NHS Lothians in staffing crisis

A lack of trainees to fill positions at Lothians hospitals is causing a staffing crisis. Picture: Greg Macvean
A lack of trainees to fill positions at Lothians hospitals is causing a staffing crisis. Picture: Greg Macvean
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A WORKFORCE crisis in Lothian hospitals is to lead to highly-paid temporary doctors being offered a 20 per cent pay rise and see existing staff workloads increase to prevent the collapse of the NHS.

While Lothian health chiefs have previously admitted to medical shortages in areas including emergency medicine, gynaecology and children’s departments, an internal medical workforce risk assessment has revealed that the issues run far deeper.

The review has shown that X-ray, maxillofacial [head, neck, face, jaw] and medical and surgical ophthalmology [eye] departments are all classed as “very high risk” with vacant posts lying empty because of a lack of suitable candidates.

Bosses have warned cash alone will not be enough to solve the problem, after they accepted that the appeal of Edinburgh and its international reputation in the medical community is no longer enough to attract workers.

The revelations come just days after Scottish doctors attending the British Medical Association (BMA) conference in the Capital warned that NHS staff were facing “relentless” pressure and that increasing intensity of workloads would lead to stress and burn-out, which could harm patients.

The reliance on expensive short-term staff will also lead to fears of enforced cuts, with budgets coming under increasing pressure. It has today emerged that:

n An offer to pay GPs £560 a night to staff emergency departments is set to fail after none applied.

n Workloads of some staff at St John’s Hospital are set to be increased in a last-gasp bid to prevent an A&E downgrade.

n The Scottish Government could reverse a planned reduction in trainee numbers in light of staff shortages.

n Pay packets of expensive locum doctors are set to be boosted further in a bid to fill posts.

n Doctor shortages in other parts of Scotland could result in even more patients being sent to Edinburgh, leading to an increased strain on Lothian resources.

n 40 per cent of emergency training posts in Lothian have gone unfilled after the latest round of recruitment.

n Health bosses are braced for an impending shortage of trained maternity consultants and gynaecologists and have admitted there is a “significant risk” permanent jobs may go unfilled.

While there are complex reasons for the situation, NHS Lothian said historic planning assumptions for the number of trained expert doctors needed had been wildly underestimated across a series of departments.

Health board sources have been privately critical of the Scottish Government model, which was designed to move away from a reliance on doctors in training.

It is understood that health board chief executive Tim Davison, who also heads the The National Reshaping Medical Workforce Project Board, has been lobbying for an increase in trainees and Holyrood today signalled it may be preparing for a U-turn.

Tory MSP and health spokesman Jackson Carlaw said the government’s long-term planning had been “disastrous”.

He added: “It should not be beyond the wit of ministers to look at how many people are in training, 
and match that up against the age of a workforce 
and population demands.

“Unfortunately, that was never done properly, leaving NHS Lothian with this staffing quandary.

“What is the point in the NHS trying to save money at one end, only to be splurging it on sky-
high locum fees on the other?”

Doctors below consultant level who work directly for NHS Lothian as locums have been paid £516 for working night shifts in emergency departments. However, the sum on offer is to increase by more than £100, such is the desperation to fill roles and beat other health boards in the hunt for trained staff.

In a bid to prevent an out-of-hours downgrade at St John’s Hospital A&E, which would see pressure ramp up on the Royal Infirmary, medical assessment teams who previously dealt only with inpatients are also to be asked to work with emergency department teams at the “front door” of the hospital.

And 12 new acute clinical development fellowship roles have been created, in a bid to support the department. It is believed that the jobs, which will see newly-qualified doctors offered six or 12-month “tasters” of emergency departments without having to commit for the long-term, are the first of their kind in the UK and have been described by NHS Lothian as an “innovative” move. Four doctors have so far expressed interest.

But a shortfall in trainees in different areas means there will be a continued reliance of expensive temporary doctors, with a lack of capacity in Lothian meaning millions will be spent on sending patients to the private sector. In the review, it emerged that vital middle-grade training rotas were at risk of becoming unsustainable in all surgical areas.

Three gynaecologists are needed in Lothian, although there is competition from NHS Tayside, Borders and Fife, which are also recruiting. There also are problems across plastic surgery, rheumatology [bone and muscle] and pathology [disease detection] departments. NHS Lothian said shortages were a “matter of significant concern as it suggests financial investment alone will not provide the required additional service capacity”. The staffing situation in children’s medicine, although improved compared to 12 months ago, remains “fragile”.

Labour Lothians MSP Sarah Boyack said: “There are more problems waiting to happen and these are really big ticket items. The scale of the problem is laid bare. This shows that there has been a complete failure to plan the workforce across NHS Lothian.

“But it’s also a reflection of failure to plan at the Scottish level. It’s time that the SNP stopped believing their own spin and started to act on the warnings from the BMA and RCN [Royal College of Nursing] that staffing levels are at breaking point.”

George Walker, a non-executive member of the NHS Lothian board, this week questioned what was being done to influence national policy.

He said: “David [Farquharson, NHS Lothian’s medical director] is not a magician. He can’t magic a solution. This isn’t in our control, it’s in the control of those who set policy nationally and NES” [NHS Education for Scotland].

The Scottish Government said specialities were being looked at on a case-by-case basis to decide on the intake of trainees next year, with advice offered to Health Secretary Alex Neil by the National Reshaping Medical Workforce Project Board.
Mr Davison, who became NHS Lothian’s permanent chief executive 11 months ago, said that while he supported a rise in trainee numbers, even that may not offer a solution.

He said: “Part of the strategy is to make these jobs attractive, but that’s difficult. The reason they aren’t attractive is that they are very onerous, busy with very antisocial hours.”

A NES spokeswoman said: “NHS Education for Scotland continues to work with the Scottish Government and regional workforce colleagues regarding trainee recruitment for 2014 and beyond with a view to evaluating options for growth in those clinical specialities where there is compelling evidence to support such growth.”