Frontline NHS staff fear that unacceptable workforce numbers are becoming "normalised", a nursing leader has warned, as Scotland's new safe staffing legislation takes effect.

Colin Poolman, director of the Royal College of Nursing (RCN) Scotland, said recent public polling also shows that 30% of people consider nursing to be a rewarding and attractive career.

The Health and Care (Staffing) Act was passed in the Scottish Parliament in 2019, but its implementation was delayed, partly due to the Covid pandemic.

The legislation - the first of its kind in the UK - places a statutory duty on health boards and care provider to ensure there are always suitably qualified staff working in the right numbers for safe and effective care.


It also imposes a duty on the Scottish Government to ensure there are sufficient numbers of registered nurses, midwives and medical professionals available to enable employers to meet their duty to ensure safe staffing.

In 2016, Wales became the first country in Europe to introduce safe staffing legislation for nurses, but Scotland has gone further by encompassing all NHS and care staff.

It has been credited with reducing the number of serious incidents relating to unsafe staffing and improving workplace culture.

Speaking as the legislation took effect on April 1, Health Secretary Neil Gray said it was "a significant day for health and social care in Scotland".

He added: "This new Act, which forms a key part of our efforts to reform and recover health and care, will ensure services are more effective, efficient and sustainable.

"It will help put in place systems and processes to allow real-time assessments on staffing levels, meaning resources can be managed more easily, and that people can get the right care, at the right time, in the right place.

"The Act will also help to embed a culture of openness so workers are informed about decisions relating to staffing and feel able to raise any concerns."

By the end of December 2023, 5.8% of nursing and midwifery posts in NHS Scotland were vacant and annual spending on bank and agency staff combined to fill nursing posts had increased by 39% between March 2022 and March 2023 to a record £447 million.

It comes as polling carried out in March on behalf of RCN Scotland found that 84% of people said they believe there are not enough nursing staff across health and care services to provide safe and effective care.

The Herald: Vacancy rates for nursing and midwifery in NHS Scotland, 2014 to 2024; vacancy rates are highest in mental health and district nursingVacancy rates for nursing and midwifery in NHS Scotland, 2014 to 2024; vacancy rates are highest in mental health and district nursing (Image: Turas)

The Herald: Spending on bank and agency nurses and midwives increased sharply year-on-year between 2022 and 2023Spending on bank and agency nurses and midwives increased sharply year-on-year between 2022 and 2023 (Image: Turas)

A representative panel of 1,097 Scottish adults interviewed between March 20 and 22 also found that more than 90% said more should be done to protect the wellbeing of nursing staff.

Respondents said that levels of stress, length of working hours and salary were hindering recruitment and pushing people out of the profession.

Only 30% felt that nursing was an attractive and rewarding career. Former health secretary Michael Matheson launched the Scottish Government's Ministerial Nursing and Midwifery Taskforce (NMT) in February 2023 to "build on efforts to make Scotland the best place for nurses and midwives to come and work by developing plans for the retention of the existing nursing workforce, as well as looking at recruitment".

However, the RCN warns that nursing vacancy rates "remain stubbornly high" and that staff shortages "continue to have an impact on patient safety and the well-being of staff".

It is calling for an annual parliamentary debate on safe staffing to scrutinise whether the requirements set out in the Act are being met.

Colin Poolman, director of RCN Scotland, said: “RCN members were instrumental in shaping this groundbreaking legislation and in securing a timetable for the Act to be implemented.

"Given the role we played, our members are welcoming the implementation of this important legislation and are hopeful that this is a significant step, along with the Ministerial Nursing and Midwifery Taskforce, to providing the environment for positive change.

“The Scottish public are under no illusion - they are experiencing first-hand the impact of record waiting times and staff shortages.

"The findings from the recent polling echo those expressed by RCN members who are concerned that unacceptable and unsafe working conditions are being normalised.

“Today marks an important milestone but implementation must be accompanied by investment, innovation and continued scrutiny, if we are to retain existing nursing staff and establish a sustainable nursing workforce for the future.”

Giving evidence to the health and social care committee at the Welsh parliament last October, RCN Wales director Helen Whyley said its safe staffing legislation for nurses had led to "a better understanding of how many nurses are needed to achieve the best standard of patient care". 

The RCN in Wales also said that it had led to "improved accountability of health boards to ensure that safe staffing targets are met" and "improved transparency on reporting of staffing levels". 

There has been criticism in the past that NHS Scotland posts which are filled on a temporary basis - for example, by locum doctors - are not counted as vacant in official workforce statistics.