Many shifts are staffed by temporary nurses

Like all trusts, it has to look at ways of recruiting and retaining more staff - and ensuring those temporary staff used are up to the job.

Ms Parsley said: "We've done things like trying to get people who are out of nursing practice back in, by getting out to supermarkets and holding roadshows."

Nurses can also access term-time contracts, do job shares, and generally work more flexibly than in the past.

The trust's vacancy rate is around 10% - up from 8% three to four years ago - but in line with the national rise, which has seen some London hospitals reach 25%.

Longer term measures such as supporting student nurses and offering return to practice courses should help boost workforce.

But while those are taking shape, the hospital has to find nurse cover.

Often, that comes from temporary nurses.

Filling in the gaps

They come in two kinds - bank nurses, who are a pool of NHS nurses hospitals can draw on - and nurses from commercial agencies.

Hospitals tend to have their own "bank", made up of nurses who work at the hospital and who want to do extra shifts or simply work part time as and when shifts come up.

We have had people turn up for duty when, in the opinion of the ward sister, they have not been competent in that area.

Karen Parsley

Ms Parsley said that even if nurse vacancy rates were drastically reduced, hospitals would always need a pool of nurses who could come in temporarily to cope with seasonal peaks in demand.

"We do everything we can to use bank staff in the first instance, partly because they know the staff, and the hospital and they are part of the team - and we know they're training."

However, the need to use agency nurses does arise frequently - and they can be of variable quality.

Ms Parsley says the fear raised in the Audit Commission report that temporary nurses are working in areas they are unfamiliar with, and placing patients at risk, is guarded against in Brighton by ward sisters.

"We have had people turn up for duty when, in the opinion of the ward sister, they have not been competent in that area. So they have been sent back to the agency."

The hospital has had to increase its pay rates for specialist areas such as cardiology and intensive care, said Ms Parsley, because agencies are offering huge incentives to staff to go to London and work agency shifts there.

That could then mean the Brighton hospital having to find its own agency nurses to replace them.

The hospital has a contract with an agency to provide staff. The deal, negotiated three to four years ago, means a set commission charge of 17%.

Without the agreement, charges would be much, much higher.

The trust carries out police checks on prospective staff for the agency, and can ensure they have had mandatory training for working in the hospital.