Agency nursing staff in Northern Ireland can earn over £36 an hour, well above the top rate of £28 offered in London.
The findings in a new report from the Audit Office also found that despite efforts to hire more full-time nurses, spend on expensive agency staff remained “extremely high” and has trebled from £52m in 2018/19 to £162m in 2024/25.
Experienced agency staff used by Trusts in Northern Ireland were on an average hourly rate of £36.86, up to a maximum of £39.39.
This is “much higher” than most of England, where the top rate is capped at £24.06, while for inner London the maximum rate for band 5 nurses is £28.87.
In 2023, the introduction of a new agency nursing framework sought to end the use of “very expensive off-contract nursing agencies” but the audit office said the reality was that agencies retained a strong grip on the market and could still command high fees.
A failure from the Department of Health to compare agency nurse prices with other UK regions for the framework was described as “a missed opportunity” that could have resulted in “substantial savings.”
The Northern Ireland Audit Office say the Department of Health failed to compare what agency nurses were being paid in England, Scotland and Wales.
With an estimated extra 2,195 nurses needed to ensure safe and effective staffing levels for the health service, the audit office said the £162m spent on agency staff was the equivalent of hiring over 2,600 experienced nurses.
Earlier this week, the Royal College of Nursing in Northern Ireland warned that a decline in the number of registered nurses and increasingly complex patient needs had become a threat to patient safety.
Although the use of temporary nursing staff to fill rota gaps is “inevitable,” the audit office welcomed an increased use of the health service’s bank system – which uses temporary registered nurses that are directly employed by trusts and cost £11 less an hour than agencies.
The combined cost of using agency and bank staff in 2024/25 was £258m.
In recruitment, it was found that the number of full-time nurses in Northern Ireland has increased from 14,000 in 2019 to 17,000 in 2025 and that nursing vacancies were down by 45% in this period.
But the audit office says this does not fully reflect workforce need, and that the 1,178 nursing vacancies advertised in 2025 were well below the 2,195 nurses needed to ensure safe and effective staffing levels.
Dorinnia Carville, Comptroller and Auditor General for Northern Ireland, said better workforce planning was needed to recruit more nurses. (Liam McBurney/PA)
Comptroller and Auditor General, Dorinnia Carville, called for greater workforce planning and noted a much lower spend on agency staff in England, Scotland and Wales despite their larger populations.
“Nurses clearly play a pivotal role in our health and social care system, both in terms of their range and volume of direct contact with patients, and because they represent around a quarter of the system’s overall workforce,” she said.
“While the use of temporary staff to fill short term workforce gaps is inevitable to some degree, this must be planned and managed effectively to ensure the long-term sustainability of services. “
“The introduction of a new agency framework has delivered some important improvements, but agency costs remain high and better value for money could be achieved.”
The Department for Health said the report “recognises the progress that has been in recent years at ending the use of off-contract agency nurses while also noting that the growth in expenditure on nursing agency staffing has ceased with the peak recorded in the 2022-23 financial year.”
It also pointed to a new nursing and midwifery framework for agency workers, saying it had cut spending by £120m.
In a statement, the department added: “Alongside this, significant progress has been made in recent years to stabilise and grow the HSC workforce. Across HSC, the Department’s strategic approach to workforce development (as articulated in the HSC Workforce Strategy) has supported sustained increased investment in pre-registration education and training, which has facilitated a 19.5% increase in whole time equivalent staff directly employed across the HSC.”