Many Scottish health boards have struggled to recruit as many consultant anaesthetists as they need, making it harder to keep coronavirus patients alive.
Recently-released Scottish Government figures show that, as of December 2019, the country was supposed to have 818 consultant anaesthetists but only had 760. Of the 58 vacancies, 25 had been unfilled for more than six months.
In proportion to their size, NHS Shetland, Highland and Dumfries and Galloway had the most vacancies. The larger health boards such as NHS Greater Glasgow and Clyde and Lothian had the highest numbers of vacancies.
In total 11 of Scotland’s 14 regional health boards had vacancies, including Lanarkshire, Ayrshire and Arran, Tayside, Grampian and Fife. The Golden Jubilee National Hospital in Clydebank, which is managed by a special health board, also had a vacancy.
Anaesthetists are key to the fight against coronavirus as they are the only people who can safely connect patients to machines called ventilators which help them to breathe.
The coronavirus, known as Covid-19, can make breathing very difficult so some sufferers will need to be admitted to hospital, anaesthetised and be connected to a ventilator with a tube which goes down their windpipe.
Donnie Ross was a consultant anaesthetist at Aberdeen Royal Infirmary between 1976 and his retirement in 2003 and was medical director of NHS Grampian. He told The Ferret that this procedure, which is called intubation, is not always simple and requires good judgement and experience.
Scottish Government data only reveals the number of consultant anaesthetist vacancies rather than the total number of anaesthetist vacancies.
Anaesthetists are a type of doctor and consultants are the highest rank of that specialism. More junior anaesthetists can connect people to ventilators but consultant anaesthetists (CAs) must supervise and oversee what is going on, either from the hospital or “on-call” from home.
Consultant anaesthetist vacancies
|Health Board||Consultant anaesthetists there should have been (whole time equivalent)||Consultant anaesthetists there were (whole time equivalent)||Vacancies||Vacancies unfilled for six months or more||Vacancies as a percentage of consultant anaesthetists there should have been|
|Dumfries and Galloway||15.15||12.15||3||2||20%|
|Ayrshire and Arran||42.76||36.76||6||4||14%|
|Greater Glasgow and Clyde||240.85||227.85||13||3||5%|
|National Services Scotland (procurement)||1||1||0||0||0|
|Golden Jubilee National Hospital (Clydebank)||34.1||33.1||1||0||0|
The data shows that NHS Shetland was supposed to have four CAs but only has two. This is a long-running problem as one of the vacancies has been unfilled for more than six months and, in March 2018, there were also two vacancies.
The Shetland Islands has been hit disproportionately hard by Covid-19. There have been 27 confirmed cases and at least one patient has had to be transferred by military helicopter from Lerwick’s Gilbert Bain Hospital to intensive care in Aberdeen.
NHS Highland is supposed to have 36 CAs but only has 30. All six of these vacancies have been unfilled for longer than six months. Unlike at NHS Shetland, this was not a problem in March 2018 when there were no unfilled vacancies.
NHS Highland has been dealing with bad publicity recently as former staff have alleged the organisation had a culture of bullying. These allegations led to the government-commissioned Sturrock report and damaged the board’s reputation as a good place to work.
The Highlands has 36 confirmed cases of Covid-19, significantly more than the eight cases it had on 22 March. Highland politicians such as Fergus Ewing have told people who don’t live there to stay away from the region.
As Scotland’s population grows and ages, the number of CAs the Scottish Government wants the country to have is increasing. In March 2018, the government wanted 789 CAs but only had 756. In December 2019, it wanted 818 CAs but only had 760.
‘Poor morale’ amongst anaesthetists
As the need for CAs increases, more and more are leaving the profession. According to Royal College of Anaesthetists (RCOA) council member, Dr Hamish Mclure, across the UK the average age of anaesthetists is increasing and over 95 per cent retire before they reach 60 years old.
A 2017 RCOA study found that in the UK “poor morale is driving some doctors to quit the profession”. The study found that anaesthetists in training often worked without food or water and continued working after their shift had finished.
