Call for shake-up in Scotland’s NHS

A RADICAL shake-up in the recruitment and training of medical staff in Scotland was proposed today in a bid to avert a staffing crisis in the health service.

More doctors, nurses, dentists, psychiatrists and radiographers are needed if the NHS is to survive, according to a government-commissioned report on the health workforce.

It also calls for more flexible working patterns to encourage medical staff to stay in their jobs and new "step down" contracts to cut the numbers taking early retirement.

The report by Professor John Temple predicts a staff shortage within the NHS in Scotland over the next ten years unless radical changes are put in place. It calls for national and local targets for recruitment into Scotland’s medical schools, a special programme to promote medicine as a career and a concerted effort to recruit medical students from a broader social background.

It also proposes more flexible training, better continuing professional development and moves to tackle morale problems, including positive changes in work practices.

The NHS is already Scotland’s biggest employer, with more than 130,000 staff, but Professor Temple’s report highlights current shortages in many areas.

Nearly 3000 nurses leave the profession every year, and the report warns an extra 6000 new doctors will be needed as a result of European legislation to restrict working hours. The European Working Time Directive is already limiting the length of the working week and by 2009 it will only be possible to ask junior doctors to work 48 hours.

The report also points out some 78 per cent of NHS staff are women, but many find the health service inflexible when it comes to their childcare needs.

Professor Temple, who is president of the Royal College of Surgeons of Edinburgh, said change in the health service and in the working practices of the medical profession had to go hand in hand. He said: "The Working Time Directive will affect all doctors, wherever they work, and this offers us a unique opportunity to take a fundamental look at the Scottish medical workforce, within the context of an integrated healthcare team."

He was asked by the Scottish Executive to review health service staffing a year ago at a time, when large numbers of doctors and nurses were threatening to leave the NHS amid complaints they were over-worked and under-funded. His remit was a fundamental review of medical workforce planning. Professor Temple appointed a small expert advisory group, which took views from a wide range of interests through a detailed questionnaire and focus group meetings.

His report, Future Practice: A Review of the Scottish Medical Workforce, contains 37 separate recommendations.

It was welcomed today by Health Minister Malcolm Chisholm, who said he would be accepting Professor Temple’s proposals.

Mr Chisholm said the report was an "important milestone" in the development of the NHS in Scotland.

But he insisted many initiatives were already under way to address the problems highlighted.

Dr John Garner, chairman of the British Medical Association in Scotland, underlined the need for a radical approach. "What we need to do is not only get flexible working arrangements and childcare arrangements, we also need to look in a much broader way at recruiting people into medicine and perhaps not always emphasise the academic achievement but the aptitude of people."

Pat Dawson, of the Royal College of Nursing, said one target should be to attract back into the NHS the estimated five to ten thousand people in Scotland who were trained as nurses but were not currently practising.

"We are treating more patients and every nurse in Scotland is working to full capacity and working unpaid extra hours."