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

Part 2: Healthcare: Duties On Scottish Ministers

Purpose

Section 12IG of the National Health Service (Scotland) Act 1978, introduced under section 4 of the Health and Care (Staffing) (Scotland) Act, requires that Scottish Ministers ensure there is a sufficient number of registered Nurses, registered Midwives and Medical Practitioners to enable Health Boards and NHS National Services Scotland to comply with their Duty to ensure appropriate staffing.

As soon as reasonably practicable after the end of each financial year, Scottish Ministers must lay before the Parliament a report setting out how they have complied with the above Duty and the extent to which their actions have enabled Boards to comply with their Duty to ensure appropriate staffing.

Assessment of Compliance

Section 12IG Duty to ensure there is a sufficient number of registered Nurses, Registered Midwives and Medical Practitioners

The Scottish Government is fully committed to a sustainable NHS supported by a committed workforce which demonstrates the necessary skills and knowledge to deliver high quality care to the people of Scotland.

In pursuit of this aim, the NHS Scotland workforce has grown for 13 consecutive years and at the time of writing stand at 161,333.8 Whole Time Equivalent (WTE) staff, having increased by 23,735.3 WTE (17.2%) in the last decade. ^[7]

Individual decisions regarding the recruitment and deployment of NHS staff are in the first instance, a matter for Boards. However, the Scottish Government has an important role to play in shaping the workforce in order to ensure we have the right number of people with the rights skills in the right place at the right time.

The Scottish Government controls the numbers of undergraduate places for Dentistry, Medicine, Nursing & Midwifery, Optometry and Paramedicine and has engaged widely as it has set controlled intakes. In 2024 the Advisory Panel for Workforce Projections and Controlled Student Intakes was created to align the controlled intake process across professions, providing a unified view of controlled places and working towards a more holistic view of the needs of the health and social care workforces as intakes are set. Alongside this internal Panel, sits the External Student Intake Education and Training Advisory Group, which includes NHS workforce planners, ensuring their voice is heard when student intake places are set.

Nursing and Midwifery

The Scottish Government continues to prioritise the sustainability and inclusiveness of the Nursing and Midwifery workforce, which currently stands at 67,714.6 WTE—an increase of 14.4% over the past decade.

Notwithstanding this, the Scottish Government recognises that to have a sustainable Nursing and Midwifery workforce supply, consideration must be given to widening access across Scotland to encourage and allow people from all walks of life to have the opportunity to gain Nursing and Midwifery qualifications, which in turn will feed in to the diversity and inclusiveness of the Nursing and Midwifery workforce.

During the process for considering student intake numbers, both Nursing and Midwifery professions are considered separately with discussion at workshops and feedback from stakeholders setting out the circumstances across the four fields of practice for Nursing and the bespoke situation regarding Midwifery.

In addition to maintaining the current Nursing and Midwifery student intake numbers, the Scottish Government is collaborating with higher education institutions to establish alternative models of programme delivery to widen access for potential students who may not be able to access undergraduate Midwifery and Nursing programmes through traditional routes. This work directly links to our ongoing efforts to implement Phase 2 of the Nursing and Midwifery Taskforce recommendations, which include recommendations around widening participation, attraction and retention.

The Scottish Government package of support for Scottish student Nurses and Midwives is currently at its highest level and is the highest level of support available to Nursing and Midwifery students across the UK. The annual £10,000 bursary is non-means tested and non-repayable. Eligible students receive free tuition, free uniforms, free disclosure and health checks as well as the reimbursement of clinical placement expenses (travel and accommodation).

Qualified Nurses

Currently, the Qualified Nursing workforce in NHS Scotland is 46,277.4 WTE, an increase of over 5,000 WTE (13.4%) in the last decade. To further enhance access to Nursing education, the Scottish Government is collaborating with the Scottish Qualifications Authority, Council of Deans Health Scotland, NHS Education Scotland, and other stakeholders to develop a Next Generation HNC in Healthcare Practice. This qualification is designed to facilitate direct entry into Year 2 of Nursing degree programmes, particularly for students who may not otherwise be able to access undergraduate education.

