The Recruitment and Employment Confederation has warned that guaranteed hours reforms could make it harder for health and social care providers to fill staffing gaps at short notice, threatening service resilience, continuity of care and ultimately patient outcomes.
Proposals requiring employers to offer eligible zero- or low-hour workers a contract reflecting the regular hours they worked over a specific reference period would, the REC argues, be a hammer blow to the two-way flexibility that health and social care rely on. Worker shortages in both sectors, combined with short-notice demand for extra staff, are a mainstay of how services manage their workforce.
The REC is the latest organisation to raise concerns, after warnings from NHS Employers and the NHS Alliance. NHS Employers has called on the government to pause the plans, warning that NHS organisations in England could face unbudgeted costs of close to £1 billion a year and that poorly designed reforms could make NHS Bank work less attractive — undermining the very staff banks successive governments have promoted as an alternative to agency cover.
The REC says requiring guaranteed hours and compensation for cancelled shifts at short notice could discourage agencies and temporary workers from accepting flexible assignments, shrinking the pool of staff available to cover sickness, vacancies and unexpected surges in demand.
Neil Carberry, REC Chief Executive, said:
“These sweeping curbs on flexible work risk making agency roles less available and less attractive, deepening the recruitment and retention crisis across health and social care. Guaranteed hours add costs, bureaucracy and legal risks that make it harder to deploy temporary staff at short notice. When health and social care providers cannot fill gaps quickly, patients pay the price through reduced access to safe and timely care. At a time when services are already under intense pressure, reducing workforce flexibility risks leaving patients to bear the consequences.”
The organisation is urging ministers to take a simpler and more targeted approach, including exempting genuinely temporary workers, to avoid lost opportunities and a boom in false self-employment.
Carberry said:
“The government keeps threatening to end agency use in the NHS in a misguided effort to save costs despite limited evidence that the consequences around access to a skilled workforce have been properly considered. Yet its guaranteed hours gamble could do far more to drive up costs, making agency work less viable and stripping services of the emergency cover they rely on to keep patients safe.”
“The guaranteed hours changes could significantly limit the choice and flexibility that health and social care workers seek when working through agencies. If a nurse does a regular shift at a hospital once or twice a week over a few months that does not mean they want that to continue indefinitely or that their own preferences around when and how much they work won’t vary over time. Many workers may decide agency work is no longer worth the hassle and leave the sector altogether. Despite the need for agency workers, the result is potentially fewer agencies, fewer temporary workers and fewer options for services struggling to fill gaps at short notice.”
In its submission to the government consultation this week, the REC argues that temporary work helps employers respond to seasonal spikes, short-term pressures and unpredictable demand. When a permanent hire does not make sense, flexible staffing keeps services effective and creates opportunities, particularly for young people starting their careers. The proposals, it says, risk closing off opportunities for people who value flexibility, shrinking the supply of regulated jobs and pushing more workers towards less secure arrangements, including bogus self-employment.
Vacancy levels in adult social care remain around three times higher than in the wider economy, according to Skills for Care figures cited by the REC in June 2026, underlining the recruitment and retention challenge facing the sector.
Read the REC statement: Patients will demand the government gives its guaranteed hours gamble a tougher health check.
Neil Carberry is Chief Executive of the Recruitment and Employment Confederation, the voice of the recruitment industry.
