Health and Care (Staffing) (Scotland) Act 2019 2024/25 Ministerial Annual Report

Part 1: Healthcare: Duties On Health Boards

Purpose

Section 12IM of the Act, Reporting on staffing, requires relevant organisations to publish and submit an annual report to the Scottish Ministers detailing how they have carried out their duties under the Act. The purpose of the annual reporting requirement is to:

• Enable monitoring of the impact of the legislation on quality of care and staff wellbeing.
• Identify areas of good practice that can be shared.
• Identify challenges relevant organisations are facing in meeting requirements of the Act and what steps they have taken/are taking to address these.
• Identify any improvement support required.
• Inform Scottish Government policy on workforce planning and staffing in the health service, alongside other sources of information and data.

Section 12IM also places responsibilities on Scottish Ministers, and states that following the receipt of such reports from Health Boards, Scottish Ministers are then Duty bound to:

• Collate the reports submitted to them into a combined report for the year to which the reports relate (published alongside this report),
• Lay that combined report before the Scottish Parliament, and
• Lay an accompanying statement (the foreword) setting out how they have taken into account/plan to take into account, in their policies for the staffing of the health service, the information included in the combined report.

Also under Section 12IM, the Act places a Duty on Scottish Ministers to publish a report setting out how each Health Board and the Agency has carried out its duties under the Act and lay said report before Parliament. This report satisfies those legislative duties within section 12IM of the Act and will be used to inform future policy and strategic objectives.

Reporting Process

Health Boards were provided with an annual reporting template to complete and submit to Scottish Ministers. The template evaluates systems, processes, and governance structures in place to meet the legislative requirements by requesting detail on:

• Evidence of their compliance with the duties under the Act, including a RAG status on their level of assurance of their compliance.
• Areas of success, achievement and learning associated with the particular Duty or requirement, along with indicating how this could be used in the future.
• Areas of risk and escalation where they have been unable to achieve or maintain compliance with a particular Duty or where they have faced any challenges and what actions have been or are being taken to address this.

Health Boards were also asked to provide a declaration of the level of assurance they have regarding compliance with their responsibilities under the Act.

Collated Health Board Reports have been published alongside this report and can be accessed here: Health Board Annual Reports^[3].

Overall Assessment of Board Compliance

At the beginning of the reporting template, Boards answered 3 overarching questions offering an overview of how their approach to implementation of the Act has influenced their processes, resulted in achievements and highlighted risks. With specific regard to workforce planning, the template also asked how the information provided in the report had been used or would be used to inform workforce plans.

The evidence provided indicates that Boards have integrated data and insights from the Health and Care (Staffing) (Scotland) Act 2019 into their workforce planning processes, aligning staffing decisions with statutory duties, operational requirements, and strategic objectives. This includes the use of evidence-based methodologies such as the Common Staffing Method, SafeCare, and the Six Steps Workforce Planning Methodology. Governance structures have also been strengthened through regular reporting to internal boards and committees, ensuring oversight and accountability. Cross-functional collaboration and shared learning have enhanced the effective use of data, while the first year of implementation has highlighted areas for further improvement in data capture and compliance. Boards are actively adapting their systems to embed the Act’s principles into routine practice, supporting sustainable workforce planning and the delivery of safe, high-quality care.

The overall level of assurance reported by Boards with regard to compliance with their Duties under the Act is summarised in table 1 followed by detail on what constitutes each assurance level.

73.7% indicate reasonable assurance, 15.8% indicate substantial assurance and 10.5% indicate limited assurance.

Assurance Level Definitions

Substantial assurance

Definition: A sound system of governance, risk management and control exists, with internal controls operating effectively and being consistently applied to support the achievement of objectives in the area audited.

Controls: Controls are applied continuously or with only minor lapses.

Reasonable assurance

Definition: There is a generally sound system of governance, risk management and control in place. Some issues, non-compliance or scope for improvement were identified which may put at risk the achievement of objectives in the area audited.

Controls: Controls are applied frequently but with evidence of non- compliance.

Limited assurance

Definition: Significant gaps, weaknesses or non- compliance were identified. Improvement is required to the system of governance, risk management and control to effectively manage risks to the achievement of objectives in the area audited.

Controls: Controls are applied but with some significant lapses.

No assurance

Definition: Immediate action is required to address fundamental gaps, weaknesses or non-compliance identified. The system of governance, risk management and control is inadequate to effectively manage risks to the achievement of objectives in the area audited.

Controls: Significant breakdown in the application of controls.

