September 2025
An Acacium Group white paper
In partnership with Cavell
Executive summary
The UK health and social care system is experiencing an unprecedented level of pressure, driven by workforce shortages, financial constraints and increasing patient demand. In this context, flexible workers (those employed through bank and agency models) play a critical role in sustaining care delivery and supporting system resilience. Access to the flexible workforce enables services to respond swiftly to changing demands, while also facilitating career mobility, workforce re-entry and retention. This adaptability is a vital component of long-term workforce sustainability and strategic workforce planning.
This white paper, based on analysis of over 26,000 responses from Acacium Group’s flexible workforce, offers a comprehensive view of their experiences, challenges and contributions across more than 1,000 client sites nationwide.
Future outlook
The proportion of workers expecting to stay in their roles over the next 5 -10 years has dropped from 55% to 41%. 11% are considering leaving, citing pay, working conditions as well as retirement.
The role of flexibility
The ability to work flexibly remains crucial to workforce sustainability. Workers are primarily motivated by work-life balance (36%), with financial needs and career development ranking as the second and third most important motivators.
Patient safety concerns
21% of flexible workers raised concerns about patient safety, with staffing shortages (65%) and burnout (13%) cited as major risks. NHS settings were perceived as less safe than private ones, particularly regarding staffing levels.
Mental health and wellbeing
While most staff rated their mental health as “good” or “excellent”, 27% reported taking time off due to illness, with 19% citing mental health as a contributing factor.
Discrimination and Inclusion
Reports of those experiencing discrimination fell 7% year-on-year, but disparities remain. Disabled staff were twice as likely to experience discrimination, with women and LGBTQ+ staff also disproportionately affected.
Financial stress and retention risks
Nearly half (46%) of respondents worry about meeting essential living costs and 29% have considered leaving the sector due to financial stress. Only 17% feel financially prepared for emergencies, highlighting widespread economic vulnerability.
Table of contents
The UK healthcare market: The big picture
Public satisfaction with the NHS reached a record low in 2024, with only 21% expressing any satisfaction and just 2% saying they were very satisfied.[i] In response, the government published its 10 Year Health Plan in July 2025, outlining its vision to ‘shift care delivery from hospitals to communities, from analogue to digital systems and from reactive treatment to proactive prevention’.[ii]
A key element of the government’s workforce policy, outlined in the letter “Temporary Staffing: Reducing Agency Spend”,[iii] is the ambition to eliminate agency use and save £1 billion over five years. While this signals a clear direction, it overlooks the persistent need for flexible staffing. Although the number of substantive nurses and doctors has increased by 25% and 26% respectively over the past five years, the NHS still faces a shortfall of 106,000 roles, highlighting that workforce growth alone hasn’t resolved underlying gaps.[iv] With framework agency use already at a record low, and financial incentives to make bank work more attractive becoming increasingly unaffordable, the feasibility of achieving the savings target remains uncertain.
High turnover, burnout, and regional imbalances continue to strain services. Although the hospital waiting list fell to 7.39 million in April 2025, more than 300,000 pathways are still waiting over a year for treatment, and around 40% face delays beyond the 18-week target.[v]
These pressures have led more people to seek private care. In 2024, private hospital admissions reached a record 939,000, a 3% increase from the previous year.[vi] Insurance-funded admissions rose by 6% and although self-pay activity dipped slightly, it remained 38% above pre-pandemic levels, making 2024 the third-highest year on record for self-funded care.[vii]
Flexible staffing, including bank, agency and other contingent workers, has played a crucial role in maintaining NHS services, particularly during the pandemic. Many staff choose this model because it offers flexibility that supports caring responsibilities and personal wellbeing. While not a replacement for long-term workforce planning, flexible staffing is a critical part of effective workforce management and should be included in future planning to ensure resilience and continuity of care.
In recent years, the system’s reliance on temporary staffing has shifted rather than declined. In 2022–23, NHS spending on bank staff in England reached £5.8 billion, compared to £5.1 billion on agency staff, highlighting the continued importance of flexible staffing in maintaining service delivery.[viii]
While the government’s plan to reduce agency use aims to improve sustainability and redirect funding to core services, this ambition is not without challenges. Previous efforts to reduce temporary staffing have often struggled due to persistent workforce shortages and the need for rapid responsiveness during periods of high demand.
As the NHS moves toward more integrated, neighbourhood-based and digitally enabled care, the role of flexible staffing will need to adapt. Delivering care across a range of settings, rather than within a single acute provider, requires a workforce that is mobile, responsive and confident working across boundaries. Staff with portfolio careers or experience in flexible roles are often well suited to this model, offering the adaptability needed to support both service resilience and personal wellbeing.
Understanding how flexible staffing fits within broader health strategies and how it can be used effectively and affordably will be key to delivering sustainable reform.
