Nursing vacancies fall but temporary staffing remains a major NHS cost

Nursing vacancies have fallen sharply as the NHS has expanded its permanent workforce, but the health service continues to spend billions of pounds on temporary staffing as trusts attempt to maintain staffing levels across services.

The latest figures show that the NHS has made substantial progress in reducing its reliance on agency staff, but the cost of temporary staffing remains significant despite years of national efforts to bring it down.

The issue highlights a more complicated workforce picture than vacancy numbers alone suggest.

Nursing vacancies have fallen substantially

The permanent nursing workforce has grown considerably since before the pandemic.

NHS England reported that the substantive nursing workforce increased by 65,339 full-time equivalent staff between September 2019 and June 2024, representing a 22.4% increase.

Over the same period, the number of substantive nursing vacancies fell by 11,057 FTE to 31,049.

That reduced the nursing vacancy rate from 12.5% to 7.9%.

The figures represent a significant improvement in the availability of permanent nursing staff.

However, 31,049 vacant nursing posts still represented a substantial workforce gap, particularly when combined with demand for temporary cover, sickness absence, staff turnover and fluctuations in clinical activity.

The vacancy picture also varies considerably between different parts of the nursing workforce.

NHS England reported that mental health nursing had a vacancy rate of 16.1% in June 2024, compared with 6.2% for acute nursing.

That variation means trusts cannot necessarily solve workforce shortages simply by increasing the overall number of nurses employed.

Agency spending has fallen, but remains substantial

There has also been a major reduction in NHS agency expenditure.

Total agency spending by NHS trusts fell from £3.46bn in 2022/23 to £3.02bn in 2023/24 and then to £2.07bn in 2024/25.

The latest figures show a further reduction.

NHS England's 2025/26 financial outturn recorded agency expenditure of £1.18bn for the year, compared with £2.07bn in 2024/25.

The government has therefore been able to point to significant progress.

In June 2026, NHS England reported that total agency spending had almost halved during 2025/26, from £2.1bn to £1.2bn.

But the figures should be put into context.

Although agency expenditure has fallen, NHS trusts still spent £6.19bn on bank staffing during 2025/26.

Combined bank and agency expenditure was £7.37bn.

The cost of temporary staffing therefore remains a substantial part of NHS workforce expenditure.

Nursing has historically accounted for a large share

Nursing has been particularly important to the temporary staffing picture.

Government figures show that NHS spending on agency nurses increased from £838m in 2020/21 to £1.1bn in 2021/22 and then reached £1.37bn in 2022/23.

The figure subsequently fell as the NHS introduced stronger controls on agency staffing and increased permanent recruitment.

NHS England's broader figures show that non-medical agency expenditure fell by around £438m, or 19%, in 2023/24.

At the same time, spending on bank staff increased by 8.6%, from £4.4bn to £4.7bn.

That shift is important.

Reducing agency use does not necessarily mean eliminating temporary staffing.

Some trusts have moved workers from expensive external agencies into internal bank arrangements, allowing them to retain access to a flexible workforce while reducing agency margins and procurement costs.

The NHS wants to go further

The government is now pursuing a much more aggressive reduction in temporary staffing.

NHS England's 2025/26 financial guidance required systems to reduce agency expenditure by 30% compared with their existing spending position.

It also set an expectation for bank spending to fall by at least 10%.

The longer-term ambition is to eliminate agency spending altogether.

The government reiterated that ambition in June 2026, saying it wants to eliminate agency spend by the end of the current Parliament.

NHS England is also supporting trusts to develop larger in-house and collaborative staff banks, with the intention of creating a more flexible pool of workers without relying on commercial agencies.

The approach is based on the argument that the NHS can access much of the same temporary workforce more cheaply through its own staffing arrangements.

Falling vacancies do not remove the need for temporary cover

One reason the issue is unlikely to disappear simply because vacancy numbers have fallen is that a vacancy is only one component of staffing demand.

Trusts need enough staff to cover annual leave, sickness absence, maternity leave, training and fluctuations in demand.

A trust can therefore have a much smaller permanent vacancy rate while still requiring temporary staff to maintain safe staffing levels.

NHS England's workforce evidence shows that monthly use of the temporary nursing workforce increased by around 3,800 FTE between September 2019 and June 2024.

That increase was largely driven by higher use of bank nurses, which rose by around 6,800 FTE over the period.

This helps explain why falling permanent vacancies have not translated directly into the disappearance of temporary staffing.

The cost difference is driving policy

The financial incentive to reduce agency use is substantial.

NHS England has introduced agency price caps, approved procurement frameworks and expenditure limits in an attempt to prevent trusts paying excessive rates for temporary staff.

The Department of Health and Social Care has also acknowledged that off-framework agency staffing can come at a premium compared with agreed framework rates.

NHS England has described agency margins as an unnecessary cost where the same flexible workforce can be accessed through other models.

The policy direction is therefore increasingly clear.

Where a trust needs temporary staff, the preferred route is becoming its own bank or a collaborative NHS bank rather than an external agency.

But workforce pressures have not disappeared

The falling vacancy rate should not be interpreted as evidence that nursing workforce pressures have been solved.

NHS England has highlighted continued differences between nursing specialties, while the long-term workforce plan warns that the NHS will continue to require substantial expansion of nursing education and training.

There are also emerging concerns around the transition from training into employment.

In 2026, NHS England reported that more newly qualified nurses were struggling to secure NHS employment after graduation, with high staff retention and organisational changes contributing to fewer vacancies in some areas.

That creates an unusual workforce situation.

The NHS can simultaneously have fewer established vacancies, significant temporary staffing expenditure and newly qualified nurses struggling to find permanent posts.

The challenge is increasingly one of matching workforce supply to the right locations, specialties and services.

From recruitment to workforce utilisation

The figures suggest that the NHS has moved into a different stage of its workforce strategy.

The immediate priority during the post-pandemic period was to increase the permanent nursing workforce and reduce large vacancy gaps.

That effort has produced measurable results.

But the next challenge is making sure the workforce is used efficiently enough to reduce the need for expensive temporary cover.

Agency spending has fallen dramatically, but billions of pounds are still being spent on temporary staffing when bank and agency expenditure are considered together.

For NHS trusts, the question is therefore no longer simply how many nurses they employ.

It is how many permanent staff they need, how effectively those staff can cover demand, how much temporary capacity is genuinely required and whether that capacity can be provided through NHS banks rather than commercial agencies.

The government has set an ambitious target of eliminating agency spending.

With nursing vacancies already considerably lower than they were before the pandemic, the next test will be whether trusts can convert that improvement in permanent staffing into a sustained reduction in their dependence on temporary workers.

The numbers suggest the NHS is moving in that direction.

But the £7.37bn still spent on bank and agency staffing in 2025/26 shows that temporary staffing remains a major part of the health service's workforce model.