NHS in Scotland improving how it plans hospital nursing

This report finds that the NHS in Scotland has made progress towards improving the planning and management of ward nursing.

The Health Department and NHS boards are addressing many of the recommendations in Audit Scotland’s 2002 report on ward nursing. Work is underway in a number of areas including:

• improving recruitment and retention of nurses through a range of national initiatives;
• improving the information available to managers to plan the numbers of hospital nurses needed and how best to use these staff;
• developing information on the quality of nursing care to identify any areas for improvement;
• better management of bank and agency nurses.

The NHS now needs to build on this development work and address continuing issues, for example ensuring that workforce planning builds in enough time to cover predictable absences such as sick leave. It should also make sure that senior nurses have time to develop their leadership and clinical roles and needs to do more to develop information on the quality of nursing care so that this becomes part of routine management information.

Bank and agency nurses can be a useful way of filling temporary nursing needs. Audit Scotland has previously recommended that NHS boards review their use of bank and agency nurses and reduce their use of agency nurses which are a more expensive way of meeting temporary staffing needs.

Between 2001/02 and 2005/06 there was a 17% reduction in the use of agency nurses across Scotland but the combined use of bank and agency nurses increased by 43 per cent . NHS boards and the Health Department need to monitor this trend and the reasons for it to ensure that quality of care is maintained and appropriate use is made of bank and agency staff. In 2005/06 bank and agency nurses cost £96 million – about 5.5% of the total nursing budget.

Over the three year period, 2002 – 2005, the number of whole time equivalent hospital nurses increased by 1,475. There has been little change in vacancy rates across the country since 2002. In the latest available information (March 2006), the total vacancy rate was 3.6%. Long term vacancies were low at 0.7%, but there are particular pressures in some boards and some specific areas of nursing such as intensive care, theatres and care of the elderly.

Robert Black, the Auditor General for Scotland, said: “Nurses are crucial to the delivery of good quality patient care and so it is good news that the health service has responded to the previous ward nursing report and is laying the foundations for better workforce planning in this area. I recognise that this is not an easy thing to get right. The NHS now needs to build on progress made and ensure it has the information needed to manage the workforce well. The use of bank and agency nurses also needs to be kept under review.”