The evolving landscape of flexible work
The NHS has announced a target to reduce agency staffing expenditure by 30% in the upcoming financial year,[ix] reflecting a broader push for financial efficiency. While this may seem to help manage headline costs, the savings are often short-lived. It is essential to approach workforce planning with a nuanced understanding of the value and complexity of flexible workforce models.
Cost comparisons often overlook the full cost of employing permanent staff, including pensions, National Insurance contributions, paid leave and training, which can skew perceptions of agency rates and their relative value.
Flexible workers play distinct but complementary roles in sustaining healthcare service delivery. Bank staff can offer continuity of care and may be cost-effective in some scenarios, while agency workers bring rapid, scalable support, particularly for urgent, specialist, or hard-to-fill roles. It’s also important to recognise that agency rates typically include pay, National Insurance, pension, holiday pay and agency margin, and that bank staffing is not always the most economical option.
Flexible work enables participation from professionals who might otherwise leave the sector entirely, such as retirees, carers, or those with other commitments, helping retain valuable experience and skills within the system. As the demand for more flexible services grows, individuals with portfolio careers who are used to working across a range of settings are especially well-positioned to deliver them effectively.
The rise of hybrid working models
Recent data shows a sharp increase in hybrid working patterns. The proportion of workers combining full-time employment with bank shifts increased from 16% to 29% in 2025. At the same time, nearly half (49%) of agency workers reported working fewer hours than six months ago, compared to 38% of bank staff. These shifts suggest that policy changes are influencing workforce behaviour, with fewer individuals relying solely on agency work. However, interpreting this trend purely through a cost lens risks oversimplifying the issue and undervaluing the role of flexible staff in sustaining NHS productivity.
“Reducing agency spend is a necessary step in meeting national targets, but it’s equally important that this is done in a way that maintains safe staffing levels and protects patient care. Working in partnership with Acacium Group has enabled us to take a more collaborative approach to workforce planning, improving governance, reducing reliance on off-framework agencies and supporting staff to move into more integrated roles within the system. North Central London Temporary Staffing Framework has made meaningful progress towards securing the right balance between financial responsibility and clinical risk.
Over the past two years, our partnership approach has contributed to a £4.9 million reduction in agency spend across our Trusts. As we look ahead, our focus remains on building a workforce model that is both financially sustainable and responsive to the needs of patients and staff, ensuring we continue to meet demand safely and support the people who deliver care every day.”
Natalie Nightingale
Head of NCL Temporary Staffing Framework
Bank work on the rise – but not without challenges
Full-time bank-only roles increased from 8% to 11% and part-time bank roles increased from 10% to 13% in our survey. While this growth reflects a rising interest in flexible work, it also reveals underlying pressures. Some workers report feeling nudged into bank roles due to reduced agency opportunities or organisational restructuring. When flexibility is driven by system needs rather than worker choice, it can lead to dissatisfaction, burnout and retention challenges.
As the NHS continues to reshape its workforce strategy, there is an opportunity to move beyond a one-size-fits-all approach. Supporting a modern, flexible workforce means recognising the unique contributions of both bank and agency staff, ensuring fair treatment and designing systems that offer genuine choice. A balanced, inclusive approach will be essential to building a resilient and sustainable workforce for the future.
Fig 1: Please specify your employment status
Employers globally use agency staff to effectively manage employment costs and varying demand as an addition to their core substantive employees. Agencies help save money and improve service, while offering skilled professionals the working lives they want. Despite this, the Department of Health continually insists that the NHS is unlike any other employer when it comes to the impact of agency workers. It has been cutting spend for years – but never solved the problem, because agency work isn’t the problem.”[x]
Neil Carberry, CEO, Recruitment and Employment Confederation
Agency work still offers unique advantages
Despite the decline in agency-only roles, agency workers remain the most mobile and flexible segment of the workforce:
This mobility is a key asset, especially in systems requiring rapid redeployment or coverage across multiple sites, something not always reflected in bank models.
It also enables service provision in remote or underserved areas where specialist professionals may not be available locally, helping bridge critical skills gaps.
Spotlight on doctors
A comparison of bank and agency doctors across Acacium Group businesses reveals a clear difference in flexibility. On average, agency doctors travel up to 5.6 times farther per shift than bank doctors, even after adjusting for regional factors. This difference becomes slightly more pronounced for short-notice shifts (4–48 hours), where agency doctors travel over six times farther. These findings highlight that agency and bank doctors are not interchangeable and relying solely on bank staffing models may limit responsiveness and increase costs.
Top motivations for working flexibly
- Flexibility and work-life balance (36%)
The top reason people choose flexible work is the ability to manage their own schedules. It allows them to balance job responsibilities with family life, avoid rigid shift patterns and fit work around personal priorities. - Pay and supplementary income (16%)
Financial stability is a major driver. Respondents cited rising living costs, the need for reliable income streams and the financial flexibility of choosing when and how much to work. - Career development (4%)
Flexible work supports professional growth. It allows individuals to maintain clinical skills, gain experience in new areas or explore different environments that may not be available in permanent roles. - Post-retirement engagement (3%)
For those who have stepped back from full-time roles, flexible work offers a way to stay active and contribute meaningfully without the demands of a permanent position. - Control and autonomy (2%)
Some respondents value the independence flexible work provides, including the freedom to move between roles, avoid workplace politics and retain professional control outside traditional employment structures.
