Organisations representing Scotland’s nurses and doctors say the Scottish government has failed to do enough to stop people leaving their professions as the NHS struggles to cope with unprecedented pressure.

Unions, professional organisations and charities have responded to the Scottish government’s recovery plan for the NHS by welcoming many of the commitments but saying ministers need to recognise that the health service needs to recover not just from covid but from a legacy of underfunding that predates the pandemic.

The Royal College of Nursing says it’s not convinced that the government has done enough to ensure Scotland has the nursing workforce it needs.

Julie Lamberth, Chair of the RCN Scotland Board, says staff shortages are impacting patients and action on staffing levels is needed urgently:

“We have been clear that fair pay, safe staffing and staff wellbeing must be the building blocks for recovery.

“The Scottish government’s plan rightly recognises that staff burn out, the impact of untaken leave and the number of staff considering retirement are key risks. However, there is little detail on how these issues will be addressed.

“As a safety-critical profession, nursing has been undervalued and under-resourced for too long. The pandemic has compounded years of working under the pressure of staff shortages and with pay that has failed to keep pace with the cost of living.

“To date the Scottish government’s workforce planning has been woefully poor and resulted in us entering the pandemic with thousands of nursing and midwifery vacancies.

“A commitment to national and international recruitment does not address the need to retain our existing experienced nursing workforce or ensure the capacity and skills are available to support those starting out in nursing.”

The doctors’ trade union, BMA Scotland, says the lack of a plan to retain current staff as the NHS struggles – and is “close to failing in places” – is a “crucial omission“.

BMA Scotland chair Dr Lewis Morrison says the recovery plan goes some way to acknowledging the scale of the problem NHS Scotland and its staff are facing, but covid simply exacerbated problems that already existed:

“This has to be a recovery plan full stop, not just one from covid, and one which acknowledges the years of understaffing and under-resourcing that are the backdrop to where we are now.

“The lack of explicit acknowledgement of the staff shortages is disappointing. We cannot hope to deliver what is currently demanded of our NHS – let alone an extra 10%. Striving to meet this commitment is unrealistic without the staff to do it, and it risks simply driving existing staff harder. That won’t work and it risks damaging those staff and making retention issues much worse.”

Dr Morrison says statements by the government that a priority will be to ‘restore face-to-face GP consultations as quickly and safely as possible’ don’t recognise the overwhelming demand that all clinicians are facing and having to deal with safely:

“They are already seeing patients face-to-face where appropriate and we must continue to allow those careful judgements to be made.

“We didn’t have enough GPs before the pandemic, and workload from covid illness in the community, which is currently rising rapidly, falls on GPs both in and out of hours.

“We have to be careful not to make an already difficult situation worse and fuel the already worrying increase in abuse GPs and their staff are facing.”

The Royal College of Physicians of Edinburgh is welcoming moves by the government to increase the number of undergraduate medical training places and, in the meantime, says Scotland must “redouble efforts” to attract doctors from outside Scotland to train or work here, and encourage those already in the NHS to stay.

College President, Professor Andrew Elder says it is important that the commitment in the recovery plan to redesigning patient pathways and improving services, apply across the board:

“Whilst it is clearly important that specific conditions, such as cancer, are targeted appropriately, we should remember that our ageing population typically have multiple health problems, and service redesign must take this into account.

“Similarly, whilst measures to enhance urgent care and also to prevent hospital admission are welcome, matched efforts must be made to ensure that all patients who are ready to return home from hospital can do so. Only by tackling issues at both the “front door” and “back door” of our hospitals will capacity for in-patient care reach its full potential.”

Richard Meade, the Head of Policy in Scotland for charity, Marie Curie, says it would have been good to see recognition in the plan of the needs of people at the end of their lives:

“It feels like it has missed an opportunity to look at improving the support for the increasing numbers of terminally ill people dying in the community as a result of the pandemic.

“Forty per cent more people died at home as a result of the pandemic instead of in hospital, partly to help free up acute capacity, and if this trend continues, which at present looks likely in the short term, then we need to make sure dying people and their carers get all the support they need.”

The charities and organisations representing clinicians say they regard the government’s NHS recovery plan as just the beginning of a process that needs to involve both those working in healthcare and patients.

“Overall,” says the BMA Scotland’s Dr Lewis Morrison, “this plan is in many ways only a start.

“It contains some good things, some things that need much more discussion, but it also has many worrying gaps.

“We need to see what it means in reality and additional plans for what is missing.

“Above all, I would just encourage everyone to be honest, open and patient as we work together to help healthcare recover from what has been a hugely challenging period.”

 

Read more: Dentists’ colossal backlog as free services expand; Survey: Unprecedented anxiety of older Scots; Doctors pay rise does “virtually nothing”; Pandemic and opportunity to rethink end-of-life care.

 

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