Editor's Viewpoint: Trusts' agency staff bill now intolerable
The escalating bill for agency staff in the health service in Northern Ireland is unsustainable. It has more than doubled in the last three years, reaching £156m in the 12 months to April last.
Not only is the total staggering but the rate of increase is also alarming, rising 16% in the last financial year.
It demonstrates a service under severe pressure to deliver safe and effective services, but which finds itself in a catch-22 situation.
Health trusts are spending more and more money on temporary medical, nursing and administrative staff, putting their resources under increasing strain.
There has been a long-running argument that trusts outside Belfast and Londonderry are having the greatest difficulty recruiting and retaining staff because they don't offer the same range of specialities and critical mass of staff as the city hospitals.
Yet Belfast has the biggest bill for temporary staff, showing that workforce pressures are systemic.
This is a UK-wide problem which has grown so severe that a cap was put on payments to temporary staff in a bid to control finances.
We know that pressures on hospitals - but also on general practice and in social services - are increasing as the population ages and that retaining doctors and nurses at appropriate levels has become more difficult. Public sector pay curbs at a time of increasing demand on services have also made the NHS less attractive.
Here we have the problem of lack of political direction as the province heads towards setting a shameful world record for the longest period without a government.
The Bengoa Report, a blueprint to streamline the health service and change the way services are delivered, cannot be fully implemented without a Health Minister in place.
A workforce strategy covering the next eight years could also transform recruitment and retention, but again there is uncertainty over its implementation.
The creation of a new medical training school at the Ulster University in Derry is seen as another potential boost to trusts, particularly the Western Trust, but it is already behind schedule and awaiting ministerial go-ahead.
The huge spending on temporary staff can only be regarded as a short-term measure. Some will always be needed to cover holidays and illnesses, but it does not address the fundamental problems in the service.