Fig. 2: Primary motivation for flexible work
The value of flexible workforce development
Flexible working offers significant benefits for both professionals and providers. For staff, particularly those early in their careers, it provides the chance to gain experience across different organisations, explore a variety of clinical environments and discover where their interests lie. This exposure helps build confidence, develop clinical skills and shape more informed career paths.
For providers, flexible workers bring fresh perspectives and act as valuable carriers of knowledge. By working across multiple settings, they share best practices, introduce new ideas and contribute to continuous improvement. Their adaptability and broad experience also mean they can integrate quickly into teams and support care delivery with minimal disruption.
To support this, Acacium Group launched a structured continued professional development (CPD) programme in 2024 designed specifically for flexible workers. The programme offers online sessions on key clinical and wellbeing topics including safeguarding, sepsis, DVT prevention and resilience. Delivered by in-house clinicians and external experts, the programme saw over 15,000 sign-ups and 6,600 attendees in its first year. One standout initiative was a sign language training series, which equipped over 1,000 professionals to better support patients with communication needs.
By investing in the development of flexible staff, Acacium Group is helping to ensure that professionals are not only available but also confident, capable and motivated to deliver high-quality care across the communities they serve. This approach benefits individuals by supporting their growth and benefits providers by strengthening the quality and consistency of care across the system.
The government has acknowledged the importance of flexibility, which is encouraging. However, their interpretation often centres on bank work, which doesn’t always provide the same level of autonomy and choice that agency roles can offer. After all, the term ‘agency’ itself reflects the principles of choice and representation.
Paul Read,
Managing Director, Pulse, part of Acacium Group
Retention outlook
The proportion of workers expecting to remain in their current roles over the next five to ten years has dropped sharply, from 55% in 2024 to just 41% in 2025. More notably, 11% of respondents are now considering leaving the sector entirely, a 5 percentage point increase year-on-year.
This shift is particularly pronounced among bank workers, 12% of whom are exploring options outside healthcare. While bank roles offer flexibility, they may not always provide the long-term security, progression or autonomy that some professionals seek. This trend raises important questions about the sustainability of current workforce strategies, especially as government policy increasingly promotes bank work as the default flexible option.
The reasons behind these decisions are deeply personal and often rooted in real-life pressures. Among those considering leaving, the top factors cited were pay and working conditions (39%), retirement (12%), career change or new opportunities (5%) and personal circumstances (4%). In fact, 36% of respondents said work-life balance and family responsibilities were key drivers in their choice of flexible or part-time roles, highlighting the need for workforce models that support, rather than strain, personal wellbeing.
To retain talent, health and care systems must move beyond one-size-fits-all solutions. That means investing in tailored retention strategies, wellbeing support and inclusive workforce planning that reflects the diverse motivations of today’s flexible workforce. Agency and bank roles continue to serve as vital entry and re-entry points, particularly for retired professionals, carers and others who might otherwise leave the sector entirely.
Perceptions of patient safety
Patient safety focuses on minimising harm and ensuring that care is delivered safely, effectively and consistently. Health and social care professionals play a vital role in this by following best practices, reporting risks and fostering open, accountable communication.
In 2025, Acacium Group surveyed 4,033 flexible health and social care workers across more than 1,000 client sites in the UK. One in five (21%) reported concerns about patient safety, highlighting the importance of listening to frontline staff and addressing the conditions that enable safe, high-quality care.
- 24% of respondents disagreed that staffing levels were sufficient to maintain patient safety.
- 6% stated outright that patient safety was not prioritised at their place of work.
Fig. 3: Do you agree or disagree that current staffing levels at [client site] are sufficient to maintain patient safety?
When asked to share more detail, their comments create a clearer picture of the challenges impacting patient safety.
- Staffing issues (65%) emerged as the most frequently cited concern, with workers describing environments marked by chronic shortages and unsafe staff-to-patient ratios.
- Workload and burnout (13%) comments highlighted the unsustainable demands placed on the workforce, including excessive duties and unrealistic expectations. The result is a workforce stretched thin, with burnout becoming a common and dangerous by-product.
- Management (5%) were less frequently mentioned but still notable, with comments noting poor leadership, lack of support, oppresive practices and failure to act on concerns.
- Communication breakdowns (4%) were reported by a small minority but flagged as critical. In high-pressure environments, even minor lapses in communication can have serious consequences for patient safety.
Fig. 4: In the past 12 months, have you had any concerns about situations that may have affected patient safety?
