Health boards vow services won't suffer as axe to fall on more staff

• Health boards have been asked to submit their workforce plans to the Scottish Government, detailing any proposed changes in staffing. Picture: TSPL

NHS Tayside said about 500 posts would be lost, while other boards revealed plans not to replace staff who leave.

It comes after NHS Greater Glasgow and Clyde said more than 1,200 jobs would be axed in the next 18 months – more than half in nursing and midwifery.

Doctors, nurses and union leaders have warned the cuts will affect patient care.

But health boards have maintained that their money-saving plans can be delivered without impacting on services.

They also indicated that cuts would mostly be made by not replacing staff who leave, rather than through compulsory redundancies.

Health boards have been asked to submit their workforce plans to the Scottish Government, detailing any proposed changes in staffing.

While the plans do not need to be signed off by ministers, it is expected that the Scottish Government will offer feedback and advice on the proposals.

NHS Tayside said it expected the number of posts to reduce by some 500 – about 4.5 per cent of its workforce – over the next two years.

Professor Tony Wells, the board's chief executive, said: "NHS Tayside has no figure set in stone for the number of posts which may not be filled due to natural staff turnover or the redesign of some of our services, but we are working along the lines of around 500 whole time equivalent (WTE] posts."

NHS Ayrshire and Arran said it expected to shed 121 WTE posts – 1.4 per cent of its total workforce.

Mark Adderley, its director of people and organisation development, said: "Our approach involves reducing the number of bank and agency staff we use and reducing the amount of overtime staff work.

"This, combined with the effects of natural turnover – for example, not filling posts when people retire or leave – means that we will be in a position to achieve our efficiency savings target."

NHS Fife forecasts a drop of 55 WTE posts this year, but stressed it was not planning any redundancies.

The Grampian board said it had a funding gap of some 34 million and had launched a voluntary severance scheme as part of its measures to reduce costs – but it had no target for the numbers it wanted to cut.

Other boards were unable to provide figures, with workforce plans still being finalised, but hinted at job cuts to come.

A spokesman for NHS Lanarkshire said: "We expect to manage any job reductions through natural turnover and by reducing the use of bank staff and overtime working.

"There will be no compulsory redundancies."

NHS Shetland said it expected to make savings of 1.5m.

A spokesman said: "Where there are vacant posts, we will use the opportunities presented to look at whether we can redesign services without dropping our high standards.

"This may result in an overall reduction in filled posts compared to the current establishment."

NHS Orkney said it needed to make 2.5m in savings in the 2010-11 financial year. "As part of our ongoing service review process, our current workforce will be assessed in terms of numbers and skills mix to ensure that it is appropriate for current and future needs," the board said.

Other non-territorial health boards also indicated the potential for posts not to be refilled, while some, including the Scottish Ambulance Service, said they did not expect any significant change in staffing.

Will patients suffer? Truth is, we just don't know

THE NHS is cutting costs and we are not sure what the effect will be on patient outcomes. As you begin to reconfigure services, do you know how you are actually affecting patient care? Will it affect either the quality or quantity of care, or both? Or do people just work harder and get stressed out but produce the same volume and quality of care? We simply don't know.

That is why the phrase "efficiency cuts" is wrong. We are not sure it is efficient to cut. We are just cutting costs and hoping patient care is not being damaged as a consequence.

We have to ask whether the same things that happened in the private sector may start happening in the public sector. Could we start seeing public sector workers being told they can keep their jobs but have to accept lower wages?

I don't think people have yet come to terms with this trade-off. Do you want a job? If you do, you are going to get lower pay. Or do you want to keep all your wages and end up without a job or see your mates sacked? I think those kind of choices are going to become quite stark in the next six months. There are ways the NHS could save money without affecting patient care. The big issue in any healthcare system, public or private, is the enormous variation in what clinicians do to people. People with similar health needs get very different patterns of care.

If you believe the healthcare system in Scotland is inefficient, you have to say: who manages it? The answer is that the doctors do. So if there is inefficiency, we should be working with the doctors to improve efficiency with them.

Managers are not the people who determine the pattern of care; it is the doctors and nurses who do.

Alan Maynard is professor of health economics at York University.