Compliance With Individual Duties

Section 12IA Duty to ensure appropriate staffing

The Duty to ensure appropriate staffing is designed to enable the provision of safe and high-quality services which meet the needs of service users through having appropriate staffing, with the right person, with the right skills, available in the right place, at the right time, to provide care. This Duty outlines that staffing must be appropriate to ensure the health and wellbeing and safety of patients, the provision of safe and high-quality healthcare and the wellbeing of staff. The following must also be considered when determining what constitutes appropriate levels of staffing:

• The nature of the particular kind of healthcare provision
• The local context in which it is being provided
• The number of patients being provided for
• The needs of patients being provided for, and
• Appropriate clinical advice.

Key findings

Almost half (47%) of Boards indicated reasonable assurance with regard to this Duty whilst 37% advised of substantial assurance and 16% of limited assurance.

Achievements, Successes and Learning

The reports published suggest Health Boards are making strong progress in ensuring compliance with the Duty at section 12IA. Most have established dedicated Programme Boards with multi-professional input, ensuring collaborative and informed decision-making. The rollout and expansion of eRostering, particularly via the SafeCare module, is enhancing real-time staffing visibility and supporting more responsive workforce management. Boards are also supporting staff in their development with the help of TURAS learning modules and internal training to build awareness and understanding of the Duty. Workforce planning is being strengthened through the use of the Common Staffing Method (CSM) and staffing level tools (SLTs), as well as through existing resources such as the Six Step Methodology to workforce planning. Importantly, staff wellbeing remains a key focus, with flexible working options, retire-and-return schemes, and comprehensive wellbeing strategies being actively promoted.

Challenges (escalation issues, risks)

The Reduced Working Week (RWW) for Agenda for Change (AfC) staff - as agreed to as part of the 2023–24 pay negotiations - is a factor across several Boards, impacting rosters, staffing levels, and rollout of digital systems. Boards have noted that implementing the RWW has required changes to roster planning and shift patterns, which has increased the workload for eRostering teams and service leads. These adjustments have also influenced the pace of rolling out systems like SafeCare and eRostering, which support compliance with the Act. Boards, particularly those that face rural issues, have highlighted that further reductions in working hours may present challenges in maintaining compliance due to existing workforce limitations.

Boards are working to balance safe staffing levels while accommodating the new working time arrangements. Financially, Boards are reviewing their service and workforce plans to align with the RWW within current budgetary frameworks. Looking ahead to the next planned reduction in April 2026, many boards are reflecting on current experiences to inform future planning and to ensure a smooth transition.

Noting the benefits of systems such as eRostering and SafeCare mentioned above, Boards are at varying stages of implementing these systems. Many have discussed variation of reporting mechanisms across services which means that they are not fully compliant. Many also advise that for Nursing the systems are more robust than in other services (i.e. through the use of CSM & SLTs).

The absence of validated SLTs for some professional groups makes it difficult to benchmark and demonstrate compliance with staffing requirements. Budgetary considerations are also limiting the ability of boards to implement necessary systems and expand the workforce in some settings. Elsewhere, recruitment and retention is an issue raised particularly in rural areas.

Section 12IC Duty to have real-time staffing assessment in place

The purpose of the duties under sections 12IC, 12ID and 12IE of the Act is to ensure that relevant organisations have in place robust arrangements to deliver the Duty to ensure appropriate staffing in the day-to-day running of all NHS services. This will be assessed through effective identification, reporting, escalation and mitigation of risks caused by staffing numbers and skill mix that are required to meet patient or service user need.

Whilst these duties will help inform longer term planning of staffing and ultimately inform workforce planning at a local and national level, this is not the sole aim. The duties are also intended to go beyond an annual setting of staffing, to support a dynamic, real-time staffing response to emerging and actual risks to the safety and quality of care being provided to patients and service users. This is essential if the legislation is to have the desired effect.

Under section 12IC, relevant organisations have a Duty to put in place arrangements for the real-time assessment of its compliance with the section 12IA Duty to ensure appropriate staffing.

Key findings

The majority of Boards indicated reasonable assurance in relation to their compliance with this Duty (63%) followed by substantially assured (21%) and limited assurance (16%).

Achievements, Successes and Learning

Many Health Boards have made steady progress in implementing the digital system eRostering, which supports staffing assessments, risk identification, and escalation in line with Duty set out under section 12IC.

In areas where these systems are not yet fully in place, Boards have adopted effective local governance processes, including safety huddles, standard operating procedures (SOPs), and direct engagement with clinical leaders to manage staffing risks and discuss staffing matters.

