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My Lords, in the 10-year health plan we committed to eliminate agency spending by the end of this Parliament. We are making significant progress. Medical agency spending fell by one-third, from £963.5 million in 2024-25 to £642.6 million in 2025-26. Overall NHS agency spending fell from £2.1 billion to £1.2 billion over the same period, a reduction of 43% and the lowest level on record.
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I thank the Minister. It is important to ask what efforts the Government are making to increase the number of permanent staff against bank or agency work. A friend of mine is a senior mental health nurse, and she tells me that agency staff cannot intervene in a severe mental health situation or give immediate medication in A&E. Can I ask specifically what permanent staffing for mental health nursing is going to be happening, and how can the Government try to increase this, bearing in mind we have an epidemic of mental health issues among young people?
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In the not-too-distant future, the mental health strategy will pull together all of the strands that the noble Baroness and her colleague are concerned with, and she is right to be concerned about them. In all these areas, patient safety comes first. That is the driver as to why we are reducing the use of agency. I agree that the end game in all of this is to increase the numbers of permanent staff, and the forthcoming workforce plan will support us in that.
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My Lords, can the Minister say in the spring of which year the workforce plan will be published?
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On the basis we have moved beyond spring of this year, I can say that, to ensure the workforce plan reflects the new Government we have, the Secretary of State and my colleague, Minister Karin Smyth MP, the responsible Minister, are working to ensure the workforce plan properly reflects the priorities—so I hope we will not be keeping your Lordships’ House or the noble Lord waiting for too long.
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My Lords, we will hear from the Liberal Democrats.
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My Lords, CQC inspections repeatedly warn that caring for unmonitored patients in hospital corridors carries severe safety risks. What assessment have the Government made of the use of agency staff in corridor areas and the clinical risks of deploying such staff in non-designated care areas?
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I am not sure about something that specific. Our whole emphasis is to end spending on agency staff, but patient safety has to come first. That is why we still have some use of agency staff, and where we need temporary staff, using the NHS staff bank, we can call on a pool of healthcare workers who are more established to directly fill temporary shifts. I would not say there is an allocation to what is described as corridor care, because we are also driving it down.
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My Lords, there has not yet been a Labour question during this Question. It will be Labour then the Conservative Benches, please.
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My Lords, does the Minister agree with me that health trusts could do a lot more than they do at the moment to offer flexible hours for nurses and other medical staff? I have known of many cases where nurses, for example, have tried to get flexible hours and, having been refused, then end up coming back as agency staff.
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The key theme my noble friend is raising here is very much about staff retention within the NHS. That is not only the ideal but the practical, best way forward. We are taking action, including, as my noble friend talks about, on flexible working. We are also taking action to make staff feel safer in the workplace, enhancing support for staff health and well-being by, for example, improving access to support for mental health and musculoskeletal conditions. They are the two biggest causes of sickness absence, which also drive demand for temporary cover.
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My Lords, when the permanent staff are asked to do overtime or to fill in, rather than have agency medical staff, they are paid at a lower rate. Why do we not pay them the same rate as the agency medical staff? This would boost morale, lead to more continuity of care and also reduce the hassle of finding agency medical staff.
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Agency staff can cost the NHS more, which the noble Lord referred to. That is why we now have the agency price cap, which did not exist when agency spending rose completely out of control—for example, it stood at around £3.7 billion in 2015-16, because there were limited national controls. The agency price cap is the maximum amount that an NHS trust would normally pay for an agency worker. I do not quite recognise the situation that the noble Lord referred to on NHS staff, but I will take it away and check the situation.
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My Lords, while the Minister talks about reduced agency spending, which is welcome, total temporary workforce costs remain largely unchanged, seemingly displacing into bank premiums, overtime and other insourcing. Will the Minister commit to publishing the total combined costs of flexible staffing, so that Parliament can judge whether taxpayers’ money is actually being saved or merely reshuffled within budget lines?
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I will certainly take away the points that the noble Lord raised, but I do not recognise his description of reshuffling, not least because the requirements on local health providers to reduce agency expenditure are quite clear. They have to report against them and drive further reductions. Those moneys are directed into front-line care. After all, that is what we all want to see.
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My Lords, I thank my noble friend Lady Davies for raising this important point. I will touch on a number of issues that have been drawn together. Within the NHS, there are three very different categories of non-permanent staff—agency, bank and temporary staff—each with different implications for the continuity of care, as my noble friend referred to. Given that agency staff are supplied externally, bank staff are supplied from the trust’s own books and temporary staff are moved between services, can the Minister tell the House whether her department monitors the impact of each of these differences on the continuity of care for patients, including whether patients can see the same doctor, if possible? If so, where is that data available?
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The noble Lord has welcomed our emphasis on the continuity of care. It is the best form of healthcare that we can offer. The only way to do that properly is through an established NHS workforce. The reality is, as noble Lords will be very aware, that there are times that we need to use some type of temporary cover in order to secure patient safety. The main thing is that we are committed—and it will be delivered through the workforce plan—to a more settled workforce and a workforce that can properly provide the care that we need. We are not yet in that place, but the steps that we are taking will get us there.
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My Lords, the Minister quite rightly said that retention is one of the most important things, both for our own staff and the advantage to patients. Yesterday, the Health APPG heard evidence from senior staff in Georgia, USA, who explained that by starting to pay off student loans between three and five years of continuing service, they had managed to retain and get a much more stable workforce. When will the department look at the cost-benefit analysis of such an approach?
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The noble Baroness has not asked me to make a commitment, and I am glad that she did not, because I could not give that commitment at this stage. However, in addition to the action that we are taking, which I referred to earlier in this Question, we are looking broadly at how we can retain people. The cost to individuals is a key matter. The noble Baroness will be aware of the constraints upon us. It is a matter of seeing what else we can do. We are undertaking targeted retention work, not least to understand why staff have left. There are a variety of reasons: some obvious and some less obvious. They all need to be tackled, and we are taking a multifaceted approach.