That the NHS faces a struggle to cope with the demands of a rapidly-ageing population should come as no surprise to anyone.
That the struggle is made worse because it is not just the patients but the staff who are getting older is also well established, not least here in the north and north-east of Scotland.
Yet today those in charge of finding the answers face a dramatic claim from independent experts: they are simply not prepared for the future.
Audit Scotland’s verdict is stark: “Processes for determining training numbers risk not training enough doctors, nurses and midwives with the right skills for the future.
“Medical recruitment numbers are based on replacing current numbers rather than looking at the impact of changing demand.”
Ministers and health boards were quick to defend themselves, citing record levels of funding and ongoing workforce planning.
But the head of the respected spending watchdog Auditor General for Scotland, Caroline Gardner, is concerned it is only the problem that is clear to them, not the solution.
“The Scottish Government and NHS boards recognise the challenges,” she said.
“But they urgently need to improve their understanding of future demand, staff projections and associated costs, and set out in detail how they plan to create a workforce that can meet the long-term health needs of the population.”
The report was music to the ears of trade unions, who have long warned that the NHS was not being properly “future-proofed”.
One in three in the nursing profession are aged over 50.
“Audit Scotland has hit the nail on the head,” Royal College of Nursing Scotland (RCN) director Theresa Fyffe declared.
“For too long plans have been restricted by what is affordable and achievable with the staff available, rather than focusing on strategic, long-term planning to meet demand.
“Staff across NHS Scotland are under enormous, unrelenting pressure to meet ever-growing demand. The significant workforce challenges set out in the report must be addressed robustly, realistically and rapidly if patients are to get the care they need.”
Unison Scotland’s head of health, Matt McLaughlin, said that while more money might have been pumped in, it was “not always used in the right way or in the right place”.
That was seen, he said, in an over-reliance on bank and agency nursing and short contracts for domestics, porters and other support staff – a major issue in this part of the country.
“Too often, workforce planning is budget driven and focuses on solving a short-term problem. We need high-level agreement and investment in a number of key areas to allow minds to focus on long-term, proactive planning,” he suggested.
Opposition politicians had a field day with the watchdog’s report, Labour calling it “absolutely damning” and the Conservatives “deeply concerning”.
Labour spokesman Anas Sarwar MSP said the workforce was “over-worked, under-valued and under-resourced” with morale at rock bottom, and pinned the blame directly on Nicola Sturgeon.
As health secretary, she had “slashed the number of training places for nurses and midwives”, he said.
Now, as first minister, she was at the head of a government, said Conservative shadow health secretary Miles Briggs, that was guilty of ignoring a “growing chorus of voices saying that we need an effective, long-term workforce strategy put in place”.
The vacancy rate for consultants had doubled in the last five years, from 3.6% in 2011-12 to 7.4% in 2016-17, he noted.
“Time and again we have seen warnings about long-term workforce planning, and these figures show the situation is only getting worse.
“Agency costs are soaring, and the percentage of vacancies in consultancy and nursing posts have more than doubled.”
A huge shortfall of nurses, he said, was among the most serious causes for concern.
“The growing strain within NHS departments is clear, and it is the SNP’s totally shambolic approach to work-force planning over the last decade that is to blame.
Labour propose a “workforce commission” to examine the requirements of the NHS.
Health Secretary Shona Robison took a defiant stance, however, insisting there was no shortage of effort going in to making sure there would be sufficient trained staff to look after future generations of patients – including after Brexit.
She said: “As this report acknowledges, NHS Scotland’s staffing levels are at a record high, with spending on staff having increased by 11% since 2011-12.
“We’re committed to not only having the right number of staff, but also to ensure that we have the mix of skills in the right places.
“NHS boards are already working with partners to develop regional delivery plans setting out how they will deliver services over the next 15 to 20 years.”
Ms Robison said long-term planning was already under way and was being updated due to Brexit.
The first part of a plan of how the government would “recruit, develop and retain the flexible, multidisciplinary workforce we need” was published last month, she noted.
“We are also committed to enshrining safe and effective staffing for our NHS in law. Ensuring effective workforce planning not only has to account for changes in the nature of the demands being placed on our health and care services, but also for the challenges that are presented by external factors like the impact of Brexit on Scotland’s ability to attract and retain workers from across Europe.”
With one generation of medical staff heading for their pensions, NHS boards have begun to pay urgent attention to wooing those about to embark on their working lives.
NHS Grampian hopes that the solution to its recruitment and retention crisis lies with forging ever-stronger links with local universities and active recruitment campaigns. A spokeswoman said: “We take workforce planning very seriously and use it to understand and mitigate any challenges we may face in coming years.
“Our nurse recruitment work has concentrated on our already strong links with Robert Gordon University, with newly-qualified nurses offered a post on graduation.
“We are also offering modern apprenticeships in diverse areas, including our mobility and rehabilitation service. We are actively recruiting to a whole range of posts across the organisation. Our vacancies are advertised locally, nationally, internationally and on social media as appropriate and recruitment staff attend various job fairs. We continue to look at new and innovative ways to attract staff.
“We believe that Grampian is an attractive place to work and live and we continue to seek new employees to join us.”
An NHS Highland spokesman said a workforce plan for the coming year would be published by the board next month.
“The plan identifies the workforce challenges we specifically face as a board and how we are working with other NHS boards, including NHS Education for Scotland, the regions and the Scottish Government, to collectively understand and tackle workforce challenges and opportunities going forward.
“This will include the development of new employment routes and new roles that will support our plans for future health and social care delivery.”