Anaesthetists also complained they were given their rotas late, that they were undervalued, that their work was damaging their physical and mental health and that they weren’t able to rest at the hospital after a night shift and so drove home when dangerously tired.
However, another 2018 RCOA study praised the Scottish government for increasing ‘core training’ numbers since 2013. Core training is the first two or three years of training which doctors do in a specialism before more advanced training.
The RCOA said that the percentage of special training year three places filled across Scotland increased from 63 per cent in 2013 to 90 per cent in 2017. “Gaps that still exist are in large part explained by residual vacancies from previous years,” it said.
Rural and smaller NHS boards in Scotland generally struggle to fill vacancies more than urban ones and rely more on expensive recruitment agencies to provide temporary ‘locum’ workers.
Even before Covid-19, the Scottish Government was encouraging recently-retired doctors to come back to work in remote and rural hospitals as locums.
Donnie Ross told The Ferret that if vacancies aren’t filled by staff or locums then either the existing anaesthetists have to work harder, staff do less training and more working or operations are cancelled. In general, the response is a mixture of all three, he said.
In response to Covid-19, Scottish health secretary Jeane Freeman has put NHS Scotland on an “emergency footing”.
She told parliament she wanted to double the intensive care unit capacity in Scotland and health boards were working towards this by training staff and repurposing facilities. Intensive care is for seriously ill people.
She also said she had put in place contingency planning to ensure oxygen supply both in hospitals and communities. Ventilators work by pumping oxygen into patients’ lungs.
Freeman also said she had ordered 450 new concentrators for use in the community as well as further contingency which can be used if necessary. A concentrator increases the proportion of oxygen in air by removing the nitrogen from it.
Freeman also said there were 13,000 beds in Scotland but she aimed to increase this by at least a further 3,000. To achieve this, non-urgent operations, such as hernia surgery and hip replacements will be cancelled.
Labour’s health spokesperson, Monica Lennon MSP, welcomed the government’s commitment to increase bed numbers and said the health service “is going to have to work differently”.
She added: “Some areas of Scotland have experienced long-standing challenges with staff vacancies. As the NHS prepares to tackle the coronavirus pandemic, managing workforce shortages across our entire health service is going to become even more challenging.”
Green MSP John Finnie pointed out the figures were better than a couple of years ago. “NHS workforce planning is key to addressing all vacancies, however, the lead-in time to train to this level is lengthy and won’t be turned around in time to address this pandemic,” he said.
The shortage was worldwide and we needed to understand why medical practitioners weren’t becoming CAs, he suggested. Brexit had made the UK, and therefore Scotland, “a less attractive option to many”, he argued.
Liberal Democrat MSP for Shetland, Beatrice Wishart, secured assurances from heath secretary Freeman that plans were in place to transfer isles patients who needed intensive care to the mainland.
She said: “As we rebuild on the other side of this crisis we must look again at longstanding staffing matters. Ensuring remote and rural areas have self-sufficient strong local healthcare is extremely important.”
Conservative Highland and Islands MSP, Donald Cameron, said: “During the emergency, I am sure our key health workers will make provision for any gaps in coverage that may arise.”
He praised NHS staff and said: “Afterwards there will be a review of how we performed, lessons will be learnt and, at that point, any shortcomings in workforce planning should be addressed.”
The Scottish Government pointed out that the number of whole time equivalent (WTE) anaesthetics consultants had risen by 38.3 per cent, from 549.0 WTE in September 2006 to 759.8 WTE in December 2019.
A government spokesperson added: “As part of our urgent action to increase intensive care unit capacity in response to the challenges presented by coronavirus, we are working with health boards to ensure those with critical care skills, including anaesthetists, are deployed where they are needed most.”
An NHS Forth Valley spokesperson said the board was increasing the number of intensive care unit beds and training staff to care for patients with serious respiratory illnesses who may require ventilation.
They also said they were scaling back on non-urgent appointments and operations but vital cancer treatments, emergency, maternity, neonatal and urgent care will continue to be provided.
NHS Shetland, NHS Dumfries and Galloway and NHS Highland have not responded to requests to comment.
Photo thanks to iStock/YakobchukOlena. This story was published in tandem with the Sunday National.