Northern Ireland's cash-strapped health service is paying up to £120 an hour for agency nurses as it struggles to plug chronic staff shortages, it can be revealed.
Hospitals and clinics are becoming increasingly reliant on agency nurses due to difficulties in filling staff posts.
The Press Association has learned that the Department of Health is having to pay between £40 and £120 per hour for uncontracted private agency nurses to ensure health facilities can be kept open.
Health bosses have admitted that the situation is not sustainable.
The Scottish Nursing Guild (SNG) is one of the most high profile agencies to supply agency staff in the region.
The Department of Health confirmed to the Press Association that payments to SNG can "range from some £40 per hour to a high of some £120 per hour."
In a statement the Department said this "would be higher and in some cases significantly higher" than rates paid to staff nurses and contracted agency nurses.
The Department added that payment rates to Scottish Nursing Guild will vary, according to posts and shifts being filled and that the highest rates will typically involve specialist nurse roles over public holiday periods.
According to its website, SNG's payrates for registered nurses range from £24 an hour to £82.50. The higher pay rate is for a nurse in charge of a specialist unit on a bank or public holiday.
SNG is not one of the Department of Health's contracted suppliers, which means there are no set rates to what the agency can charge.
The Department said SNG "have taken a conscious decision not to tender for work and enter into a contractual relationship at set rates".
A spokesperson for the Department added that SNG are only used as a last resort, when all other options to secure staff cover have been exhausted, such as bank and contracted agency staff.
"Thus it can come down to a choice to use Scottish Guild in such circumstances, or to close facilities as safe staffing levels could not be put in place," the spokesperson added.
They continued: "Agency and locum staff are only engaged when necessary, for instance providing cover where there are vacancies and in cases of sick leave and maternity/paternity leave.
"Without transformation of Health and Social Care, agency and locum costs will continue to increase. This is not sustainable, particularly at a time of serious financial pressures right across the public sector."
SNG could not be reached for comment.
The high cost of hiring agency staff has led to calls for the Audit Office to carry out a review of spending.
"It is ludicrous that at a time of growing waiting lists, bed shortages and other crises in our health service that this sort of money is having to be paid out. The Audit Office must carry out a review of spending on agency costs. It is not sustainable," said SDLP MLA Patsy McGlone.
In 2016 the Bengoa report on how Northern Ireland's health services could be more effective and efficient, made it clear that long-term transformation of health and social care is the only way to adequately tackle the issue of reliance on agency/locum staff.
The report warned of "stark increases in costs associated with locum and agency staff to provide a safe service where it is not possible to recruit to permanent positions."
It added that what the system spends on locums or agency staff is money that is not available for investing in other parts of the HSC.
In her report Delivering Together last year, then health minister Michelle O'Neill described the escalating agency and locum costs as unsustainable.
She added: "The increasing pressure on services has contributed to difficulties in attracting and retaining experienced staff and the vacancy rate in a range of disciplines continues to grow.
"These factors have led to an escalation in the costs of maintaining safe service provision through the use of expensive agency and locum staff, as well as longer hospital stays than necessary."
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