Staff engagement and training has been central to these efforts, with many Boards incorporating eRostering and the broader Health and Care Staffing Act into induction materials and awareness campaigns. Governance and monitoring are also well established, with regular internal self-assessments reported to executive leadership to ensure oversight. Additionally, clear escalation pathways, both through formal digital systems and informal management channels, are in place to address staffing concerns promptly and effectively.

Challenges (escalation issues, risks)

Again, in addition to being an area of success, the implementation of digital process were also highlighted as key area of challenge to Health Boards.

Many Boards stated that continued reliance on interim or legacy systems had created administrative burden for some staff groups, and carries additional risks for data accuracy. This is due to the ongoing risk of double keying as there is an absence of a direct interface between eRostering and either Scottish Standard Time System (SSTS) or payroll. Consequently, staff rosters need to be manually keyed from the eRostering system into SSTS, to allow staff to be paid accurately. Health Boards have cited engagement and training of staff as a mitigation. Notwithstanding this, some indicate their preference to focus training for newly recruited staff only on newly implemented systems given ongoing work to phase legacy systems out.

The unknown impact of the further reductions to the working week was highlighted as a risk by many Boards. As advised in relation the Duty under section 12IA, for many the impact will be on the implementation of electronic rostering systems, as any reductions in the working week affect the build of new service area rosters.

Section 12ID Duty to have risk escalation process in place

Under section 12ID, Boards have a Duty to put in place arrangements for the escalation of risks identified during real-time assessment of staffing levels, that were not possible to mitigate.

Key findings

The majority of Boards indicated reasonable assurance with regard to the Duty under section 12ID (58%) followed by 26% advising of substantial assurance and 16% of limited assurance.

Achievements, Successes and Learning

Health Boards have made good progress in embedding risk escalation processes in line with the Duty included at section 12ID. Many Boards have implemented structured frameworks supported by digital reporting systems available through eRostering, enabling real-time staffing assessments and robust documentation of unmitigated risks. SOPs have been developed to help guide more consistent escalation practices, and multidisciplinary safety huddles are widely used to facilitate timely decision-making. Boards that have demonstrated substantial assurance have systems such as SafeCare in place across several functions and professional groups.

Challenges (escalation issues, risks)

A key risk is the variability in application and documentation of risk escalation processes, particularly in areas where digital systems are not yet fully implemented. Many Boards continue to rely on informal communication methods, such as verbal or email reporting, which limits traceability and auditability. Additionally, the lack of a unified approach across all services and professions has led to variability in compliance levels, as indicated by some Boards still operating under limited assurance.

Section 12IE Duty to have arrangements to address severe and recurrent risks

Under section 12IE, Boards have a Duty to put in place arrangements for collating information on escalated risks and identifying and addressing risks considered to be severe and/or recurrent.

Key findings

The majority (47%) indicated reasonable assurance with regard to the Duty at section 12IE followed by 37% advising of substantial assurance and 16% of limited assurance.

Achievements, Successes and Learning

As above, most Boards report reasonable to substantial assurance, with digital systems being widely used to record, monitor, and escalate risks. Many Boards have developed locally agreed definitions, SOPs, and dashboards to support consistent risk identification and trend analysis. Governance structures, including daily safety huddles and executive-level oversight, ensure that severe risks are escalated and reviewed appropriately.

Challenges (escalation issues, risks)

Despite the achievements mentioned above with regards to local measures being implemented, Boards advise of variability, both in terms of their application and of the recording of information. The reports signal that more could be done to ensure consistent application and documentation of risk escalation processes across services and professional groups, particularly in areas where SafeCare are not yet fully implemented. Some Boards report variability in defining and recording severe or recurrent risks, leading to gaps in data collection and trend analysis. The reliance on manual or informal processes in certain areas limits auditability and may obscure emerging risks. Additionally, resource constraints, system interoperability issues, and varying levels of staff training contribute to uneven implementation.

Section 12IF Duty to seek clinical advice on staffing

This Duty requires Boards to put and keep in place arrangements for:

• Seeking and having regard to appropriate clinical advice in making decisions and putting in place arrangements in relation to staffing under sections 12IA to 12IE and 12IH to 12IL.
• Recording and explaining decisions which conflict with that advice.

Key findings

The majority (63%) of Boards provided reasonable assurance regarding this Duty, followed by 21% indicating limited assurance and 16% indicating substantial assurance.

Achievements, Successes and Learning

Several of the Boards report that professional leads are in place for the majority of services to support or provide professional advice with real-time staffing decisions, address any risk escalation and provide representation on workforce planning groups. Daily or shift-based huddles are widely used to discuss staffing levels, escalate concerns, and seek clinical input.

