Someone, somewhere has to pay for the Working Time Directive. Alas, many of the staffing agencies on which the NHS relies so heavily appear to have decided that it won't be them (see News, page ?).

If the agencies were able to demonstrate that the average 6 per cent increase they have adopted would benefit the nurses on their books rather than their own profit margins, they might have the beginnings of a negotiating position with the NHS. The fact that some agencies are able to keep increases to a more realistic level, and the calculations of NHS finance directors, suggest that even that is not the case.

Through no fault of their own, however, trusts are in many cases heavily reliant on agency staff and have little negotiating strength on this issue. It is a problem ministers should take seriously and act upon.