The Great NHS Staffing Hypocrisy: How Government Rhetoric Masks the Reality

In recent years, successive UK governments have made private healthcare recruitment agencies a convenient political scapegoat. Headlines scream about "£3 billion wasted on agency staff" while government ministers denounce these agencies for "fleecing the taxpayer." Yet behind this rhetoric lies a startling contradiction: the government itself operates one of the largest healthcare staffing organizations in the country—NHS Professionals Limited (NHSP)—which turns a healthy profit while performing essentially the same function as the agencies it criticizes.

The Government's Double Standard

NHS Professionals Limited is a staffing organization wholly owned by the Secretary of State for Health and Social Care. According to its financial statements, NHSP has made pre-tax profits of £59 million over the past five years while paying out dividends of £38 million to the government during the same period. Its net assets stand at an impressive £71.1 million, representing significant value created from what is essentially a staffing agency model.

Over this period, NHSP has generated substantial turnover, charging the NHS billions for its services while simultaneously paying dividends to the government. This raises a fundamental question: why is profit acceptable when it flows to government coffers but condemned when earned by private businesses providing the same essential service?

The £3 Billion Myth Debunked

The oft-cited figure of "£3 billion spent on agency staffing" requires closer examination. A significant portion of this sum returns directly to the government as VAT and other taxes, while the vast majority goes directly to healthcare workers themselves, the grass roots of the NHS. Only a small fraction actually goes to agencies to cover their operating costs and generate modest profits.

When accounting for total employment costs, including employer's National Insurance, pension contributions, and the apprenticeship levy, agency healthcare workers represent better value for money to the public purse than permanent staff. The full cost of employing permanent NHS staff is frequently higher than the equivalent agency rate once all associated expenses are factored in.

NHSP's Questionable Practices

Evidence suggests that NHS Professionals has systematically transferred workers away from private agencies by promising to match agency pay rates—a practice that potentially breaches the Agency Workers Regulations 2010. Under these regulations, when a worker transfers from an agency to a client (in this case, the NHS via NHSP), proper transfer fees must be paid if the worker has been in place for less than 14 weeks or proper notice given if in place for less than 8 weeks.

By circumventing these regulations, NHSP not only undermines legitimate business arrangements but also creates a situation where staff may be paid different rates for identical roles, potentially breaching equal pay regulations. This practice increases costs to the public purse while creating the illusion of reduced "agency spend."

The Real Crisis on NHS Corridors

While politicians focus on demonizing agencies, the true crisis in NHS staffing goes unaddressed. Many shifts now being posted on healthcare staffing platforms like HealthRoster are classified as "corridor shifts"—a stark indication of the deteriorating conditions in our hospitals, where patients are routinely treated in hallways due to lack of proper bed space.

The severity of the staffing crisis is further illustrated by recent evidence that one trust was fined a significant sum in April alone for cancelling surgical lists because they couldn't secure enough staff. These cancellations not only waste resources but delay critical care for patients, highlighting the real cost of inadequate staffing solutions.

Recent surveys of healthcare workers reveal the essential role that temporary staff play in maintaining NHS services. The vast majority believe they are essential for filling critical gaps in care and that without their support, permanent staff would become overworked, leading to burnout. Almost none believe permanent staff could adequately cover the gaps without temporary support.

The NHS Long Term Workforce Plan: Contradiction and Reality

The NHS Long Term Workforce Plan acknowledges that temporary staffing is "integral to NHS operations," yet simultaneously aims to reduce agency usage from 9% to 5% by 2032/33. The plan promotes NHS staff banks as the "preferred alternative" to agency work, despite evidence that this approach often increases costs rather than reducing them.

The workforce plan's strategy to "discourage staff from returning to the NHS via agencies" and instead direct them to "local staff banks" overlooks a crucial reality: only a small percentage of current agency workers say they would seek permanent NHS roles if agency work became unavailable. The majority would move to private healthcare, change careers entirely, or leave the profession—representing a potential exodus of skilled professionals from an already understaffed healthcare system.

What's Really Happened?

The government's campaign against private agencies has achieved two things:

1. It has increased costs to the public purse by shifting work to often more expensive bank systems

2. It has moved expenses to different budget lines, creating the political illusion that the "agency problem" has been addressed

In reality, the government should be proud of the fact that it has largely eradicated high-charging off-framework agencies. Now is the time to work with those remaining to help achieve their goals for the NHS so that it can continue to lead the world in free healthcare.

Time for Honest Conversation

Rather than scapegoating private agencies while quietly profiting from the same business model, the government should acknowledge the vital role that all flexible staffing solutions—whether private or state-owned—play in maintaining our healthcare system.

It is a fact that no organization of this size can work without a level of flexible workforce, and agencies are a vital and economic way of solving this problem. Healthcare staffing agencies emphasize their willingness to work with the government to create a sustainable and fair solution for NHS workforce planning into the future.

The focus should be on developing integrated workforce strategies that optimize both cost-effectiveness and service quality, ensuring the NHS maintains the flexibility it needs while delivering the best possible care to patients.

When the Secretary of State for Health criticizes private agencies while simultaneously operating a profitable staffing business that employs the same model, it's not just hypocrisy—it's a distraction from addressing the fundamental staffing challenges facing our healthcare system.

It's time for an honest conversation about NHS staffing that moves beyond political point-scoring and focuses on sustainable solutions that benefit patients, healthcare workers, and taxpayers alike.