Established practice

You have the beds. You cannot find the staff to fill them.

Workforce shortages are the binding constraint on independent hospital growth right now. With agency nurses costing up to three times the rate of permanent staff, every unfilled post compounds the financial and operational pressure.

steps: 7; steps
to start: 2 to 3 weeks; to start

The short answer

Most independent hospitals do not lack theatres or beds, they lack the theatre nurses, ODPs, ward nurses and radiographers to staff them. Plan capacity from the staff you can reliably roster, not from the rooms you have, then reduce agency dependency by stabilising the roles you lose most often, building a bank, and recruiting ethically from abroad where the numbers justify it.

7 steps

Do it yourself: step by step

0 of 7 done

For each theatre, ward and imaging room, set the sessions you could run against the sessions you can staff with permanent and bank staff. Show the gap by role.
Time
2 to 3 weeks
Typical cost
Staff time only
Who does it
Director of clinical services with finance
Done when: A one-page plan showing staffed capacity, physical capacity and the gap by role.
Typical actions: predictable rotas published six weeks ahead, flexible patterns such as term-time or set days, clear pay progression, and protected training time. Benchmark pay against local NHS Agenda for Change bands and nearby independent hospitals.
Time
2 to 6 months
Typical cost
Depends on pay changes
Who does it
Hospital director and HR
Done when: Turnover in the target roles falls over two consecutive quarters.
Use a recruiter on the NHS Employers ethical recruiters list, which follows the Code of Practice for international recruitment of health and social care personnel in England. Budget for NMC registration, OSCE preparation, visas and pastoral support.
Time
6 to 12 months per cohort
Typical cost
Commonly £5,000 to £10,000 per nurse in total costs (Solvable estimate: NMC and OSCE fees, visa, travel, accommodation and agency fee)
Who does it
HR lead with recruitment supplier
Done when: International recruits registered, employed and retained beyond 12 months.

This problem is Solvable.

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Staffed capacity and workforce gap plan

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Table

Staffed capacity and workforce gap plan

Quarter: [quarter] Prepared by: [name]

1. Capacity

Area	Physical sessions a week	Sessions staffed without agency	Sessions staffed with agency	Unstaffed sessions	Lost revenue per unstaffed session
Theatre 1					£
Theatre 2					£
Endoscopy					£
Imaging (MRI, CT)					£
Ward beds					£

2. Workforce by role

Role	Establishment (WTE)	In post	Vacancies	Leavers last 12 months	Turnover %	Agency hours last quarter	Agency cost last quarter	Main reason for leaving
Theatre nurse							£
ODP							£
Ward nurse							£
Radiographer							£
Healthcare assistant							£

3. Actions

Role	Action (retention, bank, international, apprenticeship)	Owner	Start	Expected effect

Rule for opening sessions: a new regular session opens only when it can be staffed for three months without agency.

Avoid these

Common mistakes

Planning capacity from the number of theatres rather than the number of staff.
Treating agency spend as unavoidable rather than measuring it by role.
Recruiting internationally without pastoral support, then losing staff within a year.
Publishing rotas a week or two ahead, which pushes staff towards agency work.
Opening new sessions to please a consultant before staffing is secure.

Free personal check

Done by Paul Robinson, not software

Give me three numbers and I'll show you how much capacity your staffing gaps are locking up

What I need from you

Theatres and beds you have
How many you can reliably staff each week
Agency share of clinical hours (%)

What you get

Your staffed capacity versus physical capacity
What the gap is worth per year
The three roles to stabilise first

Within 2 working days

No sign-in, no sales call. I read every request myself and reply on WhatsApp.

Free tools

Check where you stand

Your illustrative estimate

£340,000

Solvable estimate. Rounded to the nearest £500. Updates as you type.

Agency hours a year

Starting figure 20000 (from 20,000). Change it to match your practice.

Agency premium over permanent cost

Starting figure £20 (from £20 an hour). Change it to match your practice.

Unstaffed sessions per year

Starting figure 150. Change it to match your practice.

Contribution per session

Starting figure £3,000. Change it to match your practice.

Share recoverable in year one

Starting figure 40% (midpoint of 30% to 50% (all Solvable estimates)). Change it to match your practice.

Formula

annual recoverable cost of the workforce gap = [(agency hours x agency premium per hour) + (unstaffed sessions per year x contribution per session)] x share recoverable in year one

Variables and defaults

agency hours a year: 20,000
agency premium over permanent cost: £20 an hour
unstaffed sessions per year: 150
contribution per session: £3,000
share recoverable in year one: 30% to 50% (all Solvable estimates)

Defaults only. Change them in the calculator to use your own numbers.