Several Health Boards have established dedicated working groups to raise awareness and deliver targeted training on this Duty. These groups play a key role in supporting staff in understanding their responsibilities under the legislation and in embedding best practices across services. Communication strategies such as intranet updates, newsletters, and direct engagement sessions are being actively used to inform and empower staff at all levels.

Similarly, a number of Boards are developing SOPs to clarify roles and responsibilities in the provision and receipt of clinical advice, particularly within multidisciplinary teams. These SOPs aim to ensure consistency, accountability, and timely decision-making in the management of staffing-related risks, thereby strengthening clinical governance and compliance with the Act.

Challenges (escalation issues, risks)

There is scope for improved consistency in how clinical advice and conflicts are documented. Clinical advice can be recorded in varying formats such as emails, verbal discussions, clinical notes, or huddle records, making it difficult to audit.

SafeCare Implementation is seen as the future standard for documenting clinical advice, conflicts, and mitigations. However, further work is required to roll out this system.

In addition, pressures on services on occasion results in clinical leaders being pulled in to provide direct care, negatively affecting their ability to perform duties under the Act. To counter this, some Boards explicitly mention that non-patient facing responsibilities related to section 12IF are included in job plans. They will also ensure appropriate governance procedures are in place and that training and awareness activity is ongoing to assist clinical leads. Again, eRostering, once fully implemented, are expected to streamline documentation and reduce the time burden on clinical leads by automating parts of the compliance process.

Section 12IH Duty to ensure adequate time given to clinical leaders

This Duty is intended to ensure that clinical leaders receive the right amount of time and resources to discharge their responsibilities under the Act to ensure appropriate staffing, alongside all the other professional duties and responsibilities they have. These include the clinical leadership and management functions that support the delivery of high-quality care.

Key findings

The majority (63%) of Boards indicated reasonable assurance with regards to this Duty, followed by 21% advising of limited assurance and 16% of substantial assurance.

Achievements, Successes and Learning

The continued rollout and implementation of digital systems and process was a common area of success reported. Several Health Boards cited that these systems allow for the identification of protected clinical leadership time for the identified staff and allows for more easily demonstrative data to evidence compliance to Health Board monitoring groups.

Staff engagement via personal development plans (PDP), appraisals and managerial one-to-ones was another area of success, as they allow for localised monitoring and assurance reporting. Consideration of job plans, and role descriptions furthers this engagement ensuring that the appropriate staff are aware of their responsibilities under the Act.

Challenges (escalation issues, risks)

A key theme across all Health Boards regardless of assurance level was the level of variation across all staff groups in the time taken to undertake clinical leadership duties, and what constitutes sufficient time. The balancing of leadership duties and clinical activity was highlighted as a key barrier. Several Boards highlighted that wider staffing issues such as unexpected absences can result in clinical leaders foregoing their protected leadership time to undertake clinical patient activity.

Wider workforce planning and recruitment strategies were highlighted as mitigation for this challenge. This included targeted staff recruitment campaigns, staff skill mixes for rosters, and building of clinical leadership time into rotas, all with the aim of ensuring those with leadership roles have opportunity to carry them out. Some Health Boards were not able to evidence the effectiveness of these at time of report submission due to these planning and recruitment workstreams being in the early stages of development or implementation.

Additionally, monitoring and escalation through preexisting managerial PDP, appraisals and managerial one-to-ones, was highlighted as key mitigation against foregoing leadership activity.

The RWW and its impact on the availability of protected clinical leadership capacity was also highlighted as a risk to Duty compliance.

Section 12II Duty to ensure appropriate staffing: training of staff

This Duty requires relevant organisations to ensure that, in complying with the Duty imposed by section 12IA (the Duty to ensure appropriate staffing), employees receive appropriate and relevant training. This is to ensure that suitability qualified and competent individuals from such a range of professional disciplines, as necessary, are working in such numbers as are appropriate for the health, wellbeing and safety of patients and the provision of safe and high-quality health care. Section 12II also requires that adequate time and resource is provided to undertake that training.

Key findings

The majority (53%) of Boards indicated reasonable assurance with regards to this Duty followed by 42% advising of substantial assurance and 5% of limited assurance.

Achievements, Successes and Learning

As the assurance levels above demonstrate, Boards have demonstrated significant progress in meeting the requirements of this Duty, with the majority implementing structured training frameworks supported by platforms such as TURAS and LearnPro. Boards have established clear governance and oversight mechanisms, including Staff Governance Committees and Programme Boards, to monitor compliance with statutory and role-specific training. Many have embedded training into workforce planning through job planning, PDPs, and appraisal systems, with some Boards achieving substantial assurance ratings. Innovative practices such as hybrid learning models, protected learning time initiatives, and apprenticeship programmes have enhanced accessibility and sustainability of training. Some Boards have been particularly successful in aligning training with service needs and professional development goals, fostering a strong culture of continuous learning.

