HSE warns it cannot fill vacancies even with agencies as staff shortage crisis deepens

The new data reveals that hospital spending on agency staff topped the table at €304.7m last year, followed by the €118.9m spent on older people’s services. Picture: iStock

The most vulnerable patients in the HSE — including those with a disability, older people, and those using mental health services — are increasingly being cared for by temporary agency staff, startling new figures show.

Staff shortages are so acute that the HSE has warned that at times it is unable to fill vacancies even with temporary staff as agencies are struggling to recruit health workers.

A shortage of accommodation is among the reasons blamed.

The figures reveal for the first time which patients are being left to the care of temporary staff amid criticism of the high spend on agencies — which came to over €726m last year alone.

Most agency spend is on hospitals and services for older people

Hospital spending on agency staff topped the table at €304.7m last year, followed by the €118.9m spent on older people’s services.

A further €106.3m was spent on agency staff for mental health services and €77.9m in disability services.

Data for 2021 to May 2025 shows in each of these critical areas, the spending increased year on year.

The spending on agency staff for older people’s services almost doubled from €64.5m to €118.9m last year. Despite pledges to rein this in, this sector appears to be on track for a new record with some €52.1m spent already by May.

Mental health and disability services

People using mental health or disability services face long waiting lists as demand grows and these figures indicate temporary staff are being used to plug those gaps. Four years ago, disability services spent €40m on agency staff, last year it had jumped to €77.9m and, by May this year €37.2m was already spent.

In 2021, the mental health division spent €71.5m on temporary workers. Last year it was €106.3m, and by May it had reached €48.5m.

Agency bills are also ballooning in those areas which are expanding under Sláintecare plans to move healthcare out of hospitals to local communities: The Health and Wellbeing division, for example, spent €34,827 four years ago on agency staff, but last year the bill hit €324,364 and by May it stood at €106,126.

Even agencies struggle to hire staff

HSE corporate finance general manager Sarah Anderson said hiring and keeping “key staff is a constant challenge and impacts adversely on the ability to maintain safe and effective services”. 

She warned:  “At times the HSE have been unable to fill a vacancy even via agency. 

The agencies have indicated that they are experiencing difficulty in recruiting themselves due to a lack of availability and also accommodation availability and costs.

There is a global health workforce challenge, she said, with agencies also covering sick leave, maternity leave, or filling-in during recruitment.

The figures were released to Sinn Féin health spokesman David Cullinane.

“Wasteful over-reliance on agency spending has long been an area identified for savings, yet we are still seeing year-on-year increases despite the Government’s health productivity and savings taskforce,” he said.

Pay and numbers strategy 

“This increase is coming at the same time and, in my view, is directly related to the Government’s arbitrary recruitment limits under the pay and numbers strategy.”

This sets limits on staffing numbers and costs. It has been much criticised by health unions.

Mr Cullinane warned: “These staff are needed to provide essential services but they cannot be recruited directly, so the HSE is paying a premium price for agency workers instead.”

He called for “an ambitious and realistic workforce plan”, saying “strict targets to significantly reduce runaway agency spending” are also needed. Sinn Féin will propose this in an alternative budget, he added, describing the taskforce and strategy as “sticking plaster solutions”.