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Agency bill spikes 10% in Scotland as nurse posts go unfilled

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Spending on agency nurses and midwives has shot up by more than 10% in Scotland in the past year, according to the latest workforce figures, which also show an increase in nursing vacancies.

The figures show overall nursing and midwifery staff numbers in the health service in Scotland reached a record high of just over 60,070 staff by the end of March this year.

“The bottom line is that more nurses are needed if safe staffing is going to be a reality”

Theresa Fyffe

However, the vacancy rate had increased to 5% from 4.5% the previous year with more than 3,140 unfilled full-time posts for qualified nurses and midwives and support staff.

Meanwhile, the figures show spending on supplementary staff to fill rota gaps has increased with NHS Scotland forking out £26.2m in 2018-19 on agency nurses and midwives and nearly £162m on bank staff.

The data published by NHS Scotland’s information services division shows the nursing workforce has increased by 3.5% in the past five years – with numbers of qualified nurses and support staff increasing at the same rate.

While there was an increase in the number of qualified midwives in the past year - with an extra 55 in post - the figures show a decline in overall numbers over the same five-year period.

The net turnover rate for nursing and midwifery staff as of March this year was 6.9% with variation between health boards. According to the figures, NHS Grampian had the highest turnover at 10.9%.

The total number of vacancies increased by 11.7% from March 2018 to 2019, which also saw an increase in the number of posts left unfilled for three months or more. However, long-term vacancies accounted for a lower proportion of total vacancies than last year.

NHS Grampian had the highest nursing and midwifery vacancy rate at 8.7% followed by NHS Highland at 8.4% and NHS Orkney at 7.5%.

The figures show more than half of all vacant posts – nearly 1,700 vacancies - were in adult nursing with nearly 16% in mental health and almost 8% in district nursing, which had the highest vacancy rate among the different nursing and midwifery roles.

The figures show health boards are increasingly turning to bank and agency nursing and midwifery staff to fill staffing gaps.

In 2018-19 spending on bank staff increased for the seventh year in a row to £161.9m.

There was a drop in agency spending last year but this shot up by 10.9% in 2018-19 to £26.2m, the figures show.

“There has been a 7.4% increase in qualified nurses and midwives under this government”

Jeane Freeman 

The overall combined use of bank and agency staff in 2018-19 equated to more than 5,000 full-time nurses and midwives, according to the report.

NHS Grampian saw a 78.3% increase in spending on agency nursing and midwifery staff – adding up to an extra £3.6m compared with 2017-18.

However, some health boards reported significant reductions in agency spend. NHS Ayrshire and Arran saw a 51.7% reduction while NHS Greater Glasgow and Clyde saw a 22% drop.

The greatest percentage increase in bank spending was reported by NHS Tayside at 32% although spending on agency dropped by a quarter.

“The overall increase in combined bank and agency hours highlights the growing need in NHS Tayside to cover shortages with supplementary staffing,” said the report.

Elsewhere the figures suggest Scottish government policies designed to increase the number of specialist nurses, including a drive to boost numbers of health visitors, appear to be having an impact.

In 2014 the government made a commitment to increase the number of health visitor posts by 500 over the next four years and the figures indicate that target has been reached.

As of March this year there were 1,865 individual health visitors working at Band 6 or above – up 7.4% on the previous year. The number of full-time equivalent health visitor roles increased by 7% to nearly 1,624.

Based on estimates of the number of health visitors in 2014 this means numbers have increased by between 509 and 575 full-time health visitors since March 2014, said the report.

Numbers of advanced nurse practitioners are also on the rise following a government pledge to train 500 new ANPs by 2021.

The latest available data from September 2018 shows a 4.4% increase in the number of ANPs employed by the NHS from 642 to 670. The report points out this does not include new ANPs working in primary care where it is likely a number of newly trained advanced practitioners will end up.

The figures also show a gradual increase in nursing and midwifery student numbers following a big drop between 2010-11 and 2012-13.

“The 3,471 reported in 2017-18 is the highest observed since 2010-11 and representative of a need to develop newly qualified nurses and midwives that can help overcome the challenges of an ageing workforce and increasing vacancy rates,” said the report.

The figures come after a bill to enshrine safe staffing in law was passed by Scottish Parliament earlier this year.

The Royal College of Nursing said it was concerned to see the increase in vacancies and highlighted the fact many nurses in Scotland are getting close to retirement with nearly one in five aged over 55.

RCN Scotland director Theresa Fyffe said pressures on nurses and support staff were “huge” because there weren’t enough to cope with rising demand.

“We will continue to look for new ways to encourage people to apply for advertised roles”

NHS Grampian spokesman 

“The bottom line is that more nurses are needed if safe staffing is going to be a reality in Scotland,” she said.

She said the latest workforce statistics highlighted the need for a fully-funded workforce plan that took account of growing demand for services and new ways of working.

“Along with the population more generally, the nursing workforce is getting older. This poses real problems for the future, with many more nurses coming up for retirement over the next 10 years, meaning the health service will be more reliant on finding new staff than ever before,” she added.

Scottish health secretary Jeane Freeman said the figures were encouraging with the overall number of NHS staff increasing for the seventh year in a row.

“There has been a 7.4% increase in qualified nurses and midwives under this government, and over this parliament we’re creating 2,600 extra nurse and midwifery training places,” she said. “We’ve also seen the number of consultant staff in post grow by 50%.”

She said a forthcoming integrated health and social care workforce plan would set out how the government planned to tackle staffing shortages. 

Scottish government

Jeane Freeman

Source: Andrew Cowan/Scottish Parliament

Jeane Freeman

“When we publish the integrated health and social care workforce plan, the first in the UK, it will be informed by available data to help ensure that we have the right staff in the right place long into the future,” she said.

“The plan will also take into account, as far as it can, the unknown impact that Brexit will have on retaining and recruiting our workforce,” she added.

A spokesman for NHS Grampian said the board acknowledged it faced continued challenges around the supply and recruitment of clinical staff but stressed it was looking at “innovative ways” to attract people to the region.

It noted how in 2017 it took the “unprecedented step” of travelling to Australia to look for staff, which had so far resulted in the recruitment of more than 100 new nurses.

“We will continue to look for new ways to encourage people to apply for advertised roles with the organisation and would encourage anyone who is interested in returning to the profession following a break to contact us for more information,” he added.

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