Challenges (escalation issues, risks)

There is some evidence of variability in the application of training policies across professional groups and clinical settings, often exacerbated by staffing shortages and operational pressures. Protected Learning Time, while recognised as essential, is not yet uniformly implemented, with many Boards citing difficulties in releasing staff due to service demands and reduced working hours. Low completion rates for appraisals and PDPs in some areas hinder the identification of training needs, while financial constraints and limited training capacity further restrict access to development opportunities. Additionally, gaps in data integration and real-time monitoring limit Boards’ ability to track compliance effectively.

Section 12IJ Duty to follow the common staffing method

Section 12IK of the Act sets out the type of healthcare, the locations, and the employees that the CSM applies to. Relevant organisations must apply the CSM where they operate health care. Services described in section 12IK and are required to report on this internally.

Section 12IJ sets out the Duty to follow the CSM. The CSM sets out a process, including the use of speciality-specific staffing level and professional judgement tools and a range of other considerations, which must be applied rigorously and consistently. Table 3 below outlines what is included within the CSM. The application of the CSM will support relevant organisations to ensure appropriate staffing for the health, wellbeing and safety of patients and the provision of safe and high-quality care. It forms part of the evidence that relevant organisations submit to demonstrate how they have complied with the Act.

Visual of the factors to consider when applying the Common Staffing Method (CSM).

Key findings

The majority (56%) of Boards indicated substantial assurance with regards to this Duty followed by 31% advising of reasonable and 13% of limited assurance.

Achievements, Successes and Learning

As the assurance levels indicate, Boards have made strong progress in embedding the CSM into their processes. They have established annual schedules for running specialty-specific staffing level tools and for most boards, training is provided before and after tool runs. The use of TURAS, Healthcare Improvement Scotland (HIS) resources, and local SOPs are in place to help to guide staff, and some Boards have dedicated teams or leads to support implementation of this Duty. Boards are effectively using triangulation, combining staffing tools, professional judgement, and quality indicators to inform evidence-based staffing decisions. Staff and patient feedback is actively incorporated, and systems such as HealthRoster and SafeCare support real-time monitoring and reporting.

Challenges (escalation issues, risks)

Despite these strengths, several Boards face ongoing challenges in fully implementing the CSM. Some services report inconsistent application, with variations in adherence across departments and specialties. There is a lack of staffing tools for certain professions, such as psychology and mental health AHPs, where small team sizes and lack of templates hinder progress. Operational pressures and competing clinical priorities often limit the time available for preparation and participation in CSM activities.

Section 12IL Duty to train staff in the use of the common staffing method and to seek views on its application

Section 12IL of the 1978 Act (as inserted by the Health and Care (Staffing) (Scotland) Act 2019) places a responsibility on relevant organisations to encourage and support employees to give views on staffing arrangements for the types of health care covered by the CSM, and to take account of and use such views.

In addition, staff who use the CSM must be trained in its use, they must be provided adequate time to use it, and staff must be informed on how the method has been used in their area.

Key findings

This Duty is not applicable to NHS 24, the Scottish Ambulance Service or National Services Scotland. The majority (56%) of Boards indicated substantial assurance followed by 31% advising of reasonable and 12.5% of limited assurance.

Achievements, Successes and Learning

As the assurance levels detailed above show, the majority of Health Boards are making good progress in relation to the training of staff in the Common Staffing Method. Boards have adopted a dual approach, combining national resources such as TURAS with locally developed materials to ensure comprehensive training. Many Boards reported success in engaging staff through effective communication strategies and structured training schedules aligned with staffing tool runs. This approach has enabled clinical leaders to fully consider CSM outputs and incorporate staff feedback through standardised templates. The use of self-assessments and local record keeping has further supported assurance processes, with many Boards integrating these into quarterly governance reporting. These practices have not only strengthened compliance with the Duty under section 12IL but have also informed the transition of CSM related responsibilities into business-as-usual operations.

Challenges (escalation issues, risks)

Boards reported challenges in balancing the demands of the Act with clinical pressures and competing policy initiatives. In some cases, limited capacity and resource constraints have hindered the delivery of training, especially where it relies on a single staff member or team. While many Boards are actively reviewing their organisational structures to embed CSM responsibilities into BAU, these transitions are ongoing and may affect assurance levels in the short term.