This initiative supports the broader goal of diversifying the Nursing workforce and ensuring that educational pathways are flexible and inclusive.

Qualified Midwives

Currently, the Qualified Midwifery workforce in NHS Scotland is 2,632.2 WTE, an increase of almost 200 WTE (7.9%) in the last decade. In recognition of the unique requirements of Midwifery education, work is underway to develop a Next Generation HNC tailored specifically for Midwifery. This work is still in development; however, good progress has been made through collaborative working with the Lead Midwives for Education from the 3 HEIs responsible for the delivery of pre-registration Midwifery education. Mindful that articulation into year 2 is not possible for Midwifery, the requirement for practice learning hours to feature in this Next Generation HNC for Midwifery is not as critical for Midwifery, however, it is recognised that it would be beneficial for students to be exposed to some practice learning in a Maternity setting during this course.

The Scottish Government recognises the advent of a better work/life balance and the reduction of working hours has led to an increase in part time working, thus decreasing whole time equivalent numbers and this is particularly evident in Midwifery. This is considered when making decisions around the student intake numbers for Midwifery.

In October this year, the Cabinet Secretary for Health and Social Care announced the establishment of a new Scottish Maternity and Neonatal Taskforce which will provide strategic and national leadership over issues reported in these services. Alongside the Taskforce, full compliance with the Act’s general duties across all staff groups, supported by the specific Common Staffing Method obligations in maternity (midwives) and neonatal (nurses & midwives), will be instrumental in providing more robust staffing considerations.

Medical Practitioners

The number of doctors employed by NHS Scotland has increased by 28.4%, or by 3,371.6 WTE members of staff over the last decade.

As a result of the considerable time it takes to train a doctor, planning for the future medical workforce is complex as we need to make assumptions about a range of factors including population need, future service delivery models, training capacity, and workforce demographics.

In this context, the Scottish Government has followed a policy of medical workforce expansion since 2016. As above, this has involved annual increases in the medical undergraduate intake from 848 to 1,417 (67%). Whilst pursuing this expansion we have also sought to increase the amount of widening access places available from 60 per year to 110; making higher education and medical careers more accessible to people from under-represented groups and more diverse social backgrounds.

We invest over £600m a year across the training pipeline, supporting undergraduate medical education and resident doctors undertaking foundation training and specialty training who are important for the delivery of services in NHS Scotland. This is an increase of 42% since the beginning of this parliament. The 2025/26 budget has seen record levels of investment, supporting more foundation year places and additional specialty training places – with an emphasis on training more General Practitioners.

As outlined elsewhere in this report, we want to improve workforce planning further and our recently commenced 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. Phase 1 of the project, focussing on engagement and workforce modelling will report by the end of 2025, with Phase 2, exploring potential reforms, starting in 2026.

Section 12IB Duty to publish information from Health Boards on the amount spent on all agency workers

Spend on agency staffing is published through annual statistics detailing usage of agency staffing across the Medical and Nursing and Midwifery workforces. This information can be found at: Dashboards | Turas Data Intelligence^[8].

We have engaged closely with delivery partners across NHS Scotland to strengthen our approach to agency staffing. In particular, through the establishment of a Supplementary Staffing Task and Finish Group we worked with colleagues to design and implement new controls which ensure agency Nursing staff are only used in exceptional circumstances. Instead, the preference should always be to utilise substantive staff or, alternatively, workforce accessed via the staff bank where there is a need for a flexible solution. This allows us to ensure that staff have the necessary familiarity with the systems, processes and colleagues who work alongside them, benefitting not only those who are receiving care or treatment but also the wider workforce.

These steps enabled NHS Scotland Boards to deliver a 62% reduction in Nurse agency usage alongside a 16.7% reduction in medical agency reliance across 2024/25.