Scotland is heading for a health staffing crisis, with financially-squeezed GPs considering early retirement and recruitment problems in high-pressure acute and emergency wards, according to unions.
Politicians and health boards need to be honest with the public about what the NHS can deliver with ever-tightening resources, the unions said during Holyrood scrutiny of the Scottish Budget.
Information that the Scottish Government provides to Parliament on pay and staffing is “out of kilter”, with conditions reported to unions of 14-hour days, a 10% cut in real-terms earnings and record nursing vacancies at one health board, the unions told Holyrood’s Health Committee.
The NHS has “a culture of playing with numbers” to “massage over the gaps created by efficiency savings”, with staff working 90 hours a week in breach of the European working time directive, it was claimed.
Donald Harley, deputy secretary of the British Medical Association in Scotland, said: “There needs to be a degree of honesty with the Scottish public and we hope politicians will lead that public debate about what can be provided within these falling budgets.”
He added: “Although as a section of the population GPs are relatively well-rewarded, nevertheless they have seen a very significant decrease in their net draw-ins in the last seven years, against a background of practice costs rising inexorably. They are bearing all of those increases and being asked to do more and more.
“A third of that group are 55 and over, and looking at the exit door. If you keep squeezing, people will ultimately vote with their feet. We are looking at a crisis in manning in general practice.”
He continued: “From the people we speak to in A&E and also in acute, which is getting towards breaking point, we already see the fact that it’s very hard to recruit people to work in A&E.
“If we have problems now, there are even greater problems building because it takes some kind of saint to want to work in such an intense environment, constantly working overtime with lots of physical and emotional demands full-on. Within nursing and medicine, people say there are easier ways to earn a living.”
Rachel Cackett, policy adviser at the Royal College of Nursing Scotland, said boards have been making short-term savings by holding nursing vacancies open for months to save on salary costs.
“The low hanging fruit is gone and boards are having to be ever more creative to come up with the savings that they have agreed with government,” she said.
Mr Harley said: “There is a bit of culture in the NHS of playing with numbers.
“On paper we are meeting the working time directive and everything is fine, but the reality is rotas are constructed to massage over the gaps created by efficiency savings. People are working 90 hours at a stretch in a week.”
The unions welcomed Holyrood Health Secretary Alex Neil’s commitment to honour a 1% pay rise, which his counterpart in England is seeking to withdraw, but warned against presenting it as a real-terms rise.
Matt McLaughlin, regional organiser at Unison Scotland, said: “I was at least content to hear the Scottish Health Secretary’s confirmation that the Scottish Government will honour the existing 1%, but let us be clear that is not a pay rise – it is a continued pay cut.
“A number of analyses suggest that NHS workers have lost somewhere like 10% of their earnings in real terms over the last few years.”
He added: “While I have some sympathy with the Scottish Government, I think there is a disjoint in the information provided.
“There is a suggestion that we have more nurses than we have had in recent years, and when you start to add up what health boards say they are employing, that’s the kind of conclusion that you might reach.
“When you start to delve below those figures, though, and look at actual headcount of people in post at a particular time, the information suggests something slightly different.
“In June this year Glasgow health board had something like 1,800 vacancies, predominantly in nursing, the highest it has ever been.
“So, at a time when people are saying there are more nurses than ever, it would appear that there are less nurses in wards delivering services.
“Somewhere the information coming from the Scottish Government to the Parliament is out of kilter.”
He added: “The other day I saw a service redesign that seemed to suggest that registered nurses starting to work a 14-hour day was the way forward.
“Aside from breaching the working time directive and that it will have a direct impact on the quality of care, is that the message going forward? I certainly hope not.”