Assumptions and defaults

agency hours a year = 20,000
agency premium over permanent cost = £20 an hour
unstaffed sessions per year = 150
contribution per session = £3,000
share recoverable in year one = 30% to 50% (all Solvable estimates)

20,000 x £20 = £400,000 plus 150 x £3,000 = £450,000 gives about £850,000 a year in total, shown as context. With 30% to 50% recoverable in year one, about £255,000 to £425,000 (Solvable estimate).

Benchmarks

1.5 to 2.5 times permanent hourly cost
Typical premium for agency theatre and ward nursing compared with employed staff, once agency fees are included (Solvable estimate: agency charge rates including fees, against employed hourly cost including on-costs)
Solvable estimate

Despite increased demand for private healthcare, independent hospitals face significant constraints in expanding capacity due to a severe shortage of skilled healthcare professionals, particularly doctors and nurses. This workforce crisis, exacerbated by Brexit and the pandemic, limits the ability to utilize existing infrastructure fully, extend service offerings, and meet growing patient demand.

The structural root causes include a long-term underinvestment in training and development of healthcare professionals, coupled with an aging workforce and increasing demand for services.
Behavioural factors involve a lack of competitive remuneration and poor work-life balance driving staff away from permanent roles towards agency work.
Systemically, the competition for staff with the NHS, exacerbated by Brexit limiting international recruitment, creates a constrained talent pool for private healthcare providers.

Hiring agency nurses can be up to three times more costly than permanent staff (Nursing in Practice, 2022)

Reduced patient throughput and longer waiting lists for private treatments
Increased administrative burden for scheduling and managing temporary staff
Significantly higher staffing costs due to agency fees, potentially increasing expenditure by up to 200% compared to permanent staff
Loss of revenue from underutilised facilities and cancelled procedures
Negative patient experience due to delays and lack of continuity of care
Damage to brand image and trust within the private healthcare market

What it looks like in practice

Frequent cancellation of elective procedures due to lack of staff
Increased reliance on expensive agency staff to fill rota gaps
Burnout and low morale among permanent staff due to increased workload
Inability to open new beds or expand services despite physical capacity

Paul Robinson

14 years in UK private healthcare

I solve this one for hospitals

Want a hand? I'll look at your situation and tell you the three things I'd tackle first.

A few quick questions, about two minutes. I read every one myself and usually reply the same day.

No sales call unless you ask for one. Just a straight answer from me.

I reply personally, usually the same day.

Questions

Frequently asked questions

Should we pay more than the NHS?

Not always. Predictable rotas, flexibility and training often matter as much as pay. Know where you sit against local Agenda for Change bands.

Is international recruitment worth it for a single hospital?

It can be for a cohort of five or more nurses. Below that, the set-up costs and support needs are harder to justify.

How do we reduce agency use quickly?

Publish rotas six weeks ahead, build a bank from former and part-time staff, and stop booking agency for sessions you could cancel or consolidate.

Can apprenticeships really help?

Yes, over two to three years, especially for nursing associates and ODPs. Levy payers can use levy funds for apprenticeship training costs. From 1 August 2026, new levy funds expire after 12 months and the 10% government top-up no longer applies to new funds.

What should the board see?

Staffed capacity against physical capacity, turnover and agency cost by role, every quarter.

Last reviewed: 30 October 2026

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The short answer

Do it yourself: step by step

1Build a staffed capacity plan2 to 3 weeks · Staff time only

2Measure turnover and agency use by role2 weeks · Staff time only

3Stabilise the roles you lose most2 to 6 months · Depends on pay changes

4Build a staff bank1 to 3 months · Bank admin time or rostering software

5Recruit internationally if numbers justify it6 to 12 months per cohort · Commonly £5,000 to £10,000 per nurse in total costs (Solvable estimate: NMC and OSCE fees, visa, travel, accommodation and agency fee)

6Grow your own1 to 3 years · Levy payers can use levy funds for training costs; from 1 August 2026 new funds expire after 12 months

7Review capacity quarterlyHalf a day a quarter · None

Staffed capacity and workforce gap plan

Common mistakes

Give me three numbers and I'll show you how much capacity your staffing gaps are locking up

What I need from you

What you get

Check where you stand

What's this costing you?Optional: work it out with your own numbers

How we worked this outMethod, formula and assumptions

Why this keeps happening

What it leads to

Evidence

Want a hand? I'll look at your situation and tell you the three things I'd tackle first.

Frequently asked questions

Should we pay more than the NHS?

Is international recruitment worth it for a single hospital?

How do we reduce agency use quickly?

Can apprenticeships really help?

What should the board see?

You're not the only one with this problem.