Mr. Bernard Gloster:

There are a couple of factors. When staff numbers go up, we would expect agency dependency to go down, unless the demand for services is outstripping the number that the staffing is going up by. Quite simply, when we take the variables of things like new staff, numbers, absenteeism, agency workers and overtime, it does not add up properly. That would suggest to me a mix of demand and pressure in certain services and the wrong positioning of resources in some other services. Some do not have what they need, while others might have more than they need.

The control environment is another factor. I talked about this throughout the autumn. There are three factors to managing the deficit position in the health service. About a quarter to a third is in the inflationary factor, which looks like it is heading slightly downwards. We will see what it does. The next is in the growth in demand. Attendances in emergency departments for the month of January are up by 16% compared to the month of January last year, so there is very significant demand. The third part, which is the one I am responsible for, is the control environment. Our control environment has been poor. That is why the recruitment pause was introduced for certain grades and we have seen the reaction to that. Culturally, our health service has not been used to those types of controls and cross-checks.