The Scottish government has failed to plan effectively for long-term workforce challenges in the NHS and may have seriously underestimated the number of nurses needed, according to a new report.
Current projections for the number of nurses needed over the next five years risk leaving NHS Scotland with a shortfall, said the Audit Scotland report, which focuses on staff in hospitals and other secondary care settings.
“There are potential knock-on effects for delivering healthcare”
Audit Scotland report
In particular, it suggested the government in Scotland had failed to recognise the potential impact of the large proportion of nurses and midwives set to retire in the near future.
The report, published today, highlighted the mounting pressure on health services in the country with a rising number of complaints and concern about workloads.
Almost nine in 10 nurses who responded to a recent Royal College of Nursing survey in Scotland reported their workload had got worse.
Meanwhile, the Audit Scotland report showed NHS boards were spending more on agency staff, with 13 out of 14 overspending against their 2016-16 pay budgets.
The Scottish government had intended to publish a single workforce plan for health and social care but this will now happen in three stages. The first stage – published in June – is a framework to consider future challenges rather than being a detailed plan.
“There are signs that the health service is under stress and that staff face increasing workload pressures”
Audit Scotland said urgent action was needed to firm up plans, in what is the first part of a two-stage audit of workforce planning in NHS Scotland.
“Thousands of people work hard in Scotland’s NHS to deliver vital public services every day, but there are signs that the health service is under stress and that staff face increasing workload pressures,” said Caroline Gardner, auditor general for Scotland.
She added: “The Scottish government and NHS boards recognise the challenges, but urgently need to improve their understanding of future demand, staff projections and associated costs, and set out in detail how they plan to create a workforce that can meet the long-term health needs of the population.”
At present, responsibility for workforce planning at national, regional and local level is “confused” stated the report, which also highlighted a lack of joined-up planning across professional groups.
Auditors warn of future shortfall in nurses in Scotland
“There are separate planning processes for recruiting doctors, nurses and other professional groups,” said the report. “This makes it more difficult to consider how skills across different groups can complement each other.”
Overall, it suggested the number of nurses and midwives needed by 2021-22 “may be an underestimate”, especially given more than a third of staff were over 50 and the number of newly-qualifieds available to replace them has fallen – by 15% in 2014-15 and a further 7% in 2015-16.
“The Scottish government has not fully considered whether nurses and midwives already in training, alongside other routes of nursing and midwifery recruitment, are enough to fill the gap left by those retiring,” said the report.
“If this element of the workforce is not replaced, there are potential knock-on effects for delivering healthcare,” it warned.
The report shows a nursing and midwifery vacancy rate of 4.5% as of March this year.
“Scotland has too few nursing staff in post and too few nurses being trained”
A projection, taking into account anticipated numbers of newly-qualified nurses and those likely to retire, showed that if all those eligible for retirement do so at 65 then there will be an estimated 1.5% surplus of nurses and midwives by March 2022.
However, if all those eligible to retire decide to leave aged 60 then there will be a 9.6% shortfall. If some retire at 50, some at 60 and the rest at 65 then there will be a 7.9% shortfall, the analysis predicted.
When it comes to training new nurses, the report said plans were “not based on meeting the long-term needs of a changing population”.
It also raised questions about policy on advanced nurse practitioners (ANPs), who can contribute to skills mix by undertaking more complex clinical roles traditionally carried out by doctors.
The government has said it intends to increase the number of ANPs by 500 by 2021. However, the report said it was not clear if the 500 ANPs will be new nurses or trained from existing nursing staff.
The Royal College of Nursing in Scotland said it had been warning for some time that government had failed to adequately “future proof” NHS Scotland’s workforce.
“Audit Scotland has hit the nail on the head – for too long plans have been restricted by what is affordable and achievable with the staff available – rather than focusing on strategic, long-term planning to meet demand,” said Theresa Fyffe, director of RCN Scotland.
“The result is that Scotland has too few nursing staff in post and too few nurses being trained,” said Ms Fyffe.
“Staff across NHS Scotland are under enormous, unrelenting pressure to meet ever growing demand,” she said. “The significant workforce challenges set out in the report must be addressed robustly, realistically and rapidly if patients are to get the care that they need.”
Mary Ross-Davie, Royal College of Midwives’ director for Scotland, said the Audit Scotland report “shines a welcome light on the significant challenges” facing the NHS in Scotland.
“Workforce planning is highlighted as a challenge across NHS Scotland and we know this is particularly true in maternity care,” said Ms Ross-Davie.
“In Scotland 41% of midwives are over 50, with many more midwives retiring in the last year than in previous years,” she said. “Heads of midwifery are finding it increasingly difficult to fill vacant midwifery posts as midwives leave, with particular pressures in the North of Scotland and more remote areas.
“To counteract this drain on midwifery numbers there need to be clear, detailed plans for continuing to increase the number of training places for midwives and the opportunities for midwives to return to practice who have left,” she added.