Staffing levels are inadequate in some parts of the NHS in Scotland - there can no longer be any doubt about that.
Only last month, for example, a report by Healthcare Improvement Scotland (HIS) revealed some patients in hospitals run by NHS Lanarkshire could go up to two weeks without seeing a senior doctor; other patients were sometimes left with only a junior doctor in the early stages of training to review their case.
And the problem is not confined to Lanarkshire either. As part of The Herald's NHS: Time For Action campaign, junior doctors have complained that staffing levels are unsafe in their wards. Other staff have said that their hospitals are narrowly avoiding a crisis situation most days.
Now that the problem is out in the open in this way, HIS deserves credit for appearing to take action on the issue. The inspection body has announced it plans to expand its remit by examining staffing in hospitals for the first time and has now put the suggestion out to consultation. It will be a significant expansion of its role, and a welcome and much-needed one.
The need for such a change is beyond question. As the Royal College Of Nursing Scotland points out, patient care can be compromised if there are not enough staff on duty. Not only that, the staff who are on duty can be left to deal with far too much work and have too little time in which to do it. The pressure can lead to stress, which can lead to mistakes.
Under the proposals, HIS will have a role in tackling this issue - it will have the power to inspect the staffing levels in hospitals to identify the areas where there are problems and suggest action towards improvement. It also proposes to gather information from a number of sources, including whistleblowers who contact the recently launched hotline, to identify which health boards are struggling most and need prioritised help.
All of these measures are important steps forward, although HIS will have to be cautious about striking the right balance in its relationship with health boards. A hospital inspection is always likely to be most effective if it is unannounced, but HIS proposes meeting health boards in advance of an inspection, which will then be carried out at some time in the following six months. A more arm's-length regime might be preferable, although it is worth pointing out that HIS has already carried out many excellent reports that have been truly independent and critical of hospitals.
In whatever form the proposals do go ahead, their effectiveness will depend on the HIS reports on staffing being more than just paper exercises - health boards will also have to act on the reports if they are to be effective. In this respect, possible sanctions may need to be considered, although the problem with a financial penalty remains that it would only make the situation worse for health boards.
As Robbie Pearson of HIS says in the foreward to the consultation, HIS does have to work closely with health boards, but, if and when the new inspection process goes ahead, it must also remember this: HIS is there to be the voice not of the NHS but of the patients it treats.
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