Scots ministers 'break law' on safe NHS staffing by enlisting students to fill gaps

The new NHS crisis that the Royal College of Nursing in Scotland says is posing a risk to patients comes precisely three years after safe staffing became enshrined in law, after a First Minister promise in 2016, reports our sister title The Herald. 

A Royal College of Nursing study has found that seven in ten staff say patient care is being compromised due to low staffing levels.

And almost nine in 10 (86%) nursing staff from Scotland said that the staffing levels on their last shift were not sufficient to meet the needs of patients safely and effectively.

But it has also uncovered "clear evidence" that students and support staff are being used to fill staffing gaps.

The Health and Care (Staffing) (Scotland) Act 2019 which gained Royal Assent on this very day three years ago (June 6) places a duty on health and care providers to ensure there are suitably qualified and competent staff working in the right numbers and restates that nursing students are not to be counted in determining staffing level requirements.

But the RCN survey found nearly half of those responding saying that students were being counted as staff while more than a quarter said support staff were expected to perform the duties of registered staff during their last shift.

The RCN said the findings shone a light on the impact of the UK’s nursing staff shortage, warning that nurses were being “driven out” of their profession.

In a keynote address to the RCN’s annual congress in Glasgow today (Monday), the general secretary Pat Cullen will call for action and say the shortages pose a risk to patient care.

The Health and Care (Staffing) (Scotland) Act was seen as a ground-breaking piece of legislation and the first in the UK to set out requirements for safe staffing across both health and care services and most clinical professions.

It strived to ensure providers in both sectors have the “appropriate” workforce in place to deliver “safe and high-quality care”.

It aimed to support both workload and workforce planning and introduces reporting requirements to ensure staffing decisions are open and transparent.

But plans to fully implement the legislation were put on hold as part of the focus on the pandemic.

The RCN Scotland says it is fighting for work on implementation to restart, saying things are getting underway "slowly and the Scottish Government has yet to set out a clear timetable for when the legislation will be implemented.

Nicola Sturgeon made the commitment to safe staffing levels six years ago.

RCN Scotland board chairman Julie Lamberth, said: “Three years ago today we thought progress was being made as Scotland’s ground-breaking safe staffing legislation received Royal Assent. But three years on and members are telling us about the very real concerns they have for the safety of their patients and residents and their own wellbeing - yet the Act has still to be implemented.

“Urgent action is needed to protect patient safety, address staff shortages and demonstrate that the nursing workforce is valued as a safety critical profession.”

The nursing body is calling for urgent action to address the challenges facing the nursing workforce including, fair pay, good employment terms, safe working conditions for staff wherever they work, and improved data collection and workforce planning to ensure the workforce can meet the needs of the population.

More than 2,300 nursing staff from across Scotland’s health and care services responded to the RCN’s survey in March this year.

The findings show that less than a quarter (23%) of shifts had the planned number of registered nurses on shift and around a third (34%) had the planned number of nursing support staff on shift.

Just 16% agreed that they had enough time to provide the level of care they would like.

Nearly half (45%) of respondents said that due to a lack of time, they had to leave necessary care undone, They study found that staff were risking burnout by covering for gaps in the workforce - with over two thirds unable to take their breaks. Some 62% worked additional time during their last shift.

Staff in Scotland were most likely to state that during their last shift they "felt exhausted and negative" with 63% agreeing with that statement.

The nursing workforce analysis highlights that the ‘gap’ between the number of registered nurses required to run services and the number actually in post has been rising steadily since 2015 to a record high level of over 4,500 nurses.

Speaking about the report today (Monday), RCN general secretary and chief executive, Pat Cullen, will tell nurses: “Our new report lays bare the state of health and care services across the UK. It shows the shortages that force you to go even more than the extra mile and that, when the shortages are greatest, you are forced to leave patient care undone.

“Don’t ever think that it is normal to not have enough staff to meet the needs of patients. It is not. Today, members are letting the full truth be known - nursing is saying loud and clear that enough is enough. If there was ever a time to break this cycle – it is now.

“It is your professional duty to be concerned about unsafe staffing and we have your back. Twenty-five thousand registered nurses left last year – a sharp rise on the year before, at the very moment we cannot afford to lose a single individual. The pressure is too great and the reward too little.

“Nursing staff are being driven out by the current way of working - the shortage of staff and too often the poor culture.

“To those from government listening to my words – we have had enough. The patients and those we care for have had enough.

“We’re tired, fed up, demoralised and some of us are leaving the profession because we have lost hope. Do something about it – we are not going away.”

A Scottish Government spokesman said: “We are immensely grateful for the incredible efforts of all of our NHS and Social Care staff over the course of the pandemic.

“Our nurses and NHS staff are already the best paid in the UK. The 2021-22 pay uplift saw staff receive an average 4% pay rise, the highest in the UK and we are currently discussing a pay deal for NHS Agenda for Change (AfC) staff in 2022-23 with trade unions and employers, which will be backdated to 1 April. We remain committed to ensuring that NHS Scotland AfC continue to have the best pay and conditions of AfC staff in the UK.

“Growing our workforce is crucial and that’s why we have steadily increased places on undergraduate nursing and midwifery courses over 10 consecutive years – doubling the number of new intake students in the last decade.

"We have recruited more than 1,000 additional healthcare support staff and almost 200 registered nurses from overseas to help address the unprecedented challenges facing the NHS.

Nicola Sturgeon addressed the RCN Congress in 2016

“The Scottish Government remains committed to supporting NHS staff, and this year we have made £12 million available to support workforce wellbeing, we will continue to engage with our staff to ensure they get the necessary support they need.”

But one community staff nurse from Scotland who took part in the new analysis said: “I absolutely love my job, but I’m so heartbroken by the fact that I know I can’t provide care I would like right now that I’m no longer sure that I can carry on myself without physically and mentally burning out.

“I’m worried about the future for myself, my colleagues and most of all my patients and their loved ones.”