Shortage occupations list 2018: call for evidence - our response for health and social care
Response to the UK Migration Advisory Committee call for evidence on the shortage occupation list summarises skills shortages within health and social care sector in Scotland, and details the contribution of international workers.
Annex
Annex A
NHS Scotland Health Boards: Survey Results
Appended are the returns from five health boards that are representative of the broader NHS Scotland Workforce
NHS Education Scotland:
The primary employer of the trainee medical workforce in Scotland.
NHS Services Scotland :
NSS provide a number of nationwide support functions including: information services; IT; distribution; procurement; pharmacy and dental services; and the Blood Transfusion Service
Greater Glasgow & Clyde:
Greater Glasgow and Clyde is Scotland largest health board employing almost a quarter of the NHS Scotland workforce.
NHS Lothian:
NHS Lothian is the second largest health board in NHS Scotland.
NHS Grampian and NHS Orkney:
NHS Grampian are a large rural health board, who have submitted a joint return with NHS Orkney, providing an insight into the specific demands of boards in more remote settings.
Annex B
UK Wide Shortage Occupations List Vacancy Data
| SOC Code | Job Titles (& Further Criteria) | Number of Vacancies | Vacancy Rate (%) |
|---|---|---|---|
| 2211 Medical Practitioners | Clinical radiology | 43.2 | 11.9 |
| Emergency medicine | 11.1 | 4.6 | |
| Old age psychiatry | 11.7 | 15.2 | |
| CT3 trainee and ST4 – ST7 trainee in emergency medicine Core trainee in psychiatry Non-consultant, non-training, medical staff posts in the following specialties: Emergency medicine (including specialist doctors working in accident and emergency) Old age psychiatry Paediatrics |
|||
| 2217 Medical Radiographers | HCPC registered diagnostic radiographer | 57.4 (Bands 5-9) | 3.4 |
| Nuclear medicine practitioner Radiotherapy physics practitioner Radiotherapy physics scientist Sonographer |
11.3 | 3.8 | |
| 2219 Health Professionals not elsewhere classified | Neurophysiology healthcare scientist Neurophysiology practitioner Nuclear medicine scientist |
||
| Orthotist ** | 3.4 | 4.3 | |
| Prosthetist ** | 0.5 | 1.6 | |
| 2231 Nurses | All jobs in this occupation code | 3022.2 | 4.8 |
| - Adult Nursing | 1636.4 | 4.6 | |
| - District Nursing | 239.6 | 6.5 | |
| - Mental Health Nursing | 411.0 | 4.3 | |
| - Paediatric Nursing | 218.8 | 9.9 | |
| 3213 Paramedics | All jobs in this occupation code | 45.1 | 3.0 |
** Orthotics and Prosthetics services are contracted to the private sector. Therefore this does not accurately represent the number of vacancies in the broader health workforce.