Section 2 Duty for the planning and securing of services

Section 2 (2) of the Act outlines that when a Health Board is planning or securing the provision of healthcare from a third party, it has regard to the guiding principles of the Act and the need for that third party from whom the provision is being secured to have appropriate staffing arrangements in place.

Key findings

The majority (63%) indicated reasonable assurance followed by 21% advising of substantial and 16% of limited assurance.

Achievements, Successes and Learning

Many Boards have updated tender documentation, service specifications, and Service Level Agreements (SLAs) to include references to appropriate staffing arrangements, with procurement teams actively engaged in implementation. Some Boards have demonstrated structured approaches, including the use of national frameworks, standardised question sets, and collaborative working groups to ensure compliance. Several Boards have also introduced mechanisms for monitoring patient outcomes and contractor performance, such as quarterly feedback reports and contract review processes. Engagement with stakeholders, including finance and commissioning teams, has supported awareness-raising and the transition of these duties into business-as-usual operations. These efforts collectively support the delivery of safe, high-quality care and demonstrate a commitment to continuous improvement.

Challenges (escalation issues, risks)

A common issue is the lack of statutory authority to require staffing information from independent contractors, particularly in dental, optometry, and general practice services, which has led to limited assurance ratings in some areas. Continued collaboration, national guidance, and targeted support will be essential to strengthen compliance and ensure equitable service provision across Scotland.

Key Themes Summary

In the above summaries, a number of key themes arise that impacted several Boards in ensuring compliance with their duties under the Act. The Scottish Government, through working closely with Boards and HIS, have been proactively working to address these throughout the first year following commencement of the Act. This section provides further details of that work.

eRostering

In October 2020, NHS Scotland Board Chief Executives signed a national contract to implement the Allocate Optima system and its associated modules across all NHS Scotland health boards over a 10-year period. This collective package is referred to as eRostering.

Allocate Optima is the UK and Ireland’s most widely used health and care e-rostering software. It enables organisations to ensure the right staff are in the right place at the right time, supporting efficient workforce deployment across all non-medical and dental staff groups.

SafeCare, a key module within the suite, is a mobile acuity-based staffing tool that compares actual staffing levels to patient demand in real time. It supports live decision-making, enhances productivity, and safeguards patient safety.

The eRostering solution will serve as a centralised workforce management system across NHS Scotland, enabling the creation of staff rosters, management of leave, and accurate recording of time worked for all staff groups. This modern digital platform is designed to enhance rostering practices, align staffing levels with patient care needs, and ultimately support the delivery of high-quality healthcare services across the country.

The eRostering solution - particularly the SafeCare module - plays a key role in supporting NHS Boards in meeting their statutory obligations under the Act. It promotes a unified and streamlined approach to compliance, monitoring, and reporting.

Considering the importance these systems have in enabling NHS Boards to meet their legislative duties under the Health and Care (Staffing) (Scotland) Act 2019, the Scottish Government will continue to work closely with NHS Boards, National Services Scotland (NSS), and other stakeholders to support the effective rollout and integration of eRostering. This will include providing strategic oversight and ensuring alignment with wider digital transformation programmes such as payroll and HR system replacements. By maintaining a coordinated approach, the Scottish Government aims to maximise the benefits of eRostering, reduce variation in implementation, and ensure that all Boards are equipped to deliver safe, effective, and person-centred care.

Reduced Working Week

As part of the pay settlement for Agenda for Change (AfC) staff in 2023/24, the Scottish Government committed to modernising a range of priority areas which included the establishment of a working group to explore the reduction of the hours in the working week, with the aim of getting to a 36-hour working week without the loss of earnings. The agreed timescale took account of matters including, but not limited to, service provisions, safe staffing levels, staff wellbeing, and costs. The first half hour reduction in working time for AfC staff was delivered from 1 April 2024 with the further hour reduction in the standard working week to be effective from 1 April 2026. Final implementation plans have been agreed by Area Partnership Forums.

A healthy work life balance is essential for our staff who provide high quality of care to the people of Scotland. It is vital that staff feel valued and rewarded for the work they do, and that NHS Scotland remains an employer of choice. It is also crucial that we deliver this change in a way that is safe for patients and staff, supports the continued recovery of services and avoids any extra burden for our workforce.

Boards are working to balance safe staffing levels while accommodating the new working time arrangements, implementing service redesign where necessary. Financially, Boards continue to review their services and workforce plans to align with further hour reduction in the standard working week that becomes effective 1 April 2026.

