This newspaper has previously highlighted the scandalous level of spending on agency nursing and midwifery staff in the Northern Ireland health service.
The £115m spent last year to plug gaps in the workforce is obviously a grossly inefficient use of public funds with three of the five health trusts revealing that, on occasions, they have paid as much as £131 an hour to agency staff.
But the situation is even worse, according to Comptroller and Auditor General Kieran Donnelly. In his report into the situation of under-staffing he warned that both patient and staff safety and the quality of service could be compromised by agency staff working in unfamiliar clinical settings.
It is one thing to waste scarce public funds, but when the result could be detrimental to the care provided the problem moves to an unacceptably higher level.
This is not something which arose unexpectedly. The number of vacancies in nursing and midwifery have soared from 770 in 2013 to 2,700 last year and spending on agency staff has risen from £14.6m in 2006/7 to £115m last year.
It does not take a financial genius to gather that such increases are unsustainable. Yet, astonishingly, the Department of Health reduced the training budget for pre-registration nursing post between 2011/12 and 2016/17 resulting in 732 fewer posts compared to the figure in 2009/10.
Quite why it would create fewer nurses and reduce the dependency on agency staff is baffling and undoubtedly contributed to the situation outlined by Mr Donnelly.
Admittedly a recurrent funding gap of £40m hampered efforts to recruit staff but given the expenditure on agency staff surely this money could have been found or redirected.
While the problem is obvious, finding a way to redress it is less so.
Belatedly, the Department has increased the number of nurses and midwives in training, but these will take time to filter into the system and the coronavirus pandemic may make working on the front line a less attractive career option.
As well, there needs to be a transformation of how services are provided. Health Minister Robin Swann has shown his determination to create a more efficient NHS and the Bengoa report which has been with the Department for four years is a positive baseline from which to work. The health trusts cannot continue to spend money on a huge scale with no patient benefit.