Scotland Only Shortage Occupations List
| SOC Code | Job Titles (& Further Criteria) | Number of Vacancies | Vacancy Rate (%) |
|---|---|---|---|
| 2211 Medical Practitioners | Consultant in clinical oncology | 4 | 4.2 |
| Non-consultant, non-training medical staff post in clinical radiology | |||
| CT3 trainee and ST4 to ST7 trainee in clinical radiology All grades except CPT1 in psychiatry All grades in anaesthetics, paediatrics, obstetrics and gynaecology |
|||
| 2217 Medical Radiographers | Jobs on the UK SOL. Medical physicist |
||
| Staff working in diagnostics radiology (including magnetic resonance imaging). | 71.5 | 3.4 |
Areas of High Vacancy
Other Health Professionals
| Total Workforce | Profession | Total vacancies | Vacancy Rate (%) | Vacant 3 months or more | |
|---|---|---|---|---|---|
| 3086.2 | Physiotherapy | 205.6 | 6.7 | 52.6 | |
| 2347.4 | Occupational therapy | 94.0 | 4.0 | 25.9 | |
| 2118.1 | Diagnostic Radiography | 71.5 | 3.4 | 16.0 | |
| 1005.4 | Speech and Language Therapy | 52.8 | 5.3 | 16.4 | |
| 1513.5 | Paramedics | 45.1 | 3.0 | 22.5 | |
| 257 | Clinical Physiology | Cardiac Physiology | 16 | 6.22 | |
| Neurophysiology | |||||
| Respiratory Physiology | |||||
| Sleep Physiology | |||||
| GI Physiology | |||||
Consultants
| Total Workforce | Specialty | Total vacancies | Vacancy rate (%) | Vacant 6 months or more |
|---|---|---|---|---|
| 364.2 | Clinical radiology | 43.2 | 11.9 | 40.2 |
| 348.9 | General psychiatry | 41.3 | 11.8 | 25.5 |
| 313.0 | General Surgery | 29.1 | 9.3 | 5.5 |
| 201 | Geriatric Medicine | 18 | 9 | 6 |
| 125.7 | Histopathology | 14 | 11.1 | 10 |
| 122.6 | Gastroenterology | 14.6 | 11.9 | 9.6 |
| 76.8 | Old age psychiatry | 11.7 | 15.2 | 8.3 |
| 88.3 | Urology | 8.0 | 9.1 | 5.7 |
| 49.0 | Forensic psychiatry | 6.8 | 13.9 | 3 |
| 31.8 | Oral & maxillofacial surgery | 5 | 15.7 | 4 |
| 39.5 | Palliative medicine | 4.7 | 11.9 | 1.7 |
| 95.1 | Oncology | 4.0 | 4.2 | 2.1 |
| 9.9 | Vascular surgery | 4 | 40.4 | 2 |
| 8.1 | Oral medicine | 1.5 | 18.5 | 1.5 |
Annex C
Shortage Occupations List Profiles:
Clinical Physiologists; Cardiac Physiology
Cardiac Physiologists carry out cardiac diagnostic tests, such as echocardiograms, pacemaker and other implantable device checks, blood pressure measurement, and tilt-table tests. In many hospitals cardiac physiologists take on specialist roles normally carried out by medical staff such as running chest pain and arrhythmia clinics and can be responsible for the long term monitoring of patients with congenital conditions, heart valve disease or replacement valves. Cardiac Physiologists can play a key part in reducing admissions to hospital for patients.
In NHS Scotland over the last 5 years there has been a 46% increase in the demand for cardiac physiology services. As of 2018 the Cardiac Physiology workforce in NHS Scotland consists of 257 whole time equivalent (WTE) staff. 70% of departments in Scotland indicated they have at least one vacant post and the overall vacancy rate is estimated at 10%. This being the case it is assumed that the establishment for cardiac physiology is approximately 283 WTE. However, some NHS boards still require to use bank and locum staff, even when there department has a full complement of staff. There is a current shortage of 16 WTE.
Short term solutions have been explored to mitigate existing vacancy issues and to reduce patient waiting times. These include:
- Demand management through redesign of pathways, standardised referral criteria and use of alternative assessment methods.
- Build Consultant vetting into the clinical assessment, to ensure appropriate referrals.
- Facilitate international recruitment, where appropriately qualified staff exist, through inclusion on the Shortage Occupations List.
- Encourage the retention of existing experienced staff members and returners to practice using flexible working patterns, bursaries, Professional Development and extended training roles
- Limit/cap the use of locum/agency staff (cost of 1 locum would employ 2 permanent cardiac physiologists. Establish mandatory local "banks" which pay less than locum agencies, but more than Agenda for Change.
Medium Term solutions (across the 3 to 5 Years) centre around increasing the workforce by promoting recruitment into Scientist Training Programmes and Practitioner BSC programmes. This in house training approach brings the added benefit of allowing trainees to contribute to service delivery during their training.
