Welsh health board spends around £1m a month on locum and agency staff

Around £1m is spent every month on locum and agency staff to support key hospital services in Swansea Bay. The figures vary from month to month, peaking at just under £1.4m in February this year after dropping to around £700,000 last October. They were just over £1m in March 2022.

A report by Swansea Bay University Health Board said “off-contract” agencies were sometimes used for locums to fill gaps, meaning the costs were “hidden” until they were processed by the accounts team. The report said work was being done to limit this usage. General medicine accounts for the highest locum and agency spend by far, followed by psychiatry, obstetrics and gynaecology, and surgery.

The health board’s workforce and organizational development committee report said: “The data is showing that gaps within the rotas remain a significant challenge and account for approximately 48 per cent of locum duties.” All five health boards in Wales use locum and agency staff, and although the costs are not inconsiderable they are a fraction of the overall workforce budget. You can get more Swansea news and other story updates by subscribing to our newsletters here.

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A factor in these costs is rates of pay. The report said Swansea Bay University Health Board needed to do more to reduce the proportion of hours worked by locum and agency staff which were above “capped” rates. All agency hours in April were above capped rates, while just under a third of locum hours were.

A separate report before the committee said a clear instruction has been proposed by health board chiefs that locums must not be booked “off-contract” as this was not authorized.

The committee, which met on June 14, were told of successes in recruiting and retaining staff. Examples include the recruitment of 117 newly-qualified overseas nurses and 33 newly-qualified UK nurses between October last year and the middle of May this year. And 62 doctors have been appointed in the first four months of 2022.



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Meanwhile, a range of staff have been asked what working for the health board was like and what attracted them in the first place. Many clinicians felt a stronger sense of togetherness since the Covid pandemic, but there was also a sense that positive stories weren’t celebrated, and many staff didn’t know what other teams did. Swansea Bay’s location – offering beach and city life – was seen as a positive, but the recruitment process was felt to be too slow. The responses are shaping new branding to be used in future recruitment material.

The committee was also presented with findings from an external independent service which offers staff a confidential way of raising concerns. Two of the 74 concerns raised between April 2021 and the end of the March this year were about patient safety. The majority related to management and behavioral concerns. Nearly half of the 74 concerns were from nursing and midwifery teams. Staff sickness absence across the health board stood at just over 8 per cent in March. In recent months it has been higher than Wales’s four other health boards.

Speaking about locum and agency costs, health board executive medical director Dr Richard Evans said locum and agency medics were needed to cover absent doctors or temporary vacancies. “Locums can be internal, where our own staff voluntarily undertake additional paid shifts, or from a dedicated locum agency,” he said.

“This comes with an inevitable cost which has been unavoidable due to the recruitment issues which have affected the entire NHS, as well as the need for staff to self-isolate if they test positive for Covid. However, our locum costs have begun to fall. and we have a dedicated team undertaking innovative work to improve and speed up the recruitment process for our whole clinical workforce, whether that be doctors, nurses or healthcare support workers.”

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