Thank you, convener. The report, which is the first part of a two-part audit on national health service workforce planning, focuses on the overall arrangements and, in particular, on clinical staff who work in secondary care such as hospitals. Part 2 of the audit, which will be published in 2018-19, will look more closely at the community-based workforce such as community nurses and general practitioners.
Thousands of people work hard in Scotland’s NHS to deliver vital public services, but there are signs that staff face increasing workload pressures. Some of those are shown in exhibit 2 on page 13 of the report. Overall, patient feedback about the NHS and its staff is positive, but complaints are rising and staff continue to voice concerns about their workloads. Spending on NHS staff has increased to £6.5 billion, but most health boards overspent against their pay budget, and agency staff costs are increasing.
The Scottish Government intended to publish a national workforce plan for health and social care in the spring this year. The plan is now being published in three stages. The first part, which was published in June, covers the NHS workforce. In previous reports, I have highlighted the need for a clear workforce plan to ensure that there are the right staff with the right skills for new ways of working. The published plan does not set out detailed actions to deliver that workforce; instead, it provides a broad framework that sets out the challenges ahead and further work to be done.
Demand for health and social care services is expected to continue to rise, but neither the Scottish Government nor NHS boards have adequately projected how that will affect the workforce numbers or the skills that are needed in the longer term. The Scottish Government’s processes for determining training numbers are largely based on replacing current numbers in the workforce, with some consideration of previous years’ growth.
There are also concerns about sustaining the current workforce. Vacancies for some consultant and nursing positions remain high and are proving difficult to fill. In addition, upcoming retirements may increase vacancy levels in parts of the NHS. For example, over a third of the nursing and midwifery workforce is over 50, and the number of newly qualified nurses in Scotland who were available to enter the workforce fell by 15 per cent in 2014-15 and a further 7 per cent in the following year.
The national workforce plan recognises that, between 2017 and 2020, the number of existing students who will enter the workforce will not be enough to meet demand, and it states that around 2,600 additional nurses and midwives will be needed by 2021-22. That figure may be an underestimate. As I said, insufficient work has been done to determine what future demand will be, and there are shortcomings in the data on how many nurses may retire in that period, as well as other factors such as the impact of Brexit.
Finally, responsibility for NHS workforce planning is confused. It is shared between the Scottish Government, NHS boards and regional planning groups. The development of health and social care integration authorities and new elective centres may add to that confusion, and separate planning processes for doctors, nurses and other professional groups make it more difficult to consider how skills across different groups in the workforce will complement each other.
The NHS is undergoing major reform, but the funding that is needed to support that does not clearly identify the expected workforce costs associated with the changes. To improve workforce planning, more clarity is needed on lines of responsibility, the workforce supply and skills available, and the needs of the Scottish population in future.
As always, my colleagues and I are happy to answer the committee’s questions.