There are some mixed messages in the latest batch of NHS Scotland statistics. Workforce numbers are up last year, although still less than before the crash and vacancies are high. Some health boards are struggling to meet waiting time targets and most missed the four hour A&E wait target. Perhaps most challenging is increased bed blocking.
The workforce statistics show that the total number of NHS Scotland staff in post increased last year with 135,881 whole time equivalent (WTE) and 159,058 headcount on 3 June 2014. The annual increase in staff of 1.9% WTE is mainly due to increases in nursing and midwifery (1,309.6 WTE), administrative services (345.5 WTE), medical (286.2 WTE) and allied health professions (226.4 WTE).
Welcome though this year’s increase is, it’s worth remembering that the highpoint for NHS staff in Scotland was September 2010 when the WTE was 135,964. When the council staff transferred into NHS Highland are taken into account, the NHS is still around 1000 staff down since the financial crash.
In addition, the total number of vacancies remains high. Consultants 346.7 WTE, a rate of 6.9%; Nursing and midwifery 1,865.3 WTE, a rate of 3.1%; Allied health professions 481.2 WTE, a rate of 4.1%. The Health Secretary argues that this is a mixture of hard to fill specialists and increasing staff numbers. Others suspect that some health boards are balancing their books by deliberately not filling vacancies.
The statistics on waiting times and bed blocking highlight significant regional variations. Grampian, Lothian and Forth Valley missed a target to treat the majority of people within 18 weeks. Only two health boards managed to treat most patients in A&E departments within four hours. Five health boards missed an interim target to treat 19 out of 20 patients within that time frame. Only five of the 14 health boards have achieved the 26 week waiting time for treating children and young people who need care for mental health problems.
175 patients remained in hospital six weeks after being fit enough to be discharged. The main reason given was the lack of a place in a care home. The target is that no patient should be delayed in hospital for more than four weeks and that will fall to two weeks by April next year. 518 patients are waiting more than two weeks at present. In total, nearly 900 patients are in hospital when they have been assessed as ready for discharge - the equivalent of Scotland’s largest hospital.
All these numbers have increased over the last year and exclude the 300+ patients classified as Code 9, which means there is an approved cause for their delayed discharge. Interestingly, there are significant regional differences as the chart below highlights. This will be a key challenge for the new integration boards.