Scottish ministers ‘mismanaging NHS’, say opposition, as huge hourly rates revealed

Scottish opposition leaders have accused ministers of mismanaging the NHS after the “jaw-dropping” costs of hiring emergency psychiatrists came to light.

The Liberal Democrats, Labour and Conservatives will press Scottish health ministers this week to explain why the health service has spent more than £130m over the past five years hiring temporary psychiatrists for routine mental health appointments.

A joint investigation by the Guardian and BBC Scotland found that NHS boards were paying up to £837 an hour to hire locum psychiatrists from agencies because of a nationwide shortage of consultant psychiatrists.

Alex Cole-Hamilton, the Scottish Lib Dem leader, said: “These are really jaw-dropping figures. I think the average Scot will be shocked that instead of recruiting and training permanent staff, health boards are sending millions of pounds to recruitment agencies charging hundreds of pounds an hour. It’s almost the definition of a false economy.”

Paul Sweeney, Scottish Labour’s mental health spokesperson, said this level of spending was unsustainable. “The NHS is being held to ransom by years of SNP failure to recruit and retain staff,” he said.

“With many NHS staff reporting burnout, and with pressures on hospitals at an all-time high, the Scottish National party must prioritise improving terms and conditions of staff so that a career in the NHS once again becomes the peak of ambition.”

Data released by Scotland’s 14 NHS boards showed some private firms had made up to £19.5m providing locum psychiatrists over the past five years.

While some boards hire their own staff as locums, working overtime or during their holidays at enhanced rates, more than a third of the £134m spent since 2019 has gone on emergency cover provided by private companies.

The cost of that emergency cover has grown year-on-year. In the 2023 financial year nearly £15m was spent on emergency locum contracts, despite an attempt by ministers to ban their routine use in May 2023.

NHS Tayside had spent £30.5m on locum psychiatrists hired on long-term and emergency contracts, rising to a record £7.7m last year, while NHS Fife spent £29.5m, including £9.5m last year.

The Royal College of Psychiatrists, which sets the professional standards for psychiatrists, warned that some locums were not fully qualified for the posts they were covering, or were not members of the royal college. Some worked remotely, from outside Scotland.

The patient advocacy campaign Vox Scotland published the results of a survey of nearly 500 patients which found half of those treated by a locum were unhappy with their experience.

Some said they had encountered disrupted and superficial care after being seen by multiple people, with different locums giving different treatments or medicines.

The recruitment sector argues that locums are essential in the NHS and that many doctors now choose such work because they want greater flexibility and control over their working hours.

Kate Shoesmith, deputy chief executive of the Recruitment and Employment Confederation, said: “True sustainability lies in a strategy on health staffing that effectively engages, develops, deploys, rewards and supports all workers, whether substantive, bank or agency.

“This approach will eliminate the need for frequent, costly last-minute adjustments, ensuring a cohesive and functional agency model.”

Maree Todd, the Scottish mental wellbeing minister, said: “[The] NHS Scotland staffing pay bill is over £9bn a year, with spending on locum psychiatrists a tiny fraction of this.”

She added there were “clear expectations that off-framework agency spend should be minimised as far as possible in continuing to ensure vital service provision during times of unplanned absence, sickness and increased unforeseen activity”.