It could be 10 years before waiting times for operations return to pre-Covid levels, a leading surgeon has warned.
Dr Rowan Parks, president-elect of the Royal College of Surgeons of Edinburgh (RCSEd), said his prediction is based on modelling by surgical colleagues. He has urged NHS leaders and politicians to set realistic expectations for the public about the impact of the pandemic.
Parks, who takes up the presidency of the RCSEd in November, also urged ministers to accelerate NHS recruitment and redouble efforts to retain experienced staff.
His warning comes as independent health thinktank the Nuffield Trust revealed that Scottish nurses are quitting the profession at a higher rate than their counterparts in England.
Some 1,485 Scottish nurses left the profession in the six months to March this year, a rate of 2.1% of the workforce, compared with the English rate of 1.7%, the Nuffield Trust independent health thinktank has revealed.
The trust says poor workplace conditions, bullying, lack of hot meals out of hours or time to eat are cited by nurses as major reasons for retiring early or leaving to work in other professions.
One Scottish nurse who has decided to retire early told The Sunday Post: “There have been many tears shed on our ward over the past few months, it’s not unusual to hear nurses crying quietly in the toilets during their shift; their patient load too great and number of nurses on duty during their shift too small.
“I live with the fear that I will make a mistake that will cause harm to a patient – or worse – because I’m so overworked and exhausted. We all live under this shadow.”
The Sunday Post view: Like the patients they look after so well, our NHS staff are in need of care
The Scottish Government published a five-year Covid recovery plan for the NHS in August 2021 but Dr Parks said it will take longer to return to the level of service provided prior to the pandemic.
Parks said: “We’ve asked some of our surgical colleagues to do some modelling. It does very much depend on what workforce can be expanded or developed but some of them are talking about, realistically, it could be a decade, it could be 10 years.
“Therefore, there has to be a conversation with the public and the realisation that the pandemic has had a significant impact. There were challenges before the pandemic but more than ever, we need to be setting realistic expectations.
“The NHS is a fantastic institution but it has been under enormous stress before the pandemic and the pandemic has exacerbated some of the real challenges around workforce retention and we have to ensure that we value the staff we have, retain the staff we have and make it an attractive career to bring new staff in.”
The latest official figures show the number of planned operations for the quarter to the end of June this year was 27% below the same three-month period in 2019.
The figures also show the number of planned operations carried out in April, May and June this year – 55,758 – was 1.6% below the same quarter in 2021 when 56,672 elective procedures took place.
Parks said: “What the public need to understand is everybody is working their hardest to deliver healthcare to the population but there are realities and waiting times is one of those and we have to manage expectation. Waiting lists were creeping up before the pandemic but they have significantly worsened.
“We have done most of the efficiencies to increase throughput and with that we’re still seeing longer waiting times creeping in. So if we’ve got things running as efficiently as possible then the conversation has had to move to increasing capacity. That’s a conversation we started to have before the pandemic but it has really now been brought to the forefront.”
A key part of the recovery plan is the creation of 10 new national treatment centres (NTCs) but half of them are behind schedule.
© SYSTEMA centre in Inverness due to open this year will open in April, 2023, while NTCs in Aberdeen and Livingston scheduled for 2025 are now expected to fully open in 2027. NTCs in Larbert and Kirkcaldy which were due to open this year will fully open early next year. Parks is supportive of the concept of NTCs but is concerned about how they will be fully staffed.
He said: “Ultimately, we need staff and that’s not just surgical staff. It’s all the associated staff. There does need to be expansion of numbers and efforts at recruitment but it takes time to fully train surgeons. That’s why we’re pushing to start that work now because the building of these NTCs will take a number of years. This isn’t a quick fix. It’s a three, five, eight-year plan to really increase the workforce to populate these new centres.”
Scotland’s spending watchdog Audit Scotland published a report in February which said the Scottish Government’s plans to recruit and retain staff are ambitious but will be difficult to achieve.
Auditor General Stephen Boyle also warned the NHS is facing a funding crisis. “One of the key conclusions in our report is that the NHS needs to reform to become more financially sustainable, rather than reinventing back to where we were before the pandemic on an already unsustainable model,” he said.
Last week Dr Lewis Morrison, a geriatrician who has led the British Medical Association in Scotland for four years, warned that the NHS faces a “terrifying winter”.
He warned that planned operations for those on waiting lists were likely to be cancelled over the coming weeks and “there is a risk that people will choose not to access healthcare when they are unwell because they are afraid of what joining the queue to get into A&E or get into the hospital will look like”.
He said there was a high chance of NHS staff going on strike, and that he was particularly worried about nursing staff. He said that nurses who had raised concerns about staffing levels compromising care had been told nothing could be done.
Nuffield Trust chief executive, Nigel Edward said: “Across the world there’s an issue with staff burnout, particularly post-pandemic. A lot of the focus has been on planning and recruitment, but a great deal more effort needs to be going into understanding why people are leaving and the problems with retention.”
Meanwhile The Royal College of Nursing Scotland is urging immediate action from the Scottish Government to improve working conditions to prevent the haemorrhaging of staff.
RCN Scotland head Colin Poolman, said: “With increasing numbers of nurses in Scotland leaving the NMC register, and many more telling us that they are seriously considering leaving the profession, it is up to the Scottish Government to act now to demonstrate to nursing staff that they are valued.”
Campaign group Doctors for the NHS said: “Nurses don’t leave because they get a better offer of money elsewhere.
“Similarly, doctors don’t desert the UK because they are after more cash. These people are leaving because they cannot tolerate impossible working conditions.
