The astonishing levels of pay for agency doctors employed by the NHS, revealed today in our investigation, provide further evidence of how dysfunctional the health service bureaucracy has become. Nor do these findings suggest that the EU Working Time Directive, limiting doctors’ working hours, is operating to good effect. Although there were strong objections from the medical profession when this directive was imposed, there was also a recognition that doctors’ hours needed to be regulated to some degree: there is an obvious risk to patients being seen by an exhausted doctor, panda-eyed from lack of sleep. The revelation, however, that in the two years since the directive came into force, NHS hospitals have spent more than £2 billion on temporary clinical staff makes it clear that something is very wrong. One problem has been highlighted by Professor Norman Williams, President of the Royal College of Surgeons, who has expressed concern about hospitals attempting to economise by leaving vacant the posts of retired consultants, only to spend large sums employing locum staff. That is sheer incompetence and evidence of the urgent need to rationalise NHS bureaucracy. Doctors perform a vital service; but it is neither reasonable nor necessary to pay rates of £20,000 a week (equivalent to £1 million a year), especially when many of the payments to on-call doctors include hours when they are asleep. This scandalous situation has all the classic ingredients: European diktat, bureaucratic incoherence and abuse of taxpayers’ money. The public agency on which taxpayers least begrudge their involuntary contributions being spent is the NHS; but that generosity is predicated on the money being spent at the “sharp end” of patient care, not dissipated in the black hole of public sector paper-shuffling. Doctors must not work excessive hours, but both the directive and NHS administration should be searchingly reappraised.