Scottish budget must ensure the NHS has safe levels of staff – Colin Poolman

The Scottish budget comes at a time when our health and care services face unprecedented challenges.

Nearly four out of ten nurses are thinking of leaving with calls for better staffing levels and pay (Picture: Isabel Infantes/AFP via Getty Images)
Nearly four out of ten nurses are thinking of leaving with calls for better staffing levels and pay (Picture: Isabel Infantes/AFP via Getty Images)

The First Minister has promised to increase investment in the NHS and that today’s budget will deliver “a significant down payment” on that commitment.

Nursing staff across Scotland’s NHS and social care services will be watching and waiting to see what this means for them, and if this promise will really deliver the much-needed focus on growing our nursing workforce to meet ever increasing demands and ensure the safe, quality care the people of Scotland expect and deserve.

Our members are tired, emotionally and physically drained from the relentlessness of the past two years. But many were feeling this way even before the pandemic hit.

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They were already responding to the consequences of an aging population with increasingly complex health needs, of being short-staffed with high levels of vacancies, of being unable to have their breaks or have time for professional development, of going home at night carrying the guilt of the care left undone and the impact this has on patients and their colleagues.

There is no doubt the pandemic shone a light on just how critical the role of nursing staff is in providing safe and effective care, their 24/7 presence and their willingness to step up in challenging times. Our members appreciated the clapping, the rainbows brought many smiles and the goodwill of the public shown through donations and provisions was a help through those initial months in lockdown. Nursing staff felt that at last their role was being recognised.

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The public gaze has moved on. The vaccination programme, largely delivered by nursing teams, has had a significant impact and in many ways the nation is beginning to learn to live with this deadly virus.

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For nursing staff, the work hasn’t changed but the spotlight has once again gone out.

The budget presents an opportunity for the Scottish government to show it values our nurses and nursing support workers in hospitals, community teams and care homes. To pay them fairly for the job they do and to invest in the workforce now and for the future.

Nursing and midwifery vacancies in the NHS in Scotland are at a record high, and there are similarly high levels of nursing vacancies within Scotland’s care homes. There are simply not enough nursing staff to run existing services, let alone seek to improve or expand these services.

The link between low pay, staff shortages and safe staffing is clear. Nursing must be seen as an attractive and rewarding career across NHS and social care services. There must be opportunities for career development and progression.

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Measures must include significant and ongoing investment in nursing student numbers across the four fields of nursing (adult, child, mental health and learning disability), with a commitment to ensure a fair bursary, improve access to other financial support to widen access and ensure students are supported to complete their education.

But equally important is a focus on retaining our experienced nursing staff, giving them the opportunity to work flexibly, continue to contribute to nursing teams and share their skills and expertise. Over 20 per cent of our nursing and midwifery workforce are aged over 55.

We’ve seen a sharp rise in the proportion of nursing staff considering quitting the profession. Last year 38 per cent of members reported that they were thinking of leaving, compared to 27 per cent in 2019. Addressing the current staffing shortages is vital for retention. When our members were asked what would make them feel more valued, three in four said "improved pay" while half identified better staffing levels.

Over two years ago, our members supported the Scottish government’s proposal to introduce legislation to secure safe staffing. We campaigned hard to make this legislation work for patients and our members, so it is extremely frustrating that the Health and Care (Staffing) (Scotland) Act is still to be implemented.

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The Act, the first in the UK to set out requirements for safe staffing across both health and care services, also requires NHS boards to seek clinical advice when making staffing decisions and to establish a clear process for concerns about unsafe staffing levels to be reported and escalated. Implementation should ensure nursing staff can raise concerns without fear of repercussion and have these concerns heard and responded to.

The reasons for passing this Act have been made even clearer by the Covid-19 crisis. Safe and effective staffing is a fundamental element of remobilising the NHS safely and helping to ensure that Scotland’s care homes can safely deliver care to residents with increasingly complex health needs. The Scottish government needs to set out a clear timetable for implementation.

Recognising the impact of the job and working under such sustained pressure is also key to retaining the current workforce. The £4 million funding to help staff with practical and emotional needs and aid rest and recuperation is welcome but we are still hearing from members that they simply don’t have the time to take advantage of the services that have been set up.

We’re calling on the government to ensure there is a robust evaluation of how this money is being spent locally and the impact this is having on supporting health and care staff is measured.

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Today’s budget must enable a new approach to deliver fully funded, sustainable workforce planning. Planning that is based in what services need now and in the future, rather than on what is affordable. Planning that truly values the role of nursing in delivering Scotland’s health and care services and builds a workforce that has the skills and capacity to provide safe and effective care for the people of Scotland.

Colin Poolman is interim director of the Royal College of Nursing Scotland

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