Government plans to increase the number of health visitors in the NHS in Scotland by around 50% in the space of four years are unlikely to succeed unless more is done to offset staff leaving or retiring from the profession, Nursing Times has been warned.
The Scottish government pledged in June 2014 that 500 extra health visitor jobs would be created by the end of 2017-18 and announced a £40m investment plan.
According to official data, in March 2014, there were estimated to be between 1,047.9 and 1,114.7 whole-time equivalent health visitors in post – the point at which the increase was measured from.
But the latest figures, which are from March 2017, reveal that the number of WTE health visitors has only risen to 1,357.
This marks an increase of between 242.3 and 309.1 extra WTE health visitors in the space of around three years – leaving the challenge of boosting the workforce by at least 200 additional staff in just one year to meet the target.
Concerns have been raised that the extra number of health visitors being trained is not enough to keep up with those leaving the profession, with warnings that the government will “scrape short” of the target.
“I’m not convinced we are going to land that magic 500 mark… I think we will probably just scrape short”
There have been calls for more to be done to attract people into or back to the workforce, and also to secure continuous investment.
If not, it may not be possible for all health boards in Scotland to deliver health visiting services under a new model that requires all families to receive 11 checks before the child reaches five years old, according to unions.
In the past, health boards had provided services that offered as little as around five or six health visitor checks.
It is understood that the government announced the boost in the workforce to support the introduction of the new model, known as the Universal Health Visiting Pathway.
“We were always supportive of the new universal pathway but only on the proviso that we had the numbers of staff to complete the increased amount of work,” said Unite professional officer for Scotland Gavin Fergie.
“I’m not convinced we are going to land that magic 500 mark,” he told Nursing Times, adding that Unite had always believed a target of around 800 extra health visitors was required.
“As you are training more new ones, you’ve also got other health visitors leaving”
“There is an increase in retirement rate and the aging demographic among health visitors is not a secret either. Then there is also the impact of pension changes and the changes coming over the hill with the implementation plan.
“I think we will probably just scrape short of the target,” he said.
He called for the government to improve its marketing of the profession - including bringing back health visitors into practice - and warned that if the workforce was not increased there was a risk of a “postcode approach” to bringing in the new model of services.
“Already in Scotland there are health boards that can’t implement the new 11-point pathway because they don’t have enough practitioners, even though they are recruiting hard,” he said.
The Royal College of Nursing in Scotland noted that almost a quarter of health visitors in Scotland were aged over 55, and often deciding to take early retirement.
“We believe our commitment to achieve 500 health visitor posts by 2018 is on track”
Associate director Ellen Hudson said: “As you are training more new ones, you’ve also got other health visitors leaving. In addition some universities are training people on part-time courses, which means it takes longer for people to come through to the workforce.”
She said it was important to monitor the rate of retirement and wanted to see health boards continue to invest in health visiting services – including more support roles to free up nurses’ time.
Health boards were recruiting and training staff as fast as they could, but there was a shortfall in the amount of staff available, she stressed to Nursing Times.
“That illustrates we probably need more if we are going to meet the needs of every child in Scotland,” she said.
In a statement provided to Nursing Times, Scottish health secretary Shona Robison said: “We are providing funding to health boards to achieve an unprecedented 50% increase in the health visiting workforce.
[We] believe our commitment to achieve 500 health visitor posts by 2018 is on track, with over 470 students having completed training to March 2017 and 303 actively in training,” she said.
“We are working closely with health boards to monitor progress, and health boards are accounting for retirals as part of that process,” she added.