Official Report 779KB pdf
National Health Service (Common Staffing Method) (Scotland) Amendment Regulations 2025 (SSI 2025/43)
Our third agenda item is consideration of SSI 2025/43, the purpose of which is to amend the National Health Service (Common Staffing Method) (Scotland) Regulations 2024, which specify the staffing level and professional judgment tools that must be used as part of the common staffing method for specified kinds of health. No motion to annul has been received in relation to the instrument.
The committee first considered the instrument at its meeting on Tuesday 11 March, when members agreed to invite the cabinet secretary to attend today’s meeting to give evidence on it. I welcome Neil Gray, the Cabinet Secretary for Health and Social Care, who is joined by, from the Scottish Government, Erin Murphy, who is a policy manager in the nursing and midwifery policy team, and Christopher Thompson, who is a team leader in national workforce planning, guidance and strategy.
I thank the cabinet secretary and his officials for agreeing to attend the meeting at such short notice, and I invite the cabinet secretary to make a brief opening statement.
Thank you for giving me the opportunity to speak to the committee. I will briefly set out the reasons for the amendments to the National Health Service (Common Staffing Method) (Scotland) Regulations.
The amendments, which are relatively technical in nature, largely take account of changes that are linked to the implementation of the reduced working week for agenda for change staff. The first half-hour reduction in the working week for those staff was implemented on 1 April last year. It is clearly important that the staffing tools that are provided for under the Health and Care (Staffing) (Scotland) Act 2019 are adjusted to reflect the new definition of whole-time equivalent working hours. Further amendments will be required at the point at which we deliver the 36-hour working week, on 1 April 2026.
I reiterate for the avoidance of any doubt that the Scottish Government is delivering on its commitment to implement the reduced working week by 1 April 2026. I look forward to staff feeling the full benefit of that change. A clear delivery plan is being set out to give confidence regarding its delivery.
As part of the Health and Care (Staffing) (Scotland) Act 2019, the common staffing method sets out a process, including the use of tools and the consideration of a range of other factors, to determine appropriate staffing levels. Those tools will need to be updated and supplemented periodically, and corresponding updates to secondary legislation will be required. The tools provide a useful source of information to support local decision making, and they form part of a wider set of systems and processes that were introduced by the 2019 act to support effective workforce planning.
To be clear, the intention is not to prescribe what staffing numbers are appropriate or to set recommended ratios at the national level. Such an approach would lack the flexibility to account for local circumstances and would fail to take account of the dynamic nature of healthcare services and the care that they are required to deliver. Instead, the approach is designed to support robust and transparent local decision making.
It is important to recognise that this is the first year following the commencement of the 2019 act and that, as more resources become available and learning takes place in the years to come, we will naturally see incremental improvements in the approach that is taken to compliance. That is not to say that some benefits are not already being felt. I am aware of work that is being done across the system to review staffing establishments as part of broader efforts to ensure that our services are fit for purpose and able to respond to the demands that we can reasonably anticipate. The act has added impetus to those efforts, and we will learn more about health boards’ experience of implementing the legislation when we receive their annual reports in the coming weeks.
I will re-engage with the Parliament later this year to give an update on the Scottish Government’s plans in the light of the evidence that continues to emerge. I will, of course, be happy to take questions from committee members.
Thank you, cabinet secretary. Sandesh Gulhane has some questions.
I declare an interest as a practising NHS GP.
Thank you for coming to the committee, cabinet secretary. I have a number of questions. First, have Healthcare Improvement Scotland and the Scottish Government accepted that there are flaws in the tools?
No. I will bring in Christopher Thompson in a second. The tools are there to help to inform different parts of the system to ensure that staffing levels are appropriate. There is a duty on local boards to report to ministers on their staffing levels. Ministers must lay those reports and respond to them, which I will do later this year.
Christopher can correct me if I am wrong, but I do not believe that we have had any concerns expressed.
As the cabinet secretary said, it is important to point out that this is the first year of the Health and Care (Staffing) (Scotland) Act 2019. We will get the first board reports in April this year, when we will be able to get a full picture of how boards have got on with compliance with the act. HIS owns the tools and is working through a process of updating them where that is necessary. It is currently working on the maternity tool, some aspects of which could be improved on. HIS has a work plan that it will be working through to update the tools as necessary.
