Outlook critical: Staff burnout as health service struggles to cope with patient demand

It is 8pm on a geriatric ward in a central belt NHS hospital and one of the staff nurses has called in sick.

The ward is down to one remaining senior nurse, a student nurse and health care assistants, so a call has gone out to a nearby hospital to taxi over a replacement from an already short-staffed oncology unit.

But she can only stay a few hours until returning to her own patients.

“We are box-ticking with elderly, frail patients who deserve compassion and time,” said an agency nurse, who is desperate to stay anonymous to keep her shifts.

Moving nurses around at short notice to fill acute staff shortages is one of the major symptoms of our NHS workforce crisis.

With a rising sickness rate of 6% in NHS Scotland – higher than NHS England’s and the UK industry average – our frontline workers are under crippling pressure.

It’s easy to see why when the Nursing and Midwifery Council (NMC) report of 2023/24 lists poor health and burnout among the top three reasons for staff leaving its register.

Exhaustion from overwork and short-staffing, and bullying rank high among the reasons many nurses now want to retire early.

The Royal College of Nursing (RCN) Scotland says frontline emergency jobs have the biggest vacancy rates.

The NHS Scotland nurse vacancy rate is 2.9%, but at NHS24 it’s 14% and vacancies for nurses at the Scottish Ambulance Service are running at 11%.

Eileen McKenna, associate director of RCN Scotland, said: “Scotland’s health and social care system is under huge amounts of sustained pressure.

“Long-term actions to tackle this need to focus on addressing workforce shortages and building sustainable capacity in the NHS and, most importantly, in social care.

“The Scottish Government must demonstrate it values the nursing workforce through fair pay, terms and conditions, and through long-term investment in delivering the Ministerial Nursing and Midwifery Taskforce recommendations.

“Scotland does not have the nursing staff required to deliver care to all who need it. Nursing staff in health and social care are under significant pressure all year round.

“They are deeply concerned about the fragility of the system and the impact on patient safety and quality of care. This is completely unacceptable for patient safety and has a serious negative effect on staff wellbeing.”

She called on the Scottish Government to ensure the Nursing and Midwifery Taskforce delivers meaningful and sustainable change.

Scotland has far fewer nurses per head of population than Ireland, Norway and Finland, according to figures from the Organisation for Economic Co-operation and Development.

Currently, 54% of both nurses and midwives would not recommend it as a career choice, says the NMC.

Around 100 fewer hopefuls applied to study nursing in Scotland last year compared to the previous year. In medicine, applications fell in four out of five Scottish universities offering the degree course.

It’s a sorry story of young people steering away from frontline NHS jobs which were, until recently, oversubscribed.

Universities fear that stories of long ambulance queues, staff shortages and patients being treated in hospital corridors are putting school leavers off NHS careers.

Recently graduated doctors now struggle to find GP jobs because practices cannot afford to hire them on the budget allotted to run them.

The doctor’s trade journal GP revealed that some family practitioners in Scotland are leaving to instead drive taxis or to emigrate to Australia and elsewhere for jobs.

First Minister John Swinney outlined his top three priorities for the NHS in January, which included investing more in community health care to make it easier for people to see a GP.

Yet the number of practices has fallen by 100 since 2011 to just 889, while patients have increased by almost half a million since 2012 – many of them elderly with greater health needs. Only Dumfries & Galloway has retained its number of GP surgeries.

Junior doctors working in hospitals struggle to find training places for specialist jobs.

One, dismayed after not getting an oncology training place, said: “I don’t want to emigrate and wish to remain in the NHS. I am one of a number without a job for next year.”

Pulse medical journal says that 15,000 hopefuls apply for 4,000 training posts.

Australian and Canadian health authorities regularly launch recruitment drives to scoop up junior doctors cut loose in the UK without training posts to further their careers.

Recruitment drives for health staff from developing countries have filled shortages but many of them are using the UK as a stepping stone to Australia and other countries. In 2022/23, more than 12,400 UK-registered nurses applied for a references or endorsements needed to work outside the UK, more than double the number in 2018/19, says the Health Foundation. Overseas trained nurses accounted for seven in 10 of these.

Frontline health staff shortages have been a long time in the making and early signs have been repeatedly ignored, say the RCN Scotland and the BMA.

Dr Nóra Murray-Cavanagh, deputy chair of the BMA’s Scottish Council, said it has warned that workforce provision in Scotland’s NHS has been at dangerously low levels for some time.

She said: “We have obtained figures which show there are 1,003 consultant vacancies across health boards, a vacancy rate of 14.4%. This is more than double the number and rate recorded in official Scottish Government figures.

“BMA Scotland estimate it would take more than 13 years to fill all the current vacancies at this rate of progress.”

The Scottish Government said: “NHS Scotland nursing and midwifery staff has increased more than 11,000 whole time equivalent (WTE) since 2006, while there are 2,566 more WTE medical and dental consultants over the same period.”

Ellie’s story

Severe burnout left my mind and body in tatters, so I stepped away from medicine

© Andrew Cawley

Dr Ellie Scott-Gray worked as a junior doctor for four years before becoming so burnt out that she left the NHS.

Much of that was during Covid, when she says the NHS was extremely understaffed.

Her commitment to becoming a doctor was considerable, she says, but she feels that working in today’s NHS is hugely stressful.

“I worked 100% to get into medicine at Dundee and throughout the course because I wanted to become a good doctor,” she says.

“I am highly committed and spent an extra year in the medical degree course studying for an extra degree.

“I wanted to work at the acute end of emergency medicine but found that everyone was under considerable pressure.

“Most people become doctors because they want to help others and I did not have enough time to do this in my job.

“Severe burnout left my mind and body in tatters – so I made the bold decision to step away from my traditional medical career to heal, but also to look for new adventures.”

Moral distress among doctors who feel bad about not being able to give patients enough of their time has become a common reason for doctors to leave medicine.

A BMA survey revealed that insufficient staffing was a common cause.

Last year Dr Scott-Gray stepped back from long, punishing shifts in Accident & Emergency and left medicine. “Working as a junior doctor, I found senior doctors who used to be available for adequate advice and training were now so overwhelmed by work they did not have the time,” she says. “That’s understandable when you look at their current workload.”

Part of her four years in medicine was spent in Australia, where she says there was always a consultant to speak to for clinical advice.

“This is not the case in Scotland, not under current NHS work pressures,” she adds.

She has spent the last few months working as a barista in Glasgow’s south side and feels that it has given her the opportunity to reassess her career, engage with customers and remain busy.

Her family have been very supportive, she says.

She is determined to remain a health professional in the long term and her additional Bachelor of Medical Sciences degree offers possibilities for a career in research.

Shortly, she will start working in a new post as an ADHD psychosocial educator/coach.

She was diagnosed with ADHD – attention deficit hyperactivity disorder – and those with the condition are often characterised with sharp problem-solving abilities, high energy and an enthusiasm and capacity for work.

The condition is much more common among doctors than the general population the Journal of Occupational Medicine reported in January.