“Most are being worn out by the jobs they have to do, caring for people, as this government seems oblivious to obvious working conditions.”
The Scottish Government said: “The Health Secretary recently announced a new set of ambitious targets for NHS Scotland to address the backlog of planned care, which – as with health services across the UK and worldwide – have been exacerbated by the impacts of the global pandemic. We are working hard with NHS Boards to maximise capacity and opportunities in order to meet these targets.”
On staffing levels, health secretary Humza Yousaf said: “Staffing across NHS Scotland is at a new record high and has increased for 10 consecutive years. NHS Scotland has more qualified nurses and midwives per population than NHS England.
“We know that the pandemic is not over and that Covid-19 and other pressures will continue to impact the NHS for some time. The Scottish Government recognises the significant additional pressure staff are facing across the health and care services, at this time.
“We made £12m available in the last financial year to support workforce wellbeing. We will continue to do all we can to seek to alleviate those demand pressures.”
The last two years have been crushing. Nurses are crying quietly in the toilet during their shift
Nurse on why she is quitting NHS
It is 6pm in a busy receiving ward in a hospital in central Scotland and I have been on duty for 11 hours without a break or anything to eat.
Instead of the adequate number of seven nurses, we have three and, out of kindness to each other, no one leaves their post.
The constant workload of the ward drug rounds, turning patients in danger of bedsores, ward rounds with the doctor, getting patients to theatre, organising ambulances for others to go home, and speaking to community nurses and family has exhausted me yet again.
I should be clocking off from my 12-hour shift at 7.30pm but I won’t leave until almost nine because we are each doing the work of more than two nurses.
Welcome to my world. This is what NHS nursing has been reduced to in Scotland today.
The wards which are run on staffing levels so dangerously low we are only a step away from disaster. I live with the fear that I will make a mistake that will cause harm to a patient – or worse – because I’m overworked and exhausted. We all live under this shadow.
This is the biggest reason why after two years of unbearable stress, and under pressure from my husband who has seen me cry too many times after heartbreaking shifts, I am retiring early.
After 30 years of doing the job I love, I can’t go on. I am tired and I am angry.
There have been too many tears shed on our ward over the past few months. It’s not unusual to hear nurses crying quietly in the toilets during their shift; their patient load too great and number of nurses on duty during the shift
too small.
Enough is enough. I want people to know the everyday reality my colleagues and I cope with. I can’t speak openly because I have been warned that if I do, I run the risk of my pension being delayed or that I could be transferred to another ward, or given shifts which will not allow me to care for my elderly parents.
The bullying is constant and the threat of reprisals if we raise concerns are always there. Many of my colleagues in other hospitals have already left, some to volunteer with the Royal Voluntary Services because their hearts still lie with the NHS.
In the past two years the crushing shortage of nursing staff has deteriorated to dangerous levels. Many of us believe that it is all part of plan to wind down the NHS and sell it off to privatised companies, waiting to pounce on our precious health service.
American friends have warned us and urged us to keep the NHS alive because many people in the US cannot afford diabetic or other lifesaving drugs, or ambulances to hospital.
It has happened to our railways, energy suppliers, Royal Mail and other vital parts of life, so why not our health service?
The pressure to clear bedblockers is relentless now. Bed managers are pushing us to move patients on and sometimes home saying: “Never mind giving the patients their medicines – move them now!”
We have patients who need to be turned every hour because of their fragile skin, but we are only able to turn them every two hours even though it is painful for them to lie in the same position for too long.
We are in the caring profession but I am not spending quality time with my patients because I have double the amount of people to look after.
So I try to concentrate on the sickest. But I know that no matter how dedicated you are, mistakes will happen and the buck will stop at us.
Drug rounds, when we dispense painkillers and other medications, is a big part of our job and it takes full concentration, but increasingly we are expected to juggle our duties.
I had a near miss with drugs one morning because I was trying to administer medication to patients at the same time as doing a ward round. When I put the wrong medication on a patient’s table I realised immediately and lifted
them away.
I was so shaken by the experience that I contacted the Nursing and Midwifery Council for advice. They told me never to do a ward and drug round together no matter how much pressure I was getting from doctors or managers.
The ward rounds are another important part of what we do. It’s when we accompany a doctor as he meets and reviews patients’ care. It’s vital a nurse is there because we are, after all, the ones who administer their care and monitor their progress.
Doctors are now under pressure to do ward rounds alone, which means communication about patient needs is breaking down. For example, a patient may tell a doctor that they have family at home to look after them when in fact, they are forgetful and live alone.
I’ve seen patients who require hourly observations being downgraded to two-hourly ones because there are not enough nurses to support them.
Some become more seriously ill because they are missed and that is very difficult to deal with. Few nurses won’t berate themselves for this, when they should be holding the system responsible.
My husband has begged me for six months to quit because he has seen how distressed I am at home. I have lost two stone in the past 18 months because of few breaks or chances to eat at work.
Incident forms called Datix forms, which we are required to completed if there is an adverse incidents, like patient falls or drug errors, and accidents that could impact care, go unrecorded because there is no time to do them. Many nurses believe the system of reporting these has become so cumbersome and lengthy to make it difficult for us to report anything.
We have a make-do-and-mend NHS where auxiliaries are doing nursing jobs including turning patients on their own and risking their backs. I talked my daughter out of going into nursing because I did not want this stress and anxiety for her. It is a fabulous job, the best in the world, but unless we treat nurses better the NHS will grind to a halt because of the numbers that are leaving.
Some new nurses only last six months on the wards I’ve worked on before leaving for posts in the community…and who can blame them.
I am leaving after 30 years because I am broken by what has become of the NHS.
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