Has the Scottish Government or HIS ever published the reliability and validity data behind the tools that are being used? Can you explain exactly how the tools were arrived at?
The tools are there as guides for local decision makers in ensuring that there are safe staffing levels. As I said, they are intended to be dynamic and flexible to respond to local need and clinical demand. As Christopher Thompson set out, HIS is working on developing the tools to ensure that they are responsive—the tools are works in progress. As a result of the legislation and the work that the Government is doing with boards on supplementary staffing, significant work is on-going to ensure that establishment staffing levels are appropriate. A considerable benefit is coming through as a result of the legislation and the on-going work that is being done by HIS and by boards.
Would you support publishing the data around the tools and information on how they were arrived at, even if that is on an on-going dynamic basis?
Obviously, we will keep under review what we publish. We have to publish the board’s responses, which we will get at the end of next month. We will keep under review and consideration the data that is published alongside that.
Do you remove time allocated for breaks from the calculations?
I will need to defer to Christopher on that.
I would have to check that with HIS, I am afraid. I can write to the committee to confirm that.
The predicted absence allowance is 22.5 per cent, which the Royal College of Nursing says is the lowest in the UK and is too low. Do you accept that allowance or do you think that it needs to be looked at again?
As we are setting out the tools and seeing the act being implemented in local areas, and as we see the response that comes back from boards on how they are reviewing and ensuring that they have safe staffing levels, of course we keep under review areas such as those that have been suggested by the Royal College of Nursing. The process is dynamic and flexible—it is not a one-size-fits-all approach—so that we can deal with potential elements that need to be worked on as the legislation is implemented. We keep under review concerns such as those from the Royal College of Nursing that Mr Gulhane has raised.
Has the legislation provided safe staffing levels? I appreciate that a report will come out, but do you feel that the legislation has done what it set out to do?
We will see what the reports from boards say. I have not had sight of those, and they are not due to arrive with us until 30 April. Challenges remain across the system in ensuring that we have sufficient staffing levels. I will not shy away from that, but I think that this, alongside some of our work with the nursing and midwifery task force, our work on GP attraction and retention and our work with the royal colleges and others on attracting and retaining staff in all disciplines, will help us to build towards ensuring that we continue to have the high-quality and safe clinical environments that people expect.
I am not going to pretend that, on every shift in every ward, staffing is at appropriate levels, because I know that we are sometimes short. However, this is about ensuring that we get to that point. Improvements in that respect will have been made over the past year, and I am looking forward to the reports demonstrating that.
Thank you.
12:15
I want to raise with the cabinet secretary correspondence that we have received from the Royal College of Nursing, which has expressed particular concern about the proposed reduction in the working week for the agenda for change staff. It claims that there had been mixed messages from the Scottish Government and health boards; indeed, it was aware of some boards proactively informing staff that further reductions would go ahead in April, and that people had made plans and arrangements accordingly. Therefore, the late announcement from the Government that a further reduction would not go ahead this year has resulted in a great loss of trust. Cabinet secretary, do you want to respond to those points from the RCN?
I have engaged directly with the RCN, its leadership and its lay committee on many points since the decision was taken. With regard to the perceived delay, it was an issue on which I understood that there were very strong feelings from colleagues within the trade union movement, and I engaged with them to hear their perspective before I came to a decision. I took my time to come to that decision, because I recognised the strength of feeling on the matter, but also because of what I was being told and the advice that I was being given on ensuring that we safely implemented the commitment to reduce the working week.
There was no agreement in place about how we would arrive at the 36 hours. Given that the commitment in the pay deal was to get to 36 hours, I believe that I am implementing that deal by getting to 36 hours as of next April. I also believe that I am doing it in the responsible way, by having an implementation plan that takes place over the course of this year and that involves local area partnerships, the Scottish terms and conditions committee and the national trade union representative body. We will see draft plans coming through in May and confirmed plans from boards in October, and that will ensure that our approach to implementation guarantees that 36 hours will be arrived at in April of next year.
