The £900 million reason why Scotland's NHS must be better managed

Nurses are voting with their feet by leaving the health service – and taxpayers are paying the price for recruiting expensive agency staff to fill the resulting vacancies

“We care for up to 13 patients at any one time in the ‘corridor’… There is no appropriate spot to undress or toilet these patients despite waits of hours. I have seen several cardiac arrests occur in corridor patients. It makes you feel like you’re not doing a good job – the bare minimum – which in truth is what you are only able to do when managing patients in the corridor.”

The recent Royal College of Nursing Scotland report described harrowing accounts of overcrowded hospitals where nurses were forced to deliver care in corridors or worse. With testimony like this, it’s not surprising that many are retiring early while the number of Scots applying to study nursing is stagnating.

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But the cost of not filling vacancies and not having a new generation of talent coming forward is hitting taxpayers hard. Our NHS spent more than £900 million on agency nurses and locum doctors since 2019, according to figures obtained under Freedom of Information rules by Scottish Labour – and the real total for the past six years is likely to be higher as the figures only covered up to September 2024, before winter pressures hit.

Nurses want to do the job they were trained to do – and should not feel like they have been set up to fail (Picture: Christopher Furlong)Nurses want to do the job they were trained to do – and should not feel like they have been set up to fail (Picture: Christopher Furlong)
Nurses want to do the job they were trained to do – and should not feel like they have been set up to fail (Picture: Christopher Furlong) | Getty Images

Nearly £500 an hour

The biggest spenders included NHS Greater Glasgow and Clyde, which spent £103m on agency nurses, while NHS Grampian spent nearly £55m. As with any organisation, it’s more expensive to hire freelance medics at short notice than keep it in house.

A report by the BBC back in October found that some payments to locum psychiatrists were astronomical, with agencies charging £473 an hour compared to £50 an hour for an in-house junior consultant.

But there are other disadvantages to constantly hiring temps to fill the gaps, as any headteacher with a rowdy class of teenagers knows. Permanent staff in hospitals and clinics build up working relationships with colleagues and understand the community they serve, unlike someone who is suddenly parachuted in.

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But sadly, although the benefits of a permanent workforce are obvious, over the past 18 years the SNP has failed to recruit and retain enough NHS staff to meet demand. There is also a growing recognition that simply throwing more money at the problem will not improve doctors’ and nurses’ motivation to stay in the job.

Ten-year workforce plan

Just like all of us, nurses want to go to work and do the job they trained hard to do – not battle against a chaos so overwhelming that they feel set up to fail.

That is why Scottish Labour wants all healthcare staff to have access to dedicated changing facilities, rest rooms for breaks, hot meals 24/7, and protected time for learning and professional development.

Staff must also feel empowered to offer new ideas and speak up when things go wrong – not face a culture of bullying and cover up. We would also introduce a ten-year workforce plan that looks at how we recruit and motivate future generations of doctors, nurses and other NHS staff, as well as retaining the valuable skills we have now.

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As the cost of agency staff reminds us, there are 900 million reasons why it’s better to plan ahead.

Jackie Baillie is MSP for Dumbarton, Scottish Labour’s deputy leader and her party’s spokesperson for health

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