In 2024, the Nursing and Midwifery Council (NMC) reported a rise in safety-related concerns, with 5,774 raised compared to 5,068 the previous year.[xi] That same year, the Royal College of Nursing (RCN) declared a national emergency, citing unsafe care conditions in its Corridor Care report.[xii] It found that 53% of healthcare workers had delivered care in unsuitable environments lacking essential equipment, while 67% said patient privacy and dignity were compromised. The RCN described these conditions as symptoms of a system under extreme pressure, where demand consistently outpaces workforce capacity.
Public vs private
The data reveals a clear difference in how patient safety is perceived and experienced across NHS and private settings. In the private sector, 81% of respondents felt that patient safety is prioritised “a great deal” or “a lot”, compared to 77% in the NHS. This gap becomes more pronounced when looking at staffing sufficiency: 73% of private sector respondents agreed that staffing levels are sufficient to maintain patient safety, compared to just 47% in the NHS. While this may partly reflect the higher acuity and complexity of care delivered in NHS settings, such as emergency departments and intensive care units, it also highlights a growing challenge.
Increased acuity, poor patient-to-staff ratios and rising burnout are contributing to competition over the workforce, with private providers often able to offer safer staffing levels and reduced pressure on clinicians. These conditions make private sector roles more attractive to some staff, particularly those seeking a more manageable workload or better work-life balance. As such, the differences in perceived safety and staffing are not just reflections of clinical setting, but indicators of a workforce under strain and a system competing for limited resources.
Moving forward
The Government’s new 10-Year Health Plan highlights the use of AI systems to improve patient safety by spotting issues like spikes in stillbirths or brain injuries using near real-time hospital data. But as the Royal College of Nursing warns, AI must support, not replace, the judgment and presence of healthcare staff.[xiii] Ongoing investment in frontline workers is still essential.
In addition to embracing technology is the need to foster a culture of safety. All health and social care workers, regardless of role or seniority, substantive or flexible, should feel empowered and protected when raising concerns about patient safety. Building a culture where speaking up is encouraged and acted upon is essential to preventing harm and fostering continuous improvement.
Strengthening clinical practice through scenario-based training
“At Acacium Group, we have found that some of the most powerful learnings happen when clinicians are immersed in real-world scenarios. That’s why we’ve embedded mock coroner inquests and case review workshops into our clinical development programme for flexible workers. Built around real incidents, these sessions involve role-play as witnesses, legal representatives and coroners, helping staff understand documentation, communication and accountability in a safe but realistic setting.
We also run regular case reviews using internal and external serious incident reports. These collaborative sessions focus on learning, not blame. Clinicians analyse what went wrong, identify lessons and co-create action plans. They help staff build confidence, critical thinking and a stronger safety mindset.
For organisations looking to do the same: start small, use real (anonymised) cases, involve multidisciplinary teams and keep it interactive. Time and resources may be tight, but this is an investment in staff, safety and quality care.”
Karen Matthews-Shard,
Global Clinical Director, Acacium Group
Mental health and wellbeing
Acacium Group and Cavell have partnered to explore the health and wellbeing challenges facing the UK’s healthcare workforce. United by a shared belief in supporting those who care for others, this collaboration reflects our commitment to asking the right questions and driving meaningful change.
This section presents insights across our flexible workforce. Find a focused comparison of nursing and midwifery data with Cavell’s findings.
Across all staff groups, self-reported mental health is generally positive, with the majority rating their mental health as either “good” or “excellent”. Nursing and midwifery, and AHP staff reported the highest levels of “excellent” mental health (both at 43%), while admin and clerical staff reported the highest levels of “poor” or “terrible” mental health at 7%.
Over a quarter (27%) of respondents reported taking time off due to illness in the past year. Among those who disclosed the reason, just 6% cited mental health alone and a further 13% said both physical and mental health contributed.
This contrasts sharply with findings from the 2024 NHS Charities survey,[xiv] in which 76% of NHS staff respondents reported experiencing a mental health condition in the past year. Over half said they had struggled with anxiety (52%) or low mood (51%) and 42% reported feeling exhausted. Notably, 60% expressed concern about the mental health of their colleagues, highlighting the collective and systemic nature of these challenges within NHS teams.
The difference in these findings may reflect the benefits of greater autonomy and more control over working patterns. For some, the ability to choose when and how they work helps reduce stress, avoid burnout and maintain a healthier work-life balance. While flexibility is not a cure-all, it appears to offer a meaningful buffer against the pressures that contribute to poor mental health and may be a key factor in retaining skilled professionals who might otherwise leave the system.
As the health and care system continues to face workforce challenges, exploring how flexible models can support wellbeing and retention should be a key part of future planning.
Fig. 5: Describe your mental health
Work-related absence and financial stress
When asked whether time off in the past year was related to their work environment, medical (33%) and social care staff (38%) were most likely to say yes, indicating higher levels of environmental stress or burnout in these groups. Nursing and midwifery, and admin staff also reported notable levels (23% and 29% respectively), suggesting that workplace conditions remain a significant factor in staff wellbeing.
