Health / Health board estimating £4m overspend this year
NHS Shetland is projecting a £4 million overspend this financial year – with the figures prompting more discussion over the use of temporary staff.
Echoing previous years, locum staff costs account for most of the overspend.
NHS Shetland board member Colin Campbell suggested there was a growing appetite among younger professionals to go down the locum route and questioned if there was a way of “embracing” this.
But fellow board member Kathy Hubbard said locums is something she “grumpily tolerates” and said more should be done at the top of government to help the issue.
Finance director Colin Marsland explained that there is an expectation that health boards in Scotland break even – and if they do not, the government then can step in with a “brokerage” loan that needs to be repaid.
This means health boards would need to look at service redesign to achieve savings, without affecting the quality of care provided to patients.
But Marsland told an NHS Shetland board meeting on Tuesday overspends are being projected by health boards across the country.
To maintain patient care the island health board relies on plugging gaps with temporary locum and agency staff, who come at a cost.
The issue is nothing new and work has been ongoing for some time to find solutions, such as the locally administered Rediscover the Joy scheme where experienced GPs are recruited to work on temporary placements.
But at the end of July NHS Shetland’s actual spend on locum and agency staff in the 2022/23 financial year had reached nearly £3 million.
There has previously been calls for this type of spend to be included in the annual budgets.
At Tuesday’s meeting Campbell commented: “I think we do need to accept that this is the current model and needs to be model going forward”.
He said he spoke to five younger professionals in recent months who suggested they were less interested in traditional full-time contracts.
The board member suggested there was a need to “embrace” these professionals in a different form of contract.
“We need to be looking at a different way of employing these new professionals,” Campbell said.
But Hubbard said there was nothing to embrace about it – and called on leadership at the top in the Scottish Government to assist in what is a national issue.
And NHS Shetland chief executive Michael Dickson said there were ongoing change programmes, adding: “I don’t think we need to accept our lot.”
The lack of available accommodation was also raised in discussion, although it was noted a former guest house bought by NHS Shetland is now in use for staff.
Meanwhile NHS Shetland’s director of nursing and acute services Kathleen Carolan said there had been a lot of change in the last year, in the emergence from the Covid pandemic, and encouraged the board with work with management over the coming six months.
She added that the Scottish Government could consider the health board’s plans in the longer term to help facilitate safe redesign and change as an alternative to the brokerage loan system.
Board member Natasha Cornick meanwhile also said she found it “baffling” and “quite frankly crazy” that health boards are drip fed certain funding from the Scottish Government – with these allocations unknown at the start of the financial year.
But she said she acknowledged the “pressures in the system” and the amount of work being undertaken locally on the finances.
Board chairman Gary Robinson meanwhile said he felt with staff recruitment it was a case of supply and demand, but in an island community it can be hard to “grow your own”.
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