Does Agency Staffing Affect Continuity of Care in the UK?

The context is important. Adult social care continues to face persistent recruitment and retention challenges. Over 70% of providers report difficulties recruiting staff, while many are also worried about sustaining safe levels of care delivery. 

Low pay, limited progression, and demanding work conditions remain reasons people leave the sector, alongside burnout and feeling undervalued or unsupported. 

Within this environment, agency staff step in to fill unavoidable gaps, yet the same pressures that drive providers to agencies also contribute to their longer term reliance on them. Staffing shortages in residential and homecare settings have already led to ‘rising reliance on temporary agency staff and inconsistent continuity’ for people using services.

This sets up a difficult tension, namely agencies offer immediacy and flexibility, but may unintentionally weaken the sense of stability that care depends on.

Why do people leave, and what do they seek?

People leave care roles not simply for higher pay, but for better control over their lives - more predictable shift patterns, flexibility around family commitments, and the emotional safety of feeling heard. 

When concerns are raised but not acted on, or when staff feel unsupported, they sometimes step away as an act of preservation. This human reality is echoed in data showing high levels of stress and low morale, with many workers considering leaving the sector altogether.

For some, agency work becomes a way to regain autonomy through choosing shifts, avoiding burnout, and experiencing different environments. However, while this flexibility benefits the individual, it can create a workforce that is more transient, less rooted in one service, one team, or one culture.

Do culture and continuity get lost?

Care is relational, built on familiarity, trust, and shared understanding, and high turnover and frequent use of agency staff can disrupt this continuity.

Staff turnover can affect safety and outcomes by weakening organisational knowledge and team cohesion. 
In settings where teams change frequently, expertise and informal knowledge, about residents’ preferences, behaviours, or early warning signs, can be lost.

For people living with dementia, the impact can be particularly profound. Consistency of caregivers is closely linked to wellbeing, as familiarity helps reduce their anxiety and confusion. Research highlights that person-centred dementia care depends on staff understanding individuals over time, rather than delivering task based support alone.

When staff are, so to say, ‘passing through,’ even if highly skilled, that depth of understanding is harder to build, and families may find themselves having to repeat information, and residents may experience a sense of disruption that is difficult to articulate but clearly felt.

Many providers describe a practical challenge: a ‘revolving door’ of unfamiliar faces, where managers may report frustration with no shows, inconsistent quality, and a lack of continuity when relying on agencies.

This does not, however, reflect a lack of professionalism among agency staff as many bring valuable skills and dedication, but rather the nature of short term placements. Without time to embed into a team or culture, even the best staff may remain on the periphery.

Over time, this can influence the identity of a service.

Instead of a stable team with shared values and long standing relationships, services may risk becoming more transactional, focused on covering shifts rather than cultivating culture.

There is also the shift from changing expectations from newer entrants into the workforce.

Younger applicants increasingly expect fast responses and a streamlined recruitment process, and when managers cannot respond quickly, agencies, who offer pre screened candidates and immediate availability, become the easier option.

Yet younger workers are also the most likely to leave the sector, with high attrition rates linked to feeling unsupported or underprepared. 

Many are drawn instead to sectors like hospitality, which offer perceived flexibility, immediacy, and social energy.

This can create a cycle - from rapid recruitment into care, brief exposure to the demands, and then departure, leaving providers to rely again on agency cover.

Rediscovering the ‘hidden capacity’

In many ways, care services already strive for experienced care workers who know residents well, anchor team culture, and support newer colleagues. However, maintaining this stability requires conditions that encourage people to stay, fair pay, manageable workloads, and strong leadership.

Rather than recreating old models, the opportunity may lie in reimagining them - building environments where longevity is possible and valued, and where knowledge is shared across whole teams rather than held by a few.

The conversation is beginning to shift toward solutions that feel more human and sustainable.

One of them is ‘hidden capacity’ within existing teams. Some providers found that when staff are offered flexibility, better shift patterns, meaningful overtime, or a stronger voice in scheduling, they are often willing to do more.

Another is the power of advocacy. Staff who feel valued and supported can become the strongest recruiters, bringing in people who are more likely to stay and connect with the service’s culture.

There is also a growing recognition that long term investment in people, through training, career pathways, and supportive leadership, is more sustainable than relying on temporary fixes. Sector voices stress that agency staffing ‘isn’t sustainable’ as a long term strategy and must be balanced with workforce development.

Agency staff can step into situations where gaps would otherwise leave people without care, often at very short notice, bringing valuable skills, adaptability, and willingness to support services in times of need. In a sector where vacancy rates remain higher than the wider job market and recruitment continues to pose a challenge, this flexibility is helpful.

For many providers, agencies offer reassurance in the sense that they can respond quickly when managers are stretched, when recruitment pipelines are slow, or when demand fluctuates unpredictably. In a system where staffing shortages have led to concerns about maintaining safe levels of care, that immediacy can protect both residents and existing teams from further strain.

At the same time, many agency professionals bring fresh perspectives and diverse experiences. They often work across multiple settings, gaining insight into different approaches, which can enrich teams and introduce new ways of thinking. When integrated well, this external experience can complement permanent staff and strengthen practice.

However, the challenge arises when agency use becomes the default rather than the backup. Over time, a steady turnover can make it harder to build the shared understanding that underpins strong care cultures. Relationships between staff and residents, and within teams themselves need consistency to grow. Without it, care risks becoming more task focused and less relational.

For people living with dementia in particular, familiar faces, predictable interactions, and deep personal understanding all contribute to a sense of safety and dignity, which can be disrupted when staffing changes frequently.

And yet, within these challenges, there are clear opportunities.

Providers are rediscovering the ‘hidden capacities’ within their own teams, recognising that when staff are offered flexibility, listened to, and supported, they are more likely to stay and give more. There is also renewed emphasis on creating pathways for people to build careers in care, rather than simply pass through it.

In the end, the question is not whether agencies undermine culture, but how the system can reduce the need to depend on them so heavily.

By investing in people, responding to what workers really need, and designing roles that fit real lives, the sector can begin to shift from a cycle of replacement to one of retention.

And in doing so, it can create what care has always strived to be: not just a service that functions, but a community.