Financial stress is another area of concern. Over half of nursing and midwifery staff (52%) and 45% of medical staff reported being worried about meeting essential living costs. Admin staff followed closely at 44%.
Across all staff groups within the health and social care workforce:
Fig 6: If you were unable to work, approximately how long could your current savings cover your essential living expenses?
This financial fragility is not just a personal issue; it has professional consequences. These figures reveal a workforce at risk not only of burnout, but of attrition.
What supports wellbeing at work?
When asked what positively impacts their wellbeing, respondents pointed to the human and cultural elements of their work environment:
Fig. 7: Which of the following have the biggest positive impact on your wellbeing at work?
How UCLH supports and integrates its bank workforce
The University College London Hospitals NHS Foundation Trust (UCLH) has partnered with Bank Partners, part of Acacium Group, for nearly 15 years. This partnership has played a vital role in supporting healthcare professionals to work flexibly across a wide range of roles, including nursing, doctors, allied health professionals and administrative staff.
With six sites across central London, UCLH offers bank workers the opportunity to work flexibly while gaining experience in a variety of specialist services. The onboarding process is streamlined and supportive, helping new joiners quickly find their first shifts and begin contributing to patient care.
Workers can choose their hours, days and areas of work enabling them to shape their careers around their personal and professional goals. This autonomy is paired with the satisfaction of making a meaningful impact as part of the NHS. The opportunity to work across different sites and specialties also supports skill development and career progression. UCLH is also a member of Cavell’s “Working with” programme, enabling their workforce to access tools to support learning and development.
UCLH ensures that bank workers are fully integrated into the organisation. They have access to the same psychological wellbeing services, Employee Assistance Programme and staff benefits as permanent employees. Bank staff are also eligible for recognition through the annual Celebrating Excellence Awards and receive seasonal incentives, such as vouchers for their contributions during peak periods like Christmas.
This inclusive approach fosters a strong sense of belonging and professional pride among bank workers. As one staff member noted, the level of support, education and management at UCLH stands out compared to other trusts. By valuing and investing in its flexible workforce, UCLH demonstrates how temporary staffing can be both responsive and people-centred, contributing to a resilient and high-performing healthcare system.
Cavell: Focus on nursing and midwifery wellbeing
Cavell brings a focused lens on those nurses and midwives most likely to be experiencing hardship. Through emergency grants, emotional support and advocacy, the charity helps individuals navigate crises such as illness, domestic abuse and financial insecurity.
Based on data from 1324 healthcare professionals. 64% work in adult nursing, 60% are employed full-time, 24% part-time. 79% are based in NHS roles and 6% in private sector roles.
This section compares Cavell’s nursing and midwifery data with the wider flexible workforce to highlight where experiences overlap and where they differ.
Mental health and wellbeing
Among Cavell’s respondents, self-rated mental health was low, with 39% describing their mental health as “average”, while only 29% rated it as “good”. This contrasts with Acacium Group’s findings, where 43% of nursing, midwifery and allied health professionals rated their mental health as excellent. This difference is likely influenced by Cavell’s audience, many of whom are aware of or have accessed the charity’s support due to personal or financial hardship.
Health-related absences were also more prevalent among Cavell’s respondents, with 57% reporting time off due to illness in the last 12 months. In comparison, only 27% of respondents in Acacium Group’s data reported taking time off due to ill-health.
Among those who disclosed the reason to Cavell, 17% cited mental health alone and a further 34% said both physical and mental health contributed to their absence.
Financial wellbeing
Financial stress emerged as a major issue across both datasets. Cavell found that 56% of respondents had been negatively affected by their financial situation in the past year, closely aligning with Acacium Group’s data showing 56% of staff believe financial stress impacts their mental health. However, Cavell’s data suggests a slightly higher level of financial vulnerability, with 30% feeling completely unprepared for a financial emergency, compared to only 12% in Acacium Group’s wider sample of flexible workers.
42% of Cavell’s data shared that they have considered leaving nursing or midwifery due to financial stress. Similarly, Acacium Group’s data revealed that 29% have considered leaving healthcare altogether due to financial stress, highlighting the professional consequences of economic insecurity.
Workplace wellbeing and staffing
Nearly half of Cavell’s respondents (48%) identified adequate staffing as essential to their wellbeing, while 82% said staffing shortages had a significant negative effect. These concerns are echoed in Acacium Group’s findings, where staffing pressures are linked to burnout, safety risks and retention challenges. Explore further on page 13.
Impact of technology
Cavell’s data provides more detailed insight into the effects of technology. While 43% of respondents appreciated the increased flexibility and 38% noted easier access to professional development, a much larger proportion (72%) reported negative effects such as screen fatigue and 62% experienced technical frustrations.
