THE expenditure of £4.3m in the first five months of this financial year on agency nurses is an indication of the inefficiency of the NHS in Worcestershire.

One of the important factors is the failure of local management to address the issue of conditions of service, i.e. flexibility of employment and improved working relationships between management and staff.

The other issue is the failure of government to focus on the discrepancy between NHS pay and agency costs, which the hospitals are currently having to pay.

To claim that this vast expenditure is a result of expansion of services is ludicrous, when it appears obvious that the hospitals are struggling to cope with their routine workload.

J COOPER, Bewdley.