Spending on nursing agencies trebled to £162m in six years - Department slammed for failing to collect data on resigning nurses
Spending on agency nursing staff has tripled to £162m in six years - and the Department of Health has been sharply criticised for failing to collect data on how and why nurses are resigning, according to a new report .
Northern Ireland’s Comptroller and Auditor General Dorinnia Carville says nurses are leaving the NHS due to pressures of work, not feeling valued, and wanting more pay - with many opting to work for agencies instead.
The Royal College of Nursing (RSN), the DUP, and the SDLP all agreed with her that lack of workforce planning is to blame.
In response, the Department of Health (DOH) said that the growth in use of agency staff peaked in 2022-23 and that it recognises that further work needs to be done.
It did not explain why it does not collect data on nurses leaving the NHS.
Ms Carville’s report on ‘The Use of Temporary Nursing Staff in Northern Ireland’ estimated that, if agency staff had been employed at equivalent rates to Health Trusts’ internal bank staff, £186m could have been saved over four years.
Her report says the DOH does not collect data on the number of nurses leaving the NHS and said that the number one requirement to deal with the problem is "a proper evidence-based workforce plan".
Since 2023 nursing agencies have been tied into contracts in a bid to control the prices they charge the taxpayer.
"However, agency rates, introduced as part of this new framework, are substantially higher than in England, including London," she said.
The report notes that, on average, agency nursing staff cost £11 per hour more than staff employed through Trusts.
In March 2025 there were 1,178 vacancies but she says an additional 2,195 nurses are required for safe and effective staffing.
Asked why so many nurses are leaving health trusts to work for agencies, she pointed the News Letter to a survey from the Chief Nursing Officers Group which cited "pressures of work, not feeling valued, and wanting more pay".
Last year's annual Nursing and Midwifery Council survey found that in NI, aside from retirement, 24% left due to physical and mental health combined with burnout and exhaustion, she added.
"So you are seeing a pattern there. We do call on the department to obtain nursing staff retention data on an annual basis, looking at the demographics and using that to factor into a workforce plan."
Upper Bann DUP MLA and Health Committee member Diane Dodds agreed. "Northern Ireland’s health service has become dependent on expensive agency staffing because workforce planning has failed," she said.
She does not criticise nurses employed through agencies. "The responsibility lies with a system that failed to recruit, retain and properly support enough permanent staff."
SDLP Health Spokesperson Colin McGrath said the NHS "does not have enough nurses" and that patients "are being let down by a system that is constantly firefighting rather than planning ahead".
He added: "Every pound spent plugging gaps at premium rates is a pound that could have been invested in training, recruiting and retaining permanent staff."
Professor Rita Devlin of the RCN said spending £162 million on agencies is neither sustainable nor acceptable.
This could employ over 2,600 staff, she said, but the issues won’t be resolved "unless we address the failure to properly plan, recruit and retain nurses".
The Department for Health responded that the report recognises progress it has made in tying agencies into contracts in a bid to control pricing - and that the "growth" in use of agency staff peaked in 2022-23.
It added that agencies are used "to ensure that safe and effective services can be sustained" but that a Planning Group has been formed to reduce their use.
Tying agencies into contracts has already reduced spending by £120m, it said. It has also increased nurses employed by 3,257 or 21.6%.
The Department of Health also provided an additional statement on lack of nurse training places highlighted in the report.
A spokesperson said: “The Department of Health has undertaken rolling strategic workforce planning reviews to estimate regional workforce need over a five-to-ten-year horizon. The outputs, along with additional evidence from Health and Social Care organisations, inform the Department’s annual commissioning of pre- and post-registration training places.
"The Department recognises that workforce planning across HSC needs reform and has committed to working with HSC partners to develop a strategic workforce model to better estimate future workforce requirements. This will support efficient commissioning of training places across all professional groups.
“Sustained investment in pre-registration nursing and midwifery training over recent years reached an all-time high annual intake of 1335 places, across local universities, in recent years. This investment is showing positive results, with a 16% increase in nursing and midwifery staff in post across HSC between March 2019 and March 2024 [based on current data].
“Additionally, internationally recruited nurses are vital in addressing our resource issues. Since 2016 1,666 international nurses have been recruited regionally across the five HSC Trusts through the well-established International Nurse Recruitment project.
“The Health Minister has also recently agreed to commission 1045 Nursing & Midwifery places from the three Northern Ireland universities commencing this autumn, subject to budget agreement.”