The cost of compassion in today’s healthcare system
“These findings reflect what we at Cavell see every day; the toll that financial stress, poor mental health and issues like domestic abuse take on the people who care for others. Many of the nursing and midwifery professionals who come to us are not just struggling, they are at breaking point. Without a safety net, some have faced homelessness, gone without food or heating, or been forced to choose between their health and their job.
The high levels of self-reported mental health challenges and illness-related absence reflected in the data are not surprising to Cavell. They mirror the real-life stories we hear from professionals who work in extremely challenging conditions and often have nowhere else to turn. These are skilled, dedicated individuals who continue to show up for their patients, even when their own wellbeing is under strain.
The financial vulnerability highlighted in the data is particularly concerning. When nearly a third of respondents say they are completely unprepared for a financial emergency, it underscores the need for greater protection and support for the workforce. We must all ask what more can be done to ensure they remain secure and able to thrive in their vital roles.”
Lewis Allett
Chief Executive, Cavell
Discrimination and its consequences
Although our data shows signs of progress, discrimination remains a significant concern in some regions, particularly the South West (33%), Midlands (23%) and Wales (22%), where more workers report witnessing or experiencing it.
19% of the flexible workforce has experienced or witnessed some form of harassment or discrimination. However, there was a 7% drop from 2024 to 2025. Satisfaction with how reports were handled also rose from 29% to 39%, suggesting progress in organisational responses. However, reporting remains low: Only 10% reported it themselves and 7% said it was not reported. 14% preferred not to say, suggesting lingering discomfort or fear around disclosing incidents of harassment or abuse in the workplace.
When asked for more information about their experience of discrimination or harassment, 10% highlighted verbal and physical abuse from patients or their families. 14% specifically mentioned flexible staff feeling undervalued or excluded, pointing to a need for greater inclusion and equity for non-permanent staff.
This sentiment may have been compounded by recent ministerial rhetoric. In late 2024, the Health Secretary described agency staffing as a “rip-off” and “extortionate,” as part of a wider campaign to reduce temporary staffing costs. While cost control is a legitimate policy goal, such language may contribute to a culture in which agency workers feel stigmatised or less respected. It is important to recognise that public messaging from leadership can shape workplace culture and influence how staff are treated on the ground.
When flexible workers are not included in the day-to-day life of the team, it sends a message, intentional or not, that their presence and contributions are less valued. This can be particularly disheartening for individuals who are committed to their roles and who often step in during times of high demand or staff shortages.
Fig. 8: Have you ever experienced or witnessed any form of discrimination?
Disability and health conditions
Flexible workers with a health problem or disability are twice as likely to report experiencing or witnessing discrimination (37%) – twice the rate of those without (18%). This aligns with the 2024 NHS Workforce Disability Equality Standard (WDES) findings that disabled staff continue to report significantly higher levels of bullying, harassment and discrimination from colleagues and managers compared to non-disabled staff.[xv]
Of those who chose to share more information about their experience, 25% described being bullied by managers or colleagues. In many cases, this behaviour appeared to be linked to perceived vulnerability. Another 25% of comments highlighted a failure by management or HR to respond appropriately to complaints. Some workers reported that formal grievances were ignored or allowed to lapse, leaving them without recourse or protection.
Discrimination disparities for minority groups
- 37% of people with a health problem or disability have experienced or witnessed discrimination.
- Women are 25% more likely to experience or witness discrimination than men.
- 20% of people from the LGBTQ+ community have experienced or witnessed discrimination.
- 20% of women have experienced or witnessed discrimination.
- 18% of heterosexual people with no health problems or disability have experienced or witnesses discrimination.
“The NHS is an incredibly diverse workforce and it is vital this is represented at the highest levels. It is clear that despite pledges to improve the situation, for too many, discrimination and inequality in the NHS remain. While funding for equality, diversity and inclusion roles remains under attack, NHS leaders should see {the WDES} report as a wake-up call that they need to do more to protect staff and end this abuse of our diverse workforce.”[xvi]
Professor Nicola Ranger,
General Secretary and Chief Executive of the Royal College of Nursing
Gender differences
Women make up around three-quarters of the healthcare workforce.[xvii] Specifically, in the NHS, 76.7% of the 1.3 million staff are women according to NHS England.[xviii] Despite this, data revealed that female flexible workers are 25% more likely to experience discrimination than male staff, with 20% of women reporting such experiences compared to 16% of men. This gender gap points to ongoing challenges in achieving gender equity in workplace culture and behaviour.
Sexual orientation
LGBTQ+ staff reported a slightly higher rate of discrimination (20%) than their heterosexual peers (18%). While the difference is smaller (2%), it still signals the need for continued focus on LGBTQ+ inclusion and allyship. The Workforce Sexual Orientation Equality Standard and NHS Staff Survey data also indicates that LGBTQ+ staff are more likely to experience harassment, bullying or abuse from patients and colleagues and are less likely to feel their organisation acts fairly about career progression.[xix]
Racial differences
Agency staff reported experiencing or witnessing racism more frequently, with an average rate of 10%, compared to 5% among bank staff. This suggests that agency workers, often placed in unfamiliar or less supported environments, may be more exposed to racially motivated incidents.
