Theresa Fyffe
Director of RCN Scotland
In light of the announcement on cuts to the NHS workforce this week, one thing is clear: NHS Scotland- and the Scottish Government – face a massive challenge. Our health service has a declining workforce, yet needs to deliver high quality services to more and more people who are living longer and have increasingly complex health needs.
It is all very well saying the NHS budget is protected, but when that budget is not enough to even keep services at a standstill – as costs and growing demand outstrip funding – a more meaningful way out of the current situation needs to be found. This is being made all the more urgent by the fact, confirmed in individual health board projections also published this week, that the NHS is set to lose even more nurses by the end of this financial year.
The Scottish Government’s argument that the NHS does not need as many nurses because of advances, such as increased day surgery, just does not stack up. If people are being cared for at home rather than in hospitals, where is the evidence of a corresponding investment in community nursing and other services outside of hospitals? We certainly have not seen any evidence of this so far and it is not immediately apparent in any health board plans for the future.
The pressure on health boards to balance their books and make increasing savings – this year they are required to make 3% efficiency savings, which Audit Scotland thinks may be unachievable given the public sector’s finances – has resulted in them chipping away at the workforce to save money. This has largely been done by not replacing staff when they leave or offering voluntary redundancy packages as, thankfully, compulsory redundancies have been ruled out by the Scottish Government. This approach, however, means that remaining staff are often delivering the same services with fewer staff, for more patients.
So this leaves the NHS in an extremely difficult situation and the Scottish Government needs to show some leadership. Instead of demanding that health boards balance their books, while making increasing savings with less and less staff, the Government needs to set out a vision for the NHS. For instance, could more effort be put into reducing non-workforce costs such as sharing clinical and backroom services?
Instead of devolving all responsibility for tough decisions to health boards, the Government must support boards by taking the difficult regional and national decisions which are needed to manage demand and change services, while also maintaining quality. Indeed, the public is far more willing to consider radical suggestions for improving services than they are given credit for. For example, a YouGov survey we carried out earlier this year showed that, even if they may have to travel further, 75% of Scottish people are more likely to support the creation of specialist healthcare centres, for complex surgery or cutting edge cancer treatments, for example, if this freed up NHS money to improve local healthcare.
So if the pressure is mounting on health boards, staff are overstretched and the public is willing to support radical decisions, it is most definitely time for the Scottish Government to step up to the plate.: Fewer and fewer nurses cannot provide more and more services to more and more people. The Government needs to be bold and support local health boards by taking the very difficult decisions needed to change the way services are delivered and to reduce demand. The alternative – more finance-driven, local cutbacks to professional healthcare staff – can only put patients, nurses and services at risk.
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