Mental health campaigners have protested the significant use of temporary locum psychiatrists in Scotland, claims it leads to substandard and harmful medical care.
Peter Todd, a campaigner based in Caithness in the north of Scotlandsaid the heavy reliance on locum psychiatrists by the NHS was evidence of a growing crisis in mental health services across the country.
Scotland’s NHS boards told him they had spent more than £125m since 2019 paying for locums to fill in for the many consultants who either retired, left the NHS or were not recruited.
Todd said that in his experience, which was echoed by other patients in his area, the heavy reliance on locums led to poor continuity of care and poorly maintained records. A survivor of child sexual abuse, he said each new psychiatrist intended to rehearse his lifetime experiences and medical problems; a process that reinforced the trauma.
“When you see a permanent psychiatrist, you only have to explain once, but when you see locum after locum after locum, you feel like you’re a tape recorder who has to repeat yourself and repeat yourself,” he said.
NHS Tayside, which has faced a series of significant shortfalls, has spent more than £29.8m on locum psychiatrists since April 2019; NHS Grampian £22.3m, and NHS Fife £17m over the four years from 2019 to 2023.
The true cost of the crisis emerged earlier this month when NHS Western Isles confirmed it was spending more than £1.2m in 2022/23 on locums to fill two psychiatry posts at its general hospital in Stornoway and hourly to pay
With a population of 26,600 people, it has had to spend more than £4.3m on freelance psychiatrists since the 2019/20 financial year to cover those posts.
Like other rural health boards, NHS Western Isles is struggling to recruit doctors on current pay scales, forcing them to pay well above normal. Last month it offered new GPs salaries of up to £150,000 to work a 40-hour week, 40% higher than normal.
The Scottish Liberal Democrats said NHS data showed there were 117 locum psychiatrists working in October last year, compared to 462 staff psychiatrists, with up to 46% of posts unfilled in some boards.
NHS Grampian said the Covid pandemic was not a cause of the crisis. “Recruitment and retention was an issue pre-pandemic, and it continues,” it said in a statement.
“Some clinicians have opted for early retirement, partly due to a change in their pension rules, and there are fewer appropriately trained psychiatrists entering the job market. This is not an issue unique to Grampian.”
Dr Jim Crabb, of the Royal College of Psychiatrists, said much more needed to be done by the NHS and the Scottish Government to encourage and value psychiatry. Mental health has not had the 10% of health spending it was promised, and is being cut by 5% a year.
“Funding has always been bad,” he said. “Despite serious diseases such as schizophrenia, depression and anxiety costing economically developed societies more than conditions such as asthma and arthritis, much less is spent on mental health compared to physical health care.”
NHS Tayside said they faced significant recruitment challenges; it takes 13 to 15 years to train to become a consultant psychiatrist. Data showed that 42% of consultant psychiatrists were over 50, with many intending to retire early.
“This peak in retirements will far exceed the number of new consultants,” it said, so hard work has been done to recruit doctors from the local area.
“Despite these efforts, trainee numbers are relatively low and this, together with the length of training, means that recovery from the current position of high locum use in psychiatry will take a number of years to achieve,” it said.
Willie Rennie, a Scottish Liberal Democrat MSP campaigning for mental health funding, said: “It’s all well and good for ministers to pay lip service to mental health, but the proof is in the pudding when it comes to budget time.
“Along with training more staff, serious consideration must also be given to how we attract and secure staff to work in every type of community so that everyone can access mental health support regardless of where they live.”
A Scottish Government spokesman said recruitment had improved recently but agreed more needed to be done “to ensure best value” for health spending.
“We are considering how we can better support the recruitment and retention of psychiatrists, including actively exploring possible solutions to address issues such as the use of locums and how we attract new or existing psychiatrists to take up posts in Scotland.” they said.