Domiciliary care staff reported the highest rate of racism-related incidents, with 21% of comments referencing racism. Unlike other settings, these workers typically operate alone in patients’ homes, without the immediate support of colleagues or managers. This isolation can increase their vulnerability to discriminatory behaviour.
Flexible domiciliary workers may feel they have limited options for reporting racism, especially when it comes from patients. This can negatively impact wellbeing, morale and retention in an already stretched workforce. Tackling this issue requires clear reporting pathways, stronger support systems and training for staff and patients on respectful behaviour. Providers must ensure flexible workers feel safe, respected and empowered to speak up.
Employment type
Agency staff report higher levels of discrimination related to their employment status, with an average of 12% of comments referencing agency discrimination, compared to 8% among bank staff. This suggests agency workers may face bias due to being perceived as external or temporary. These findings may also reflect the impact of anti-agency rhetoric and recent policy efforts to reduce agency use, which could be influencing how colleagues, managers and patients treat agency staff.
Management issues are also more common among agency staff, averaging 14% , versus 11% for bank staff. This likely reflects the fragmented oversight and inconsistent support structures that agency workers often experience, particularly when managed by third parties or unfamiliar teams.
In contrast, bullying is slightly more prevalent among bank staff, at 8% compared to 6% for agency staff. This may point to more entrenched interpersonal dynamics within permanent teams.
Investing in the future of female leadership
“As Co-Chair of the IHPN Women Leaders Network, I’ve seen first-hand how powerful it is to create space for women in independent healthcare to connect, grow and lead. Over the past year, the network has become a platform for sharing experiences, building relationships and supporting the next generation of women leaders.
At Acacium Group, we’ve found real value in being part of this work. Insights from the network’s events and discussions have helped shape how we support women across our own teams. Hearing honest stories about career transitions, imposter syndrome and leadership challenges has created a sense of shared purpose and practical learning.
The launch of the Equality, Diversity and Inclusion toolkit was a standout moment. It’s a practical resource that reflects the realities of our sector and has helped us spark meaningful conversations about inclusive leadership.
The Women Leaders Network may be new, but its impact is already clear. By supporting the development of women leaders, it strengthens not just individual organisations but the wider healthcare system. As these leaders grow, they bring fresh perspectives, stronger representation and more resilient leadership to both the independent sector and the NHS. I’m proud that Acacium Group is part of this journey.”
Alex Ryan
Group Director of Service Development, Acacium Group
Flexible workers and the experience gap
Flexible health and social care professionals, whether working through bank or agency, play a vital role in delivering care across the system. Many choose flexible roles to balance family responsibilities, manage health conditions, or remain in the workforce after retirement.
For some, this model offers a more sustainable way to continue working, particularly when managing mental health or other personal challenges. However, recent data suggests that their experience within the system is not always equitable, highlighting the need for greater inclusion and recognition of their contribution.
Many flexible workers choose this path not out of convenience but necessity. In fact, 36% of respondents cited work-life balance and flexibility as key reasons for choosing flexible or part-time roles. These professionals are not on the margins. They are at the heart of a modern, adaptable workforce. Find out more in the flexible worker motivations section.
Reduction in flexible worker satisfaction
Key indicators of satisfaction and support declined across the board. Looking at averages across the period of 2022 to 2025, overall satisfaction dropped from an 80% average (across 2022 – 2023) to 76% average (across 2024 – 2025). This reflects a broader long-term downward trend across several critical areas:
- Induction remained low, falling from 76% to 73% suggesting flexible workers are not always adequately welcomed or prepared for new settings.
- On-site support dropped from 82% to 75% indicating a weakening of guidance and assistance.
- Working environment declined from 83% to 76% pointing to broader issues with morale, resources or team dynamics.
These figures reflect a long-term and growing disconnect revealing that the systems around flexible workers are not always designed to support their integration. Budget constraints and staffing pressures can limit the availability of permanent staff to provide guidance, while negative perceptions of bank or agency staff may further impact how they are treated on the ground.
“Flexible workers are still too often treated as temporary stopgaps rather than valued members of the workforce. Declining satisfaction and support point to a deeper issue: a lack of meaningful investment in their integration, development and wellbeing. This neglect does not just affect them. It places additional strain on substantive teams and the wider healthcare system.”
James Bowen
Business Operations Director Acacium Group
Looking ahead: the integration imperative
The variation in flexible worker experiences across different organisations reveals that poor integration is not inevitable. Sites achieving consistently high satisfaction scores share common characteristics: structured induction programmes and digital systems that grant appropriate access from day one.
