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NHS Scotland logoThe Scottish Government has bowed to opposition pressure to publish workforce projections for the NHS in Scotland.

Publication is surrounded by huge caveats – the introduction explicitly says it has been done “in response to the Opposition Parliamentary Motion on the NHS” and warns that the information is not “quality assured”.

The main findings are an estimated reduction in whole time equivalent (WTE) staff members of 3,790 (2.8 per cent) by the end of the financial year 2010/11. Nursing and midwifery takes the biggest hit – 1,523 WTE, followed by administration services (1,053 WTE).

In an accompanying press release, health secretary Nicola Sturgeon repeats her guarantee that there will be no compulsory redundancies, and says that there will be more staff in the NHS at the end of this parliamentary term than at the start. She also says the quality of patient care is paramount.

She has also announced that a national scrutiny group will be formed, made up of the main health trade unions, NHS employers and the government, to scrutinise plans and “ensure they do not compromise the quality of care”.

“NHS boards are committed this year to securing more than £100 million in non-workforce related efficiency savings which will all be reinvested in frontline care. But the drive to deliver services more efficiently also involves looking at staffing requirements and these projections are part of that process.

“These figures are not set in stone. I expect boards to continue to try to minimise the reductions by working hard to maximise non-workforce related efficiencies.”

Unison expressed concern. Tam Waterson, Chair of UNISON Scotland’s Health Committee said: “We are concerned at the scale of these planned job cuts. The Scottish government’s commitment to ensure no compulsory redundancies is welcome, as is the involvement of unions in scrutiny of the health board plans. But it is clear that we face deep cuts which will impact on our vital health services.”

The union says that 1250 job cuts are planned for Greater Glasgow and Clyde this year, 700 in Lothian – with another 1,300 in the pipeline for next year. Tayside plans to 500 full time equivalent jobs. Grampian has announced 600 job cuts, and Highland plans to cut 100.

Unison adds that NHS Scotland requires to save £270 million in the current financial year to balance the books following a tight Scottish budget settlement in February – and warns that further pressure on funding is likely after the Westminster government implements its emergency budget in June.

RCN Scotland director Theresa Fyffe accused health boards of short-termism, saying that as the wage bill makes up 70 per cent of health board budgets, it had become the primary target for cuts.

“RCN Scotland fully recognises that health boards need to find ways to save money. However, in the interests of protecting standards in patient care, health boards must focus on the long-term needs of patients, rather than on short-term cuts to the workforce this year, which may cause costly problems in the future.”

Speaking ahead of today’s parliamentary debate on the cuts, she added: “Health boards are using a number of short-term measures to cut wage bills, ie not replacing someone if they leave, replacing registered nurses with unregistered nursing assistants or redeploying highly skilled and higher-paid specialist nurses to carry out regular ward shifts to cover staff shortages.

“If health boards across Scotland continue to pursue such cost cutting measures on the wage bill without properly carrying out service redesign and looking at other areas of cost pressures, they will be left with a demoralised and overstretched workforce and may risk standards in patient care. It would also make it difficult and more costly to redesign services to meet patient needs in the future as appropriately skilled nurses and other healthcare professionals may no longer be in the workforce, due to today’s short term cost-cutting measures.”

She said the RCN had agreed in principle to be part of the scrutiny group, but warned: “We will also be seeking assurances that health boards will only implement their workforce plans if they have first considered all the options available to them, not just short-term cuts to the workforce.”

The BMA has also confirmed it will be part of the scrutiny group. Scottish chairman Dr Brian Keighley said: “The NHS is currently running at full capacity where even small cuts to frontline services will have a direct impact on patient care. It is therefore essential that in reaching these decisions, NHS managers consult with healthcare professionals locally and value the medical leadership offered by doctors to reshape and develop services to make them more efficient without affecting the quality of patient care.

“As part of this national scrutiny group, the BMA will seek to ensure that decisions made by local NHS boards to make cuts will have a minimal impact on patient care and will maintain the high quality care services that our patients expect.”

The tables can be found on the Scottish Government website.

Nicola Sturgeon. <em>Picture: Scottish Government</em>

Nicola Sturgeon. Picture: Scottish Government

So many questions remain to be answered on the Scottish government’s plans, announced yesterday, for universal health checks for the over-40s.

First of all, who is going to do them? The announcement talks about “face-to-face” checks for all Scots aged 40-74. That’s an awful lot of people and health services are, we’re constantly told, already stretched.

Will it be GPs? Will it be nurses working in the community? Will it be another type of healthcare worker, possibly taking a more tick-box, protocol-based approach? We don’t know yet.

And, assuming it works and does identify people in need of health treatment, where will the expanded services needed to cope with this rise in demand come from? The first patients are supposed to receive their “heart MOT” in 2011, the announcement says – coincidentally the year that we’re expecting to see real terms cuts in health spending.

And will it get to the people in need? The reaction of one 40-something male to the news yesterday was “I’ll go for that”. But he’s middle-class, on a decent income and already pushy enough to go along to his GP and ask for a check if he’s concerned – ie, not the target audience.

Will it really mean that practices and community staff will be stowed out with looking after the middle-class worried well, while those really at risk continue to keep away until something catastrophic, like a heart attack, brings them – often too late – into contact with health services? Does that really make sense?

The announcement shouldn’t be confused with the Grampian pilot project, which was talked about in the same press release. “Life Begins at 40” is a web-based initiative which encourages people to have a self-assessment and, presumably based on the results, to seek further help. Will the “universal health checks” follow a similar format? Presumably not as they are “face to face”, rather than web-based (although the Grampian project will have a telephone element for those without online access).

Nicola Sturgeon, the health secretary, makes the valid point that the “heart MOT” health checks will provide useful research in health prevention – the success of a general health check-up will be tested for the first time, she says.

She also gets in a pre-emptive strike at those who might complain that it’s a service for the middle-class, by saying that the government will continue to support health check programmes that target those at most risk – such as Keep Well, which is aimed at those in the poorest communities.

We’ve had a while to get used to the idea of universal health checks – it was mentioned in the SNP’s 2007 election manifesto (and in Labour’s incidentally).

But the question remains, is it really the best use of scarce resources? And what services will have to be cut to pay for it?