Mr. Stephen Mulvany:

It can be flexible and cost-effective, particularly in medical. The premiums can vary very significantly and we are not in control of the market. The variations from direct pay for other grades are smaller and more standard. While there tends to be a normalised rate, the VAT cost creates a 23% gap between our costs, direct and agency. It is expensive overall. Approximately 5% of our total pay costs are agency and overtime whereas in hospitals approximately 10% of costs are agency and overtime. Overtime is also an issue, particularly in services that are over reliant on it.