The data reveals an industry in transition with flexible workers navigating the gap between policy ambition and operational reality. The model of treating flexible workers as temporary additions is proving counterproductive. There is a clear need to create supportive environments where all workers, regardless of their employment model, can contribute effectively to patient care.
The improvements in digital access demonstrate that change is possible when there is commitment to addressing systemic barriers. However, the broader decline in satisfaction scores suggests that digital solutions alone are insufficient. True integration requires cultural change, investment in support structures and recognition that flexible workers are not a temporary solution but a permanent feature of the modern healthcare workforce.
Welcome improvements in digital access
Across this same period, access to patients’ electronic records has seen the most improvement, with a 7% increase in satisfaction; a welcome shift given its history as one of the most frustrating barriers for flexible staff.
Previously, limited access meant highly qualified professionals were unable to carry out essential tasks independently, leading to inefficiencies, wasted resources and added pressure on permanent staff. The recent improvement suggests a concerted effort across regions to address this issue, enabling flexible workers to contribute more effectively and feel more empowered in their roles.
Fig 9: Flexible worker satisfaction
Methodology
Survey distribution and participation
The following bank and agency health and social care professionals were included: admin and clerical, allied health and health science services, doctors, nurses, healthcare assistants, psychiatry and psychological therapists and social care workers. The survey is optional, meaning responses are not reflective of the entire Acacium Group flexible workforce population.
Agency healthcare workers are employed by private agencies and work temporarily in the NHS, often choosing from a wide range of shifts, including days, nights and weekend shifts, across various locations and departments. This flexibility allows them to balance work with personal commitments but can lead to less consistency in their work environment.
In contrast, NHS bank workers are directly employed by the NHS on a flexible, as-needed basis, also enjoying a variety of shift options. They tend to work within the same NHS trust, providing more stability and familiarity with their work environment and can book shifts in advance, accessing shifts before they are offered to agency workers.
Data collection
Our data collection is powered by cutting-edge software designed to monitor, measure, analyse and enhance workers’ and clients’ experiences with Acacium Group businesses.
This report focuses on data from ‘flexible workers’ defined as either agency or bank health and social care workers in the UK, operating across public and private providers.
References:
[i] https://www.nuffieldtrust.org.uk/research/public-satisfaction-with-the-NHS-and-social-care-in-2024-Results-from-the-British-Social-Attitudes-survey
[ii] https://assets.publishing.service.gov.uk/media/6866387fe6557c544c74db7a/fit-for-the-future-10-yearhealth-plan-for-england.pdf
[iii] https://www.england.nhs.uk/long-read/letter-further-action-reduce-nhs-spending-temporary-agency-staffing/
[iv] https://researchbriefings.files.parliament.uk/documents/CBP-7281/CBP-7281.pdf
[v]https://www.bmj.com/content/389/bmj.r1222
[vi] https://www.phin.org.uk/news/phin-private-market-update-march-2025-united-kingdom
[vii] https://www.covermagazine.co.uk/news/4414445/2024-record-private-healthcare-phin
[viii] https://www.bmj.com/content/384/bmj.q140
[ix] https://www.england.nhs.uk/long-read/letter-further-action-reduce-nhs-spending-temporary-agency-staffing/
[x] https://www.rec.uk.com/our-view/news/press-releases/government-statement-use-agency-workers-revision-failed-tactic-rec
[xi]https://www.nmc.org.uk/about-us/reports-and-accounts/fitness-to-practise-annual-report/
[xii] https://www.rcn.org.uk/news-and-events/Press-Releases/corridor-care-congress-030624
[xiii] https://www.theguardian.com/society/2025/jun/30/nhs-will-use-ai-in-warning-system-to-catch-potential-safety-scandals-early
[xiv] https://nhscharitiestogether.co.uk/news/research/three-in-four-nhs-staff-struggledwith-their-mental-health-in-the-past-year/
[xv] https://www.england.nhs.uk/long-read/nhs-workforce-disability-equalitystandard-2024/
[xvi] https://www.nursingtimes.net/workforce/disabled-nhs-nurses-face-persistingworkplace-abuse-says-new-report-27-06-2025/
[xvii] https://www.wbg.org.uk/publication/health-inequalities-and-gender-a-briefing-fora-new-government/
[xviii] https://www.england.nhs.uk/2021/03/nhs-celebrates-the-vital-role-hundreds-ofthousands-of-women-have-played-in-the-pandemic/
[xix] https://www.nhsstaffsurveys.com/static/c1a573e95b1a49428676ef4b24f5efe7/National-Results-Briefing-2024.pdf
Take action:
understand how your flexible workforce is experiencing work
Gaining insights into your flexible workforce’s experiences, motivations and future trends provides the basis for long-term workforce planning. Recognising what drives your team and where improvements can be made is essential for nurturing talent and creating a positive and productive environment.
Acacium Group provides insight into the experience of health and social care workers in NHS Integrated Care Systems, Health Boards and local authorities and private providers in England, Northern Ireland, Scotland and Wales.
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