Spending on staff in Scotland's NHS is increasing and overall staff numbers are at their highest level ever but there are urgent workforce challenges, and the Scottish Government and health boards have not planned effectively for the long term.
In the first part of a two-stage audit on workforce planning in the NHS in Scotland, Audit Scotland focuses on clinical staff in hospitals and other secondary care settings. It reports that the Scottish Government has not yet adequately estimated what impact increasing and changing demand for NHS services could have on the workforce or skills required to meet this need.
As well as determining the right mix of skills needed to meet future demand, the NHS faces recruitment challenges in the current workforce. Vacancies for some consultant and nursing positions remain high and difficult to fill. Increasing retirements could escalate vacancy levels in parts of the NHS where there are higher proportions of older staff, such as the general nursing workforce.
Major health reform is under way, in particular shifting services towards more community and home-based care. The long-term impact of health and social care integration on the NHS workforce remains unclear, and dedicated funding for NHS reform does not clearly show the associated workforce costs.
Overall, patient feedback about the NHS and its staff is positive. However, complaints are rising and staff continue to raise concerns about their workloads. NHS boards are spending more on agency cover to help meet workload requirements, and 13 of the 14 territorial boards overspent against their 2015/16 pay budgets.
The report says responsibility for NHS workforce planning across national, regional and local levels is confused, and there is a risk of more fragmentation as integration authorities develop their own arrangements and new specialist centres are established.
The Scottish Government intended to publish a single workforce plan for health and social care. This will now occur in three stages and the first publication, in June 2017, is a framework to consider future challenges, rather than a detailed plan.
Caroline Gardner, Auditor General for Scotland, said:
"Thousands of people work hard in Scotland's NHS to deliver vital public services every day, but there are signs that the health service is under stress and that staff face increasing workload pressures.
"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."