Recruitment

We continue to take forward a number of initiatives designed to support us in the attraction and retention of highly skilled and qualified staff across our system. With regards to the medical workforce, we have funded the creation of hundreds of additional posts across all specialities and have increased investment in speciality medical training by 43% since the beginning of this parliament

In addition, since 2016, the Scottish Government has increased the annual medical undergraduate intake from 848 to 1,149 (67% increase). The 25/26 budget saw record levels of investment, supporting greater foundation year places and additional specialty training places with an emphasis on training more General Practitioners (GPs).

The medical education and training pipeline aims to ensure that there are a sufficient number of trainees coming through the system/pipeline to deliver and sustain the medical workforce with the right skills for the future while meeting patient and service need in the present.  It takes approximately 7 years to train a registered doctor (and longer for consultants and GPs) and therefore the policies and choices now are shaping the workforce we will have in 15 to 20 years’ time.

Notwithstanding this, we are committed to further improving workforce planning and our recently announced Future Medical Workforce project will allow us to hear directly from doctors in order to make improvements to the medical education pipeline, ensuring we can continue to deliver the medical workforce Scotland needs.

Additionally, a number of initiatives and policies are underway for Nursing and Midwifery, including ongoing efforts to implement the recommendations of our Nursing and Midwifery Taskforce (NMT). The aim of the Taskforce was to work collaboratively, bringing in a range of expertise and knowledge, and to listen to Nursing and Midwifery staff to identify what was important for them, all with a view to developing a workplan of recommended actions to deliver sustainable changes and build on efforts to make Scotland the best place for Midwives and Nurses to thrive at work.

A key priority of the Taskforce was engagement with frontline staff which took place through the Listening Project. In person staff engagement events were held in all Health Board areas across Scotland in a range of acute and community settings to hear from staff representing all areas of Nursing and Midwifery. The NMT published their final report: Ministerial Scottish Nursing and Midwifery Taskforce: Report and Recommended Actions ^[4] in February 2025. The Scottish Government’s Chief Nursing Officer will lead on phase 2 of the Taskforce which will focus on implementation of the recommended actions, overseen by a Ministerially chaired implementation board.

Retention

The Scottish Government recognises that it’s more important than ever to retain experienced staff with the skills needed to deliver high quality care in Scotland. Supporting employees with flexible, multi-stage career paths can benefit both the NHS and improve patient care.

We continue to work in partnership with NHS Scotland employers and trade unions to develop and evolve national staff policies to aid in the retention of experienced staff such as flexible working patterns/locations, and career development and advancement.

Resources are available to support this with the Centre for Workforce Supply, commissioned by the Scottish Government and hosted by NHS Education for Scotland, working closely with Health Boards across Scotland to share best practice in retention. This is undertaken via webinars, bespoke workshops, pastoral care accreditations and best practice guidance which are available to all NHS Scotland staff via a dedicated online hub.

Rural and Islands Health and Social Care Recruitment

The Scottish Government recognises that recruitment interventions for rural and island communities need to be dynamic and tailored to these unique communities if they are to have an impact. This Government had previously committed to develop a remote and rural workforce recruitment strategy by the end of 2024 in the 2021 National Workforce Strategy for Health and Social Care ^[5]. However, following extensive engagement with key stakeholders and policy colleagues it was the view that a standalone, static recruitment strategy was not conducive to a whole system approach.

Rather than a published strategy, it was agreed that a direct support model would be developed. This model takes a sustained whole-system approach to provide rural and island health and social care employers with the help they need to overcome recruitment challenges. The Centre for Workforce Supply (CWS) and the National Centre for Remote and Rural Health and Care (NCRRHC), both hosted by NHS Education for Scotland (NES), have been commissioned by the Scottish Government to develop this sustained model of direct support that will provide rural and island health and social care employers with the help they need to improve recruitment success.

The Direct Support Model seeks to achieve this through the establishment of a Rural and Island Recruitment Network, a Support Toolkit to inform local decision-making and a library of evidence to support Boards in understanding what has worked well elsewhere.

This long-term, dynamic and connective model of support will enable the whole-system approach which is necessary to provide employers with the help they need to overcome recruitment challenges.

Work is also underway to provide additional support for the delivery of healthcare in our island and rural communities. As set out in the Programme for Government 2023-2024, the Scottish Government has committed £3.03m in 2023-2026 to progressing the National Centre for Remote and Rural Health and Care.

The National Centre for Remote and Rural Health and Care, which was launched in October 2023, is providing specific support to primary and community healthcare workers in our island communities. The work of the Centre focuses on four pillars, education and training, research and evaluation, recruitment and retention and leadership and best practice.

