A sudden ban would:

• Leave critical gaps in staffing, particularly in hard-to-fill roles or during unexpected demand spikes.
• Overburden substantive staff, leading to increased burnout and moral injury.
• Compromise patient safety and service delivery, prioritising cost-cutting over care.

This proposal feels like a blunt instrument—a political move to save money on paper rather than a patient-centric strategy to address the root causes of agency reliance. Without addressing the underlying planning and retention issues, a ban risks destabilising an already fragile system. Covering these gaps through recruitment will take time.

Why Staff Turn to Agency Work

Agency workers aren’t the cause of the NHS staffing crisis—they’re the product of it. Many healthcare professionals leave substantive roles not for higher pay but for greater flexibility and autonomy, which the NHS fails to provide.

In today’s society, working habits have shifted:

1. Flexibility is a Priority: Professionals want control over their schedules and work-life balance. Agency roles offer this freedom, while substantive NHS roles often don’t.
2. Burnout is Rife: Moral injury—where staff are unable to provide the care, they know patients deserve—drives many to seek roles where they can regain emotional and professional stability.
3. Generational Expectations Have Changed: Younger professionals value flexibility, purpose, and mental health support, yet the NHS’s rigid structures have been slow to adapt.

The NHS must recognise these shifts and redesign substantive roles to compete with the flexibility offered by agency work.

Contingency Staff: Necessary, But Only for Now

Agency and bank staff play a vital role in keeping the NHS running today, but their necessity reflects systemic failures that must be addressed. They are a temporary solution, not a long-term strategy.

To reduce reliance on agency workers, the NHS must:

• Embed Flexibility in Permanent Roles: Allow staff to adjust their hours and responsibilities to meet their personal and professional needs.
• Address Burnout and Moral Injury: Support staff well-being through manageable workloads and mental health resources.
• Plan for Realistic Capacity: Move beyond reactive approaches to build a workforce model that aligns with patient needs at both a regional and national level.

A System Stuck in the Past

The NHS isn’t just competing for staff within healthcare—it’s competing with industries that have embraced modern working practices. Flexible hours, remote options, and well-being initiatives are no longer perks; they’re expectations. This is a point I believe some miss, just because you have trained to work in healthcare does not mean you will inevitably work in the NHS.

Healthcare roles won’t always lend themselves to such practices, but the NHS must find ways to adapt. Without modernisation, substantive roles will continue to feel untenable for many workers, and agency reliance will persist.

The Bigger Picture: Pragmatism Over Politics

The staffing crisis is not a budgeting issue—it’s a workforce issue. Blaming agencies and banning spend doesn’t solve the problem. It just pushes it deeper into the system, with patients paying the price.

The government’s 10-year NHS plan must include:

1. Strategic Workforce Planning: Build a model that anticipates future demand, aligns resources, and plans for retention.
2. Flexibility and Inclusion: Redesign roles to reflect the needs of a modern workforce, including options for part-time or flexible contracts.
3. Data-Driven Decisions: Use real-time insights to plan staffing effectively and reduce the need for reactive solutions.

A Call to Action

The NHS doesn’t need sticking plasters or headline-grabbing bans. It needs structural reform—reform that acknowledges the realities of today’s workforce, proper planning that prioritises patient care, and supports staff well-being.

Agency workers shouldn’t be vilified for stepping in where the system has failed. Instead, we must focus on creating a system where substantive roles are desirable, flexible, and sustainable. Only then can we build an NHS that works for everyone—patients, staff, and society.