Agency bills draining NHS budgets

Published: 30/11/2021

RCoA calling for an urgent increase in higher anaesthetic training places to support the elective recovery and invest in the future of the NHS

The Royal College of Anaesthetists is warning that a combination of chronic workforce gaps1 and high staff sickness means that anaesthetic departments are incurring large agency bills to meet targets to deliver additional operating capacity.

While agency anaesthetists are a useful resource to draw on to offer short term cover, some Clinical Directors for anaesthesia have told the College that they have had to spend hundreds of thousands of pounds on agency locums to make up for the longstanding workforce shortfall in their departments. These staffing gaps endanger emergency cover and can lead to cancellations of more routine procedures at short notice.

This is made all the worse coming fresh on the heels of a defeat in the Commons of an amendment to Clause 34 of the Health and Care Bill that would have required the government to publish independently verified assessments of current and future workforce numbers every two years. 

Without a plan to fill the current gap of 1400 senior anaesthetists, the elective recovery is in jeopardy, so the College is calling for an increase of 100 higher anaesthetic training places a year over the next four years. Anaesthetists in higher training have already completed up to nine years of medical training and, under the supervision of fully qualified staff, provide care for patients needing emergency and planned services, while also gaining the skills they need to contribute to the NHS for many years to come. This will go some way to providing a stable workforce for the future.

Dr Fiona Donald, President of the Royal College of Anaesthetists, said:

“The NHS workforce is at a critical junction, with numerous staff leaving or retiring and higher training places not available to many, hospitals often have no other option than to employ expensive locums as a temporary fix. However, papering over the capacity cracks with costly short-term staff is not the answer and will ultimately be to the detriment of the NHS’s sustainability, and their bottom line.

“We have to remember that this isn’t just about dealing with the immediate backlog of operations, it’s also about building back a better NHS. With so many anaesthetists in training eager and qualified to apply for higher anaesthetic places it is simply not logical for the government to delay the investment we are calling for, especially when Clinical Directors are telling us they are spending upwards of £300,000 for just one locum. An extra 400 training places over four years could go a long way not only to reducing agency staff costs, but to also providing additional capacity, now and in the years to come.

“The Secretary of State said last week that he is serious about tackling the elective waiting list and recovering the NHS. We are saying that his plans must include investment in the anaesthetic workforce. With anaesthetic services so critical to the recovery and the future of the NHS, anything less than what we are calling for will harm the building back of healthcare services and ultimately cost the government significantly more money.”

Case studies from our network of Clinical Directors (anaesthesia)

“We have had one agency locum working 4 days per week for about a year. Assuming he took some annual leave, he has probably worked about 180 days over the last 12 months, costing £316,800.”

“We used locum consultant anaesthetists for 321 days from April 2020 until April 2021 and 96 days from April 2021 until August 2021 - estimated cost £733,920.”


  1. There is currently a gap of 1,400 consultant anaesthetists in the United Kingdom – RCoA Medical Workforce Census Report 2020.