Report reveals nursing rip-off by private agencies in north of Ireland

A new report has laid out the scale of public funds Stormont is pumping into rip-off private nursing agencies every year, rather than using in-house staff. The standout figures in The Use of Temporary Nursing Staff in Northern Ireland show the Department of Health (DoH) spent £162 million on agency nursing staff in 2024-25, a figure three times the £52 million frittered away in 2018-19.

Authored by the comptroller and auditor general Dorinnia Carville, the report also reveals the scale of the shortfall in overall nursing staff levels. It shows the region has 17,024 “whole time equivalent registered nurses in the HSC [Health and Social Care] system”. This number is 2,195 short of the nurses needed to provide “safe and effective staffing levels”.

The use of staff from private agencies outside the government-run HSC body is an attempt to cope with this shortage. However, as is usually the case with privatisation in public services, the cost of bringing in agency staff is much higher than HSC employing workers directly. A more cost-effective measure for temporary staff is bringing in ‘bank nurses’. These are workers hired directly by Health and Social Care.

Agencies take a cut from every nurse whose services they provide to HSC. In England, this is capped at £4.87 per hour. However, the Department of Health has not secured this kind of deal, meaning:

…fees have ranged from £2 per hour to £15 per hour.

Six Counties’ agency nurses more expensive than those in London

This has dropped somewhat in May 2025 to a maximum of £10 per hour. Carville states that DoH:

…could not provide an explanation of why the variance is so significant.

Absurdly, this means HSC has been paying higher sums per hour than the NHS does for nurses working in Central London. As the report outlines:

In most of England, this rate is capped at £24.06 per hour while in inner London, which pays the highest rates for agency nurses in England, the comparable rate is capped at £28.87 per hour.

The highest rate paid for agency nurses for night, and Saturday shifts is £36.10 per hour in inner London which is still lower than the £36.86 average hourly rate for Band 5 nurses working standard day shifts in Northern Ireland.

The figures go even higher in some cases. For “Sunday and Bank Holiday shifts” in the Six Counties, some nurses receive £52.10 per hour. In the case of Inner London, the figure is £43.32. Nobody ought to begrudge skilled workers being well-paid for essential work. The issue is the agencies acting as rent-seeking middlemen, hoovering up inflated profits.

Payments dwarfed the agency spend figures for Scotland and Wales, despite those countries’ larger populations. The DoH forked out that £162 million sum in 2024-25, versus £57 million and £79 million for Scotland and Wales respectively during the same period.

Surely for all this spending we’re getting better results, though? Well, you may be shocked to know, that just as with rail, water, buses and any other privatised service, the public not only pays more, but they get worse results. Carville explains how:

…research shows a connection between a high usage of agency nurses with increased patient mortality rates, less work being completed by nursing staff, reduced patient safety levels and lower patient satisfaction.

The comptroller and auditor general also cites an October 2022 statement from then-minister of health Robin Swann acknowledging that use of agencies:

…was not a cost-effective use of taxpayers’ money, and could lead to a lack of workforce continuity, with the potential to undermine patient safety.

Nursing — neoliberalism working as intended

Staff often end up in agencies or leave the profession entirely due to the dire conditions in the public health system generally. These ultimately stem from Tory austerity policies throughout the 2010s that also hit Stormont’s finances. Carville highlights a 2024-25 Nursing and Midwifery Council (NMC) survey which found:

…24 per cent of those surveyed left their roles in the profession due to physical and mental health combined with burnout and exhaustion.

It also showed that:

Just 28 per cent of leavers would promote the profession – with 51
per cent considering themselves active detractors of the profession.

The report said higher agency pay rates:

…caused core staff shortages and an increased dependency on more costly agency staffing.

This is neoliberalism working as intended. Use austerity policies to defund services until the staff crack, and the service breaks. Staff leave their roles for private sector equivalents or quit entirely. Patients gravitate towards private options too. You now have an inflated private sector which the public option must rely on to meet its obligations. More money therefore flows into private coffers, and the literal death spiral littered with deceased patients continues until ultimately public health care is gone entirely.

Carville provides six recommendations for hopefully heading off that dire outcome. Notably, she suggests that:

The Department of Health should consider actions taken in other jurisdictions in the UK to reduce reliance and spend on agency nursing staff and ensure learning is built into future strategies.

Other proposals include introduction of targets to reduce agency usage, and working out how to better retain HSC staff. Addressing the broader dysfunction within Westminster and Stormont was perhaps beyond her remit.

The non-existence of a functioning executive in the Six Counties between 2017-2020 and 2022-2024 prevented major decisions on health care being made. Tory pandemic mismanagement placed a crushing burden on nurses, driving many away. Yet more fundamental is the capitalist system in which oligarchs buy off politicians and ensure austerity policies that crush the ordinary person. Health care is one of the most grave casualties, as this report lays bare.

Featured image via Charles McQuillan/Getty Images