There have been stories recently about how much the NHS are paying agency staff to work shifts. These kind of locum shifts are usually contracted at short notice or include unsocial hours. But it’s madness – £188 for an hour’s work? I have heard worse recently: a GP paid £200 an hour for working at New Year, and an anaesthetist paid almost the same for working at Christmas.

This is one outcome of allowing market forces to dictate NHS spending. There was a time when the NHS made people work “emergency”, unfeasible or dangerous hours for pennies in order to save money, but the pendulum has now swung too far. The problems started when out-of-hours work began to be counted up by a government who had decided to start contracting for it, hoping to save money. They did not believe the hours that they were told were being worked and then they badly underestimated them. It ended up being far more expensive than had been planned for. “Medical professionalism” started to erode: every little thing  is expected to be costed and accounted for. In turn, it is easy for healthcare workers to refuse to do things – even important things – that have not been contracted for, and then blame the contract as the reason why. Professionalism in healthcare is desperately needed, but I am not convinced we will realise this until the NHS is on its knees and the doctors have all clocked out.