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Early workforce warning ahead of winter in Scotland

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Over-stretched Scottish health services will struggle to implement government guidance on coping with winter pressures because of ongoing staffing problems, warn nursing leaders.

The warning comes alongside the publication of two reports – one detailing the challenges of last winter and the other setting out how the government expects health boards to prepare for winter this year.

The report on winter 2014-15 highlights efforts to increase capacity including an increase of 1,126 full-time nurses and midwives, increases in acute medical beds and more intermediate care.

“What these reports both show is that the NHS is under huge pressure”

Ellen Hudson

It also flags up advances in workforce planning such as staffing tools to help ensure there were in enough nursing staff.

“Over recent years there has been significant developments in the nursing and midwifery workload and workforce planning tools available to NHS boards in Scotland,” stated the report.

“These evidence- based tools provide information on the nursing and midwifery whole time equivalent requirement based on the measurement of workload generated by individual patients,” it said.

Nevertheless hospitals struggled to cope with a surge in demand from increased cases of flu and respiratory illness leading to delays in accident and emergency during December, January and February.

Meanwhile, delays in discharging patients from hospital added to the pressure services were under.

Nursing bodies said the figures in the report masked the full picture, which included increased vacancy rates and a more than 50% increase in the use of agency nursing and midwifery staff.

The amount spent on bank nurses also increased by £11.4m in the year up to March 2015.

“There has been significant developments in the nursing and midwifery workload and workforce planning tools available to NHS boards”

Report

The new guidance said health boards must carry out “robust analysis” to work out staffing levels for winter 2015-16.

They must submit draft winter plans by the end of this month and final plans by the end of October, which must be explicit about plans for extra beds and staff.

Nursing rotas for the festive period should not include the use of agency staff and must “conform to workload planning tool guidance”, boards have been told.

Plans must also factor in intermediate and community care, including community nursing and hospitals will be expected to “ensure a proactive approach to discharge”.

“Discharges should be made early in the day, including over weekends, and should involve key members of the multidisciplinary team, including social work,” stated the guidance.

“Test scheduling and the availability of results, discharge medication, transport requirements and availability of medical and nursing staff to undertake discharge should all be considered during this process to optimise discharge pre-noon on the estimated date of discharge,” it added.

However, the Royal College of Nursing in Scotland said it would be difficult for health boards to put the guidance into practice, given the scale of staff shortages and vacancy rates.

“The scale of local reform expected… will be a mountain for already over-stretched health boards to climb before the end of October”

Ellen Hudson

“What these reports both show is that the NHS is under huge pressure,” said RCN Scotland associate director Ellen Hudson.

“As we have repeatedly said, change is desperately needed and this requires a frank debate about the real situation on the ground,” she added.

“Patients, quite rightly, expect health boards to plan for winter and it is good that the government is focused on this serious issue,” said Ms Hudson.

“But the scale of local reform expected, even before the Scottish government’s own national reviews on issues such as out-of-hours care are complete, will be a mountain for already over-stretched health boards to climb before the end of October,” she said.

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