Scotland’s 
NHS workforce
The current picture

Prepared by Audit Scotland
February 2017

Auditor General for Scotland
The Auditor General’s role is to:
•	appoint auditors to Scotland’s central government and NHS bodies
•	examine how public bodies spend public money
•	help them to manage their finances to the highest standards 
•	check whether they achieve value for money. 

The Auditor General is independent and reports to the Scottish Parliament 
on the performance of:
•	directorates of the Scottish Government 
•	government agencies, eg the Scottish Prison Service, 
Historic Environment Scotland 
•	NHS bodies
•	further education colleges 
•	Scottish Water 
•	NDPBs and others, eg Scottish Police Authority, Scottish Fire and 
Rescue Service.

You can find out more about the work of the Auditor General on our website: www.audit-scotland.gov.uk/about/ags 
Audit Scotland is a statutory body set up in April 2000 under the Public Finance and Accountability (Scotland) Act 2000. We help the Auditor General for Scotland and the Accounts Commission check that organisations spending public money use it properly, efficiently and effectively.

Introduction
Major challenges lie ahead for the NHS in Scotland. As I reported last year , there are growing pressures on NHS boards which are struggling to juggle service delivery and progress major reform, at the same time as managing considerable financial challenges. 
Nearly 160,000 people work in Scotland’s NHS, which provides vital services for millions of us every year. Their hard work and commitment, sometimes in life-or-death circumstances, is always to be admired. However, the NHS faces challenges if the workforce is to meet the growing demands of our ageing population and adapt to new ways of working.
We know that our audit work on health and social care in Scotland has a role to play in the wider debate about what’s needed to transform these services and make them sustainable for the future. 
Building on our recent findings, we’ve begun a new two-part audit to evaluate how the Scottish Government and NHS boards are tackling the issues, through workforce planning and national and local initiatives.
The first report focuses on overall workforce planning and workforce pressures in hospitals and will be published in summer 2017. The second is due out in 2018/19 and will explore primary care and GP workforce issues.
In advance of our first report, this briefing provides some key information on the shape of the current NHS workforce and sets out some of the issues that we’re delving into during the course of our audit.
Caroline Gardner
Auditor General for Scotland 

Key issues for the NHS workforce
NHS staff numbers are at their highest ever level, but there are key issues relating to the workforce.
Vacancy rates among some groups of NHS staff have been increasing, along with spending on agency staff.
Turnover rates, a measure of retention, and sickness absence rates have increased slightly over the last few years, and vary widely by NHS board.
There is a trend towards an increasingly ageing workforce with 38 per cent of NHS staff aged over 50, compared with 34 per cent in 2012. Nursing and midwifery have particularly high rates of older staff.
The NHS workforce
138,458 
Whole-time equivalent (WTE) 
•	NHS staff, March 2016: up 5 per cent since 2012.
•	4.7 per cent of the Scottish working age population is employed by the NHS.
•	In 2015/16 just over £6 billion (55 per cent) of NHS spending was on staff costs.

Age of NHS staff (March 2016)
The largest age group among NHS staff is 50-54, around 18 per cent of staff

3 per cent of NHS staff are from an minority ethnic group. Four per cent of the overall population are from a minority ethnic group.

Fewer than one per cent of NHS staff are recorded as having a disability.

•	Over three-quarters of NHS staff are female 
•	Among medical staff the percentages of men and women are almost even
•	One in ten nurses is male
•	Two in ten allied health professionals are male

Note: Allied health professionals (AHPs) include physiotherapists, occupational therapists and speech and language therapists, among others.
Source: ISD, Annual Population Survey and 2011 census. Excludes GPs
Vacancies
•	Consultants have the highest vacancy rate of the three staff groups.
•	The vacancy rate has increased for all staff groups over the period, though consultant vacancies dropped between 2015 and 2016.
•	Vacancies that have been open for three or six months have also been increasing, particularly for consultants.
Specialty vacancy rates
Specialty	2016 
WTE in post
	2016
Vacancy rate (%)	2016
Percentage of training establishment that is unfilled	
General Practice	3,645.0*	5.0*	8.3	
Consultants	5,115.6	6.5	6.5	
				
Psychotherapy	12.5	22.8	0	
Occupational Medicine	14.0	22.2	0	
Intensive Care Medicine	9.0	18.2	5.0	
Old Age Psychiatry	51.4	17.4	32.0	
Orthodontics	25.5	15.3	Not available	
General (acute) Medicine	145.6	12.9	Not available	
Clinical Radiology	324.4	11.1	Not available	
Histopathology	103.7	10.9	0	
Respiratory Medicine	98.3	10.9	0	
Medical Oncology	16.7	10.7	4.8	

Note: *From the 2015 primary care survey. Our second NHS workforce audit will focus on GP issues.
Source: NHS, NES and ISD. Includes the top ten specialities where the establishment was more than ten
The table shows the overall consultant WTE in post, along with the vacancy rate and unfilled training places. It also shows the ten specialties with the highest consultancy vacancy rates, along with the unfilled training place rates, where available.

Vacancies
•	Consultant, allied health professionals and nursing vacancies in 2016 show that generally the more rural the area the higher the vacancy rate.
•	There are exceptions to this, for example NHS Ayrshire and Arran and NHS Western Isles have higher rurality levels than the Scottish average, but low vacancy rates.
Source: ISD, SG measure of rurality. Excludes special boards

Spending on clinical and non–clinical agency staff
•	Total staff spending increased by 7.7 per cent between 2011/12 and 2015/16, while WTE staff increased by five per cent.
•	The percentage of staff spending that was on agency staff increased during that time, from 1.4 per cent to 2.8 per cent. Among the territorial boards, this ranged from 1.9 per cent at NHS Tayside to 6.8 per cent at NHS Shetland.
•	The amount of spending on other non-core staff costs, like internal bank* (except for nurses) or overtime, is not available.
*Bank is the use of internal supplementary staff for single or groups of shifts.

Turnover
•	Staff turnover is a measure of retention, and is calculated by dividing the number of leavers by the total staff establishment.
•	Nationally, turnover rates have increased slightly since 2012 from 6.1 to 6.4 per cent.
NHS Shetland had the highest turnover rate: 11.5%
NHS Ayrshire and Arran had the lowest turnover rate: 6%
Sickness absence
•	The NHS Scotland sickness absence target is four per cent. In 2015/16 no territorial board met this target.
•	The national sickness absence rate in 2015/16 was 5.2 per cent, an increase from 4.6 per cent in 2011/12.
NHS Western Isles had the highest sickness absence rate: 5.9%
NHS Borders had the lowest sickness absence rate: 4.4%
Ageing workforce
•	Over a third of nursing staff are over 50, higher than the overall population percentage.
•	This chart shows the percentage of staff over 50 years old, which gives an indication of the numbers likely to retire over the next few years.
•	The proportion of older staff has been growing across each of the staff groups.
45% of staff are over 50 in NHS Western Isles
34% of staff are over 50 in NHS Grampian
Our work
•	Our work on the workforce is part of a wider programme of work on the NHS and social care.
•	Future publication dates are indicative.
•	Our transforming health and social care page has more information about our work in health and social care.
•	If you have any queries about our NHS workforce audit , contact Richard Robinson E: rrobinson@audit-scotland.gov.uk