THE NHS in Scotland is facing “urgent workforce challenges” but the Scottish Government has no long-term recruitment plan to cope with rising patient demand, according to Scotland’s public spending watchdog.

Audit Scotland criticised the Scottish Government’s recent workforce plan for health and social care as a “broad framework” and “not a detailed plan to address immediate and future issues”.

In a report published today, the watchdog said: “There are urgent workforce challenges facing the NHS and improving workforce planning is critical to addressing these pressures...The Scottish Government expects demand for health and social care to rise but it has not yet adequately projected how this will impact on the skills and workforce numbers needed to meet this demand.”

Comment: 'Lack of bravery' has stood in way of workforce change

Despite record spending on NHS staff and higher than ever number of employees, Audit Scotland said the NHS was facing a triple crisis of an ageing population, an ageing workforce and recruitment difficulties.

It said: “More than a third of the nursing and midwifery workforce is over 50 years old, and the proportion of staff across the NHS that is over 50 years old is increasing. There are persistent vacancies among certain specialities in hospital care, together with a failure to fill all available medical graduate training posts, and to retain doctors in Scotland once qualified.” It added that while "upcoming retirements may increase vacancy levels", the Scottish Government “has not fully considered whether nurses and midwives already in training...are enough to fill the gap left by those retiring”.

The report highlighted the surge in spending on agency staff from £83 million to £171 million during the past five years. Although agency workers account for only 2.6 per cent of overall staff spending, the report stressed that it was the main factor tipping health boards over their annual pay budgets - partly because boards “consistently underestimate the staff they need”.

The report also stressed the problem of long-term consultant vacancies, noting that two international recruitment campaigns for emergency medicine specialists by NHS Lanarkshire ending with “little success”. In 2016, 30 per cent of interview panels for consultants “had to be cancelled as either the candidate withdrew, or there were no suitable applicants”.

Current data also makes it impossible to track whether medical students trained in Scotland enter the NHS, take career breaks or leave Scotland altogether. As a result “the Scottish Government will struggle to quantify the effect of increasing student intake on the take-up of places in NHS boards.”

Caroline Gardner, Auditor General for Scotland, said: “The Scottish Government and NHS boards recognise the challenges, but urgently need to improve their understanding of future demand, staff projections and associated costs, and set out in detail how they plan to create a workforce that can meet the long-term health needs of the population.”

Theresa Fyffe, director of the Royal College of Nursing Scotland (RCN) said: “Audit Scotland has hit the nail on the head – for too long plans have been restricted by what is affordable and achievable with the staff available - rather than focusing on strategic, long-term planning to meet demand. The result is that Scotland has too few nursing staff in post and too few nurses being trained.”

Chair of BMA Scotland Dr Peter Bennie said: “The report recognises long-term workforce planning has not been effective.”

Health Secretary Shona Robison said they were committed to having the "the right number of staff" and the "right skills mix". She added: “Ensuring effective workforce planning not only has to account for changes in the nature of the demands being placed on our health and care services, but also for the challenges that are presented by external factors like the impact of Brexit on Scotland’s ability to attract and retain workers from across Europe.”