The cost of bringing locum psychiatrists on emergency contracts to treat mental health patients in Scotland has surged dramatically, reflecting the urgent crisis facing the country’s mental health system. Figures revealed by various health boards and advocacy groups show the amount spent on temporary mental health doctors has steadily increased over the last five years, coinciding with the declining number of full-time psychiatrists employed within the NHS.
Specifically, the expense related to locum psychiatrists soared to £14.7 million last year, almost double the cost from five years prior. This alarming trend has raised serious concerns among mental health professionals, patients, and advocacy organizations, as reliance on temporary staff has been linked to inconsistencies and deteriorations in the quality of care provided to those seeking treatment for mental health issues.
The Scottish government has stated its commitment to reducing the reliance on locum doctors. Still, it has acknowledged the unavoidable need for temporary staff within such a large organization as the NHS. Advocates assert, though, the increasing use of locums can lead to fragmented patient experiences, where vulnerable patients find themselves repeating their histories to various doctors, resulting in feelings of frustration and anxiety.
'There simply aren't enough of us'
According to the Royal College of Psychiatrists (RCP), nearly half of the locums currently filling consultant posts across Scotland lack the full qualifications for their roles. Dr. Jane Morris, chairwoman of the RCP in Scotland, offered a grim perspective on the state of the workforce, stating, “I think the whole agency locum question is a reflection of a real crisis in the Scottish psychiatric workforce. There simply aren't enough of us.”
From March 2019 to March of this year, the number of whole-time equivalent NHS psychiatrists plunged from 781 to just 651, exacerbated by the skyrocketing costs associated with hiring temporary staff. A detailed investigation by The Guardian and the BBC unveiled the increase in total locum spending from £20.8 million in 2019/20 to £34.8 million last year. Most locums are sourced through long-term contracts with agencies under framework deals, but some health boards are increasingly resorting to emergency contracts to keep acutely necessary services afloat.
Some health boards had been instructed to minimize the use of these expensive off-framework contracts, yet expenditure shot up to £14.7 million last year, illustrating the dire need for temporary staff. NHS Tayside, the board with the highest locum spending over the last five years, accounted for £30.4 million of the total costs, with over 84% of this utilized through off-framework routes.
Various reviews have been conducted to assess the efficacy and safety of mental health services, especially when temporary doctors are involved. Critics contend these locums, sourced sometimes from overseas locations like India or England, may not be familiar with local guidelines, posing additional risks to patient care.
Young patients face unique challenges
This growing reliance on locum staff is particularly troubling for young patients, who are statistically more likely to experience deteriorations in mental wellbeing. Many report feelings of helplessness and abandonment due to the inherent differences when treated by temporary psychiatrists.
Peter Todd, for example, who has endured a demanding travel schedule to reach psychiatric appointments, noted he saw six different locum psychiatrists over five years before finally being assigned to a stable, permanent doctor last year. He remarked on the repetitive nature of retelling his traumas to each new locum and the lack of continuity contributed to his feelings of distress: “They asked me the same questions again and again, whereas if they had read the medical file they wouldn’t need to.”
Financial burden on the NHS
Financial constraints have become pressing hurdles for NHS boards. The staggering costs incurred by hiring locums often drain resources from other areas of the health service, leaving hospitals grappling to maintain adequate staffing levels. Gordon Jamieson, chief executive of NHS Western Isles, expressed concerns, emphasizing how the cost of locums has forced his organization to divert funds from other budget areas. “If you don’t respond to the market cost, then you have no service,” he said, acknowledging the volatile nature of the locum market.
Emergency contracts have significantly raised the stakes; for example, NHS Lothian once paid approximately £348,328 for 416 hours of work with one locum psychiatrist, costing about £837.33 per hour. Comparatively, the standard rates for on-framework locums hover around £165 per hour, with NHS internal locum services providing coverage at even lower rates of £67.60 per hour.
No clear path forward
This crisis led to urgent calls for change from health professionals who argue the growing expenses associated with locum psychiatrists do not justify losing consistent relationships between patients and their caregivers. Dr. Morris stated, “Not only would this be very expensive for taxpayers, but it would also lose quality assurance, and I don’t think we’re too late to resolve this.”
Critics contend the challenges faced by mental health provisions are not merely staffing issues but also blame strategic decision-makers whom they hold accountable for recent cuts to mental health spending. According to Dr. Amanda Cotton, spokesperson for the Senior Medical Managers group, these cuts undermine the sustainability of mental health services. From 2021, Scottish ministers had pledged to allocate 10% of NHS spending to mental health; instead, the figure has fallen to about 8% as recent budgets reveal cuts of £19 million from national mental health funding.
The Scottish government officials have conveyed plans to convene working groups focusing on solutions to the locum crisis, pledging attention to recruitment and retention needs within the psychiatric workforce. Maree Todd, the mental wellbeing minister, made it clear the government has recognized the pressing need for improvements, but skepticism persists among those affected.
The future of mental health care
Scotland stands at a crossroads, with stakeholders from various sectors advocating for urgent action to combat the mental health crisis exacerbated by mounting locum costs and staffing shortages. While plans are on the table to increase training places and address barriers to recruitment, the enduring effects of these systemic challenges remain palpable.
Patients relying on NHS mental health services navigate not only high costs and inadequate care but also endure the emotional toll associated with fractured treatment experiences. The voices of those like Peter Todd, alongside surveys from advocacy groups such as Vox, are pivotal as they shine light on the dire need for comprehensive change within the Scottish mental health framework to restore trust and deliver quality care to those who need it most.