“This Is the Hardest It’s Ever Been”: What We Learned at Health & Social Care Recruitment Roundtable #2

On September 11th, I hosted the second in our series of health and social care recruitment roundtables — a 65-minute, off-the-record discussion between leaders in NHS and private healthcare recruitment, staffing agencies, tech providers, and talent specialists.

We focused on the seismic shifts hitting our sector in 2025: from rising costs to shrinking talent pools, tighter agency rules, and a clampdown on international hiring.

Here’s what we discussed — and what we learned.

Fiscal Measures by Government Impacting Business

From minimum wage increases to rising employer NI contributions, cost pressures are hitting across the board.

For an employer with 30 staff earning £36,000 a year, recent changes to National Insurance rates and thresholds could increase annual costs by around £15,000. For a large employer with 5,000 staff, that figure rises to just over £2.5 million.

(These figures reflect a 1.25 percentage point increase in employer NI contributions (from 13.8% to 15.05%), along with a lowered threshold for contributions from £9,100 to £8,000.)

NHS Agency Restrictions Are Causing Gaps and Burnout

Multiple contributors — including former NHS resourcing leads — shared that agency spending cuts are having unintended effects:

• Ward gaps are growing
• Clinicians are being overstretched
• Experienced admin and support staff are being laid off

“There’s a letter from NHS England going out telling trusts to cut agency spend — but that’s left people like me out of work and wards still understaffed.”
— Former senior NHS resourcing specialist

There was consensus that while reform was needed, the pendulum may have swung too far — with skilled, ethical agencies being unfairly caught in the crossfire.

“The NHS is trying to save money, but you can't just remove agency clinicians and expect no impact. Some are driving 100 miles to fill a shift at short notice to provide crucial care for us all — what happens when they’re gone?”
— Matt Farrah

Several attendees shared how capped agency rates haven’t been adjusted to reflect wage increases — making some placements for staffing agencies “unworkable.”

“The minimum wage went up, but the capped rate didn’t. Our margin dropped to £1.44 an hour — it’s barely viable unless you’ve got big volumes.”
— Senior Recruitment Consultant, urgent care agency

The Talent Pool Is Shrinking — And Hiring Takes Longer

All participants agreed: the candidate market is the toughest it’s been in years.

• Applicants are harder to find, especially for clinical and specialist roles.
• Time-to-hire is getting longer, with vacancies often open for 6 months or more.
• Talent loyalty to the NHS is waning, and some are choosing the private sector instead.

“We’ve seen attrition drop in our private hospital, and we’re able to hire ex-NHS staff who are exhausted but still want to work in healthcare.”
— Marketing Lead for large private healthcare provider

The recent tightening of international recruitment rules is causing major disruption — especially in social care.

“For a while it slowed down. Then it stopped overnight. Employers that used to rely on overseas nurses have hit the brakes.”
— Agency director

While the NHS appears exempt (for now), most agreed the sector is still deeply reliant on international staff:

“We used to hire 200–300 nurses a year from India and the Philippines. That’s drying up — and we don’t have the homegrown pipeline to replace them.”

One attendee cited that:

• UK nationals average 21-hour contracts
• Overseas workers average 40 hours and stay 3–4x longer
• Sick leave rates are significantly lower among overseas workers

This raised the question: If we restrict international hiring, how do we replace that labour?

We Need to Train and Inspire the Next Generation

A key takeaway was the lack of investment in UK-based training and long-term workforce development.

“If we stop overseas recruitment, where’s the plan to train more people here? Bursaries have gone. Degrees are expensive. Where’s the incentive?”
— Matt Farrah

Some called for a return of bursaries, or tied-in support for training (e.g. subsidised degrees in exchange for years of NHS service). Others pointed out how much more could be done to market health and care careers.

“There’s too little storytelling. We need to inspire people — and make nursing look like the credible, fulfilling career that it is.”

However, some positive moves were highlighted in social care:

“We’re doing more apprenticeships in social care, even 8-month ones. It’s a good start.”
— Nonny

Green Shoots?

While much of the conversation focused on challenges, a few participants shared signs of hope:

• Attrition is falling in some private sector organisations
• Apprenticeships and entry routes are helping in social care
• Retention strategies are reducing the need to constantly hire
• New hospitals and new models of care may bring new roles — and new opportunities:

“The future hospitals being built now won’t look like the ones we have today. New jobs will emerge — but we need the skills to fill them.”
— Jaz

Takeaways

• The pressure on agencies, internal TA teams, and providers is real — and growing
• Budgets are down, expectations are up, and the talent isn’t always there
• The narrative around agencies needs rebalancing: some are essential lifelines
• We need to tell better stories, fund better training, and plan for the long term
• Government action to help businesses, generally, would help ease challenges facing those hiring

Want to Join the Next Roundtable?

If you would like to join us for our next open conversation between people working in recruitment, workforce, HR, or operations across health and social care, get in touch - email: matt@nurses.co.uk.