Using the conservative estimate of 30 additional WTE required within 4 years, this would require substantial investment in these training programs now in order to see the benefit within 4 years. The current production rate of Cardiac Physiologists in Scotland is around 5 per year.
Physiotherapy
The number of physiotherapists working in NHS Scotland has remained fairly static over the last five years but the demand for this role is increasing dramatically as services are transformed across Scotland. This is seen particularly in primary care where first point of contact practitioner (FCP) physiotherapists can safely manage the majority of the musculoskeletal (MSK) caseload in general practice, freeing up GPs time to manage more complex care. NHS Boards across Scotland have indicated challenges in recruitment across all of the allied health professional (AHP) workforce but particularly around physiotherapy. There are currently 205.6 physiotherapy vacancies, which represents a rate of 6.7% of the total physiotherapy workforce.
Increased demand for physiotherapists is likely to continue over the coming years as the FCP role becomes more recognised and valued; services continue to be developed; and the benefits are realised. Primary Care Implementation Plans that have recently been submitted by NHS Boards (18 out of 31 received to date) indicate that adverts will shortly go out for up to 73 FCP physiotherapists across Scotland.
Prosthetics/Orthotics Scotland British Association of Prosthetists and Orthotists (BAPO)
Prosthetists and Orthotist have been on the national workforce shortage list for the last 3 years and the situation is worsening with Health Education England actively supporting the profession and trying to find alternative training courses including developing apprenticeships. The profession has been identified as small and vulnerable within the UK.
In the UK two training schools exist for undergraduate education (Strathclyde University - Scotland, and Salford University - England). Qualifying entitles you to apply for HCPC registration, to practice as a Prosthetist/Orthotist. Prosthetics/Orthotics experiences a high attrition rate with graduates entering clinical practice lasting an average of 3-5 years before moving on, whilst others return home or choosing alternative professional routes such as further education.
Historically the workforce in Scotland has been fairly stable but with recent changes to service provision such as the Musculoskeletal (MSK) 4 week targets, the numbers of clinicians have been rising in most boards.
Whilst five years ago, a job advert in Scotland would attract at least 6-8 applicants, now NHS Scotland have unfilled posts and services report that it is increasingly difficult to recruit to temporary contracts.
For example NHS Greater Glasgow and Clyde report a vacancy rate of around 12% for the past year. In the last 12 months they have lost 10 staff (some temporary, some bank) and have 2 members of staff on maternity leave. NHS GG&C were unable to fill a recent yearlong maternity cover due to 0 applicants.
NHS Forth Valley – run a mixed model service with 2.8 WTE employed by the NHS and 0.7 WTE employed by a contractor supplying clinical service to the board as part of a national contract. The contractor has had a band 6 vacancy for over 6 months being unable to recruit to this position.
One of the benefits of using a contracted model is the larger pool of staff available to cover holidays/sickness and study leave. NHS Forth Valley report they have not had full cover for any of the above roles in over a year, due to staff shortages in Scotland by the contractor resulting in service disruption. Two months ago NHS Forth Valley advertised for a 3 month secondment band 5 backfill post and had no applicants.
Because there is a shortage of Orthotists in England new graduates often start in band 6 positions and then are unwilling to apply for a band 5 in Scotland. In other cases graduates are often employed prior to graduation in England.
With such a small workforce in Scotland the Prosthetics/Orthotics workforce can be adversely affected by external factors and has a small pool of resources available to address these issues.
Supporting Publications
Contribution of EEA Citizens to Scotland:
Scotland's Place in Europe:
Scotland's Population Needs and Migration Policy:
https://www2.gov.scot/Resource/0053/00531087.pdf
Publications – Social Care in Scotland.
Scottish Care (2017) Care Home Workforce Data Report
Scottish Care (2018) The 4Rs: The open doors of recruitment and retention in social care
Scottish Government (2018) Early Learning and Childcare providers: delivery support plan
Contact
Email: Niall.Anderson@gov.scot
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