Workforce Planning

Looking towards the future, it will be important to ensure our approach to workforce planning, recruitment and retention reflects our broader aspirations for NHS Scotland as described in our Health & Social Care Service Renewal Framework.

That Framework describes how our workforce will be supported to work in more collaborative, flexible ways across territorial and organisational boundaries. It will mean working more with people as partners in the delivery of care and having improved access to information about the people they support. We recognise the vital role of effective workforce planning in supporting the renewal of our health services. Work is underway to develop a comprehensive plan that strengthens workforce planning across Scotland, ensuring it is fit for the future and aligned with the ambitions of the Service Renewal Framework.

Protected Learning Time

The Protected Learning Time (PLT) Implementation Group is working to enhance learning and development across NHS Scotland through three key workstreams. The group was established to support the implementation of the Agenda for Change (AfC) Review Recommendations, confirmed by the Cabinet Secretary on 1 March 2024. These include a consistent approach to Protected Learning Time across all NHS Scotland Boards, ensuring that statutory, mandatory, and profession-specific training is completed within working hours.

The Protected Learning Time objectives are to standardise statutory and mandatory training, support consistent identification of core mandatory learning by job family, ensure systems are integrated and accessible, and establish clear measures of success to support consistent implementation and continuous improvement. A key aim of this work is to reduce duplication, promote standardisation, and deliver training on a Once for Scotland basis - ensuring all staff have access to the same high-quality learning, regardless of location. A set of Once for Scotland statutory and mandatory training modules are due to be launched for consistent adoption in early 2026.

Staffing Level Tools (SLTs) & The Common Staffing Method

The CSM provides a structured and consistent approach to local workforce planning across NHS Scotland. It incorporates the use of specialty-specific staffing level tools and professional judgement tools, alongside key contextual factors such as current staffing levels and vacancies, staff skills and experience, local service context, patient needs, and appropriate clinical advice. This process supports Boards in identifying and mitigating staffing risks and determining whether changes to staffing are required. The CSM must be applied at least once per financial year and forms a core component of the evidence submitted by Boards to demonstrate compliance with the Health and Care Staffing Act.

Central to the CSM are the staffing level tools developed and maintained by HIS, which use validated formulae to calculate workload and determine Whole Time Equivalent (WTE) staffing requirements based on clinical need, throughput, and care quality. HIS are responsible under the Act for reviewing these tools and making recommendations to Ministers, subject to parliamentary scrutiny. The Act also enables Ministers to expand the scope of the CSM to include additional healthcare services and staff groups as new tools are developed, ensuring the method remains responsive to evolving service needs.

In their annual reports, Boards detailed difficulty with the consistent application of the CSM and inconsistencies in the use of SLTs. On 25 April, HIS published their annual report ^[6]setting out how they have complied with their duties under the Act. Within that report, HIS similarly advised of the challenges Boards were encountering with regard to application of the CSM and SLTs. Considering the relatively short period which has passed since the Act was commenced, it is not surprising that work is ongoing across Boards to develop and implement the necessary systems and processes required to aid and ensure compliance.

Acknowledging the challenges which have been highlighted, HIS confirmed they will undertake a thematic review into Board compliance with the CSM and a review into its effectiveness in the 2025-26 reporting period. Similarly, they say there is an identified need to develop further resources to support Boards in the provision of training on application of the CSM. The Scottish Government will work with HIS and representatives of Boards to achieve this.

Further Guidance on Planning and Securing Services

As outlined earlier in this report, some Boards have advised that they have encountered difficulty in evidencing how they have satisfied the requirements of the Act in instances where they are contracting services from third parties. In particular, Health Boards must have regard to the guiding principles of the Act and the need to ensure appropriate staffing in respect of any contracted services. The Scottish Government has worked with Health Boards to explore these issues in more depth and to provide additional guidance to inform local approaches.

In the context of primary healthcare, the requirements of the Act can generally be met by recognising that care is typically delivered on a one-to-one basis; one healthcare professional providing care to one patient at a time. In dentistry, this is usually two professionals (such as a Dentist and a Dental Nurse) caring for one patient. Provided that care is delivered to the required standards and by suitably skilled professionals, it can be considered safe.

Boards may also take reassurance from the fact that, once a contract or agreement is in place, any concerns about care standards can be addressed through existing regulatory frameworks. These include legislation governing dentistry, optometry, general practice, and pharmacy, as well as the oversight provided by professional regulators who can intervene if necessary.

Taking account of the above, work is now underway to review existing national guidance on this section of the Act to reflect the position outlined above.