Before starting my medical training I worked as an auxiliary nurse in mental health for those months between the end of exams and the start of the University year. That experience shaped my career. It revealed to me the stark reality that quality of patient care depends on having the right number and skill mix of staff. Within the medical profession generally there is widespread concern that levels of medical staffing have fallen to dangerously low levels. The Francis Report into incidents at the Mid Staffordshire NHS Foundation Trust highlighted the importance of adequate numbers of staff in assuring safe patient care.
Mental health has never before enjoyed such a positive profile or this degree of cross party support. The Scottish Government’s Programme for Government highlights the importance of prevention. The support for child and adolescent mental health services is to be welcomed, as is promised investment.
More people are coming forward for help with their mental health and that is a good thing, but we need the staff available to be able to meet that expectation. We have a visionary strategy for mental health but unless we achieve the right balance in our NHS workforce, we risk missing this opportunity.
Promotion of mental wellbeing is not simply the province of mental health specialists but of everyone. There is a vital role for registered nurses working in schools, as health visitors and in primary care. To make sure we have the workforce to meet the demands for mental health support, action is needed now.
Scotland has a high vacancy rate in mental health nursing, currently 4.5%, in line with the high vacancy rate across the nursing workforce generally. There are 438 whole time equivalent mental health nursing vacancies across Scotland. One in three nurses will retire in the next ten years.
Vacancy rates in psychiatry are even higher. For the period ending June 2018, the figure was 10.5%, with 7.0% of posts vacant for six months.
Inadequate staffing creates a negative spiral with staff moving elsewhere or being lost to their profession. Those dedicated staff who work to temporarily keep services going can never be a substitute for permanent staff who can mould and shape a service.
This challenge was illustrated in the Royal College of Nursing’s Safe Staffing Survey, published in September 2017. The survey asked RCN members across the UK about their last shift or day worked in health or social care. Of the 1,300 shifts in in-patient mental health wards, respondents noted that a third had a shortfall of registered nurses. A fifth of shifts had temporary staff and nearly half of healthcare support workers in mental health in-patient settings were temporary.
Put simply, when properly staffed, we see improved patient outcomes, reduced mortality rates, and the quality of patient care improves. Conversely, insufficient numbers bring low morale, high staff turnover, and potentially life-threatening consequences for patients.
The Health and Care (Staffing) (Scotland) Bill debated in the Scottish Parliament this month (December 2018) last week is a potential lever to ensure the provision of safe and effective care. The Bill as introduced is a good foundation but it will be important to take advantage of opportunities to see it strengthened as it moves through Parliament, if the legislation is going to make a real difference for staff and patients. This is work I know the Royal College of Nursing is actively engaged with.
Bolstering the legal baseline for safe staffing is a great start but we also need a wholesale change of approach to the recruitment, support and retention of nurses, doctors and allied health professionals.