I absolutely understand what has been said, and I have engaged on the matter with almost all the relevant trade unions—I still have some to come—but, as I have said, this is Government delivering on the pay deal. We have not reneged. I understand the perception of the phasing of all of this and how people thought that it was going to be implemented, but there was no agreement as to how that would be done from Government. Therefore, I believe that we are delivering on the agreement that we set out in the pay deal two years ago.
Thank you.
Good morning, cabinet secretary. First, I declare an interest as a former employee of NHS Dumfries and Galloway who worked in the operating room department and perianaesthesia area. As such, I know that safe staffing is always considered in intensive care; whether there is one-to-one or one-to-two staffing depends on the number of people who have been ventilated and intubated. All of that is taken into consideration. It is my understanding, too, that in NHS Dumfries and Galloway, which is an example that I know, people meet three times a day to look at the staffing and the templates, which they use as guidance; to think about and assess patient acuity—that is, how sick the patients are; and then to make adjustments and decisions on that basis.
Just to be clear, as all of those templates across the NHS in Scotland are assessed and implemented, will we be able to look at the reports that are generated to see what is working well in one place versus what has not worked as well in another? Is that the plan with publishing the reports?
I thank Emma Harper for that question, because she has illustrated what I was setting out in response to Sandesh Gulhane about the processes that are in play in all environments, in both health and social care, and what must be taken into consideration in order to understand what will be a safe staffing level for a particular shift.
Emma Harper rightly points to the fact that a number of factors will be dynamic and have to be flexible. In the example that she provided, the number of people who are intubated or in intensive care and requiring ventilation would change depending on the number of patients who are in that particular unit at that time. There is an understanding of that. The safe staffing legislation provides transparency around the tools that are used, the way in which the safe staffing level is determined, and ensuring that we comply with that across the NHS and social care estate. That is essentially what the legislation is designed to do.
Is a risk assessment part of that whole process of planning?
Of course. It has to be. That is why it is important that it is done at a local level, to respond to local need and the local environment, and to the various factors that Emma Harper will be familiar with, given her previous practice, in arriving at what will be required and what a risk assessment would arrive at as the best requirement for that particular shift, or for a longer period of time, depending on the environment that we are talking about. That is why it cannot be prescribed nationally. It has to be delivered locally, but we need the transparency that the legislation provides around how those decisions are taken, and when there has been challenge in the previous year, to arrive at a safe staffing level. The reports will come through in April to determine that, and the ministers will need to respond to those in the Parliament in due course.
I assume that there is a staff to patient ratio across specialisms that is fairly standard with regard to the minimum requirement. To go back to your answer to Sandesh Gulhane, I wonder whether the tools that will be used to report against that will show disparity in shortfalls and point to specific needs.
I have a very specific interest in that, because during the previous parliamentary session, under a bit of pressure, we got HIS to look at the neonatal unit in Kilmarnock, and we discovered that it was 24 staff short. There must be a better and quicker way of dealing with such a shortfall. I presume that the tools that you are implementing will be able to highlight that very quickly.
They should be, yes, but to supplement that, I reiterate what Emma Harper has just put on the table and my response to Sandesh Gulhane—I cannot prejudge what will be in the reports. I will see the boards’ decisions and the risk assessments and other factors that they have used to determine what the staffing establishment should look like. When there have been issues, that needs to be clearly communicated in the reports that come through to ministers.
To add to Mr Whittle’s point, he will be aware that HIS now routinely inspects maternity and neonatal services. The first inspection is under way and we expect the reports on that in May.
In the light of what we are picking up through the boards’ reviews and other areas of learning, we will interact with boards that have a responsibility to make sure that they are honouring what they should be and providing safe staffing.
Thank you, cabinet secretary. No one else has indicated that they wish to ask a question, so we will move on to the next item, which is to consider the negative instrument on which we have just taken evidence from the cabinet secretary.
As no member wishes to comment, I propose that the committee does not make any recommendations on the instrument. Are we agreed?
Members indicated agreement.
At the committee’s next meeting, we will continue our stage 1 scrutiny of the Right to Addiction Recovery (Scotland) Bill, taking evidence from the representatives of health and social care partnerships, local government, NHS boards and alcohol and drug partnerships. That concludes the public part of our meeting today.
12:24 Meeting continued in private until 12:24.