NHS Scotland spends nearly £30m on locum psychiatrists in a year

The NHS in Scotland spent nearly £30 million on locum psychiatrists in a year.

Figures obtained by freedom of information requests showed that Scotland’s 14 health boards splashed out £29,606,336.61 on locum psychiatrists in 2022/23.

This was up nearly £10 million – a whole 50 per cent – from just three years previously. The spend in the 2019/2020 financial year was £19,868,166.

It comes after the Record reported earlier this month that one Scottish health board had spent £1.2m in a year on just two locum psychiatrists.

The Royal College of Psychiatrists in Scotland said using agency locums for “the gaping wounds in NHS” is “a massively expensive patch up job that doesn’t fix the problem.”

Labour said “eye-watering sums of money are being wasted plugging gaps created by SNP incompetence” while the Lib Dems blamed “a long term refusal to invest in staffing and capacity”.

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NHS Tayside spent the most on locums in 2022/23, with a bill of £6,448,655. It was followed by NHS Grampian which spent £4,903,000 and NHS Greater Glasgow and Clyde which spent £4,731,513.

NHS Ayrshire and Arran spent nothing on locum psychiatrists, while Orkney only spent £74,149.

Locum doctors generally cost the NHS more money because they are on short-term contracts. They are often necessary to provide cover but can cost two or three times the funds that a permanent doctor would.

Agency fees also drive up the cost of using locums as well as the increased hourly rate.

Dr Jim Crabb, policy lead and consultant psychiatrist, Royal College of Psychiatrists in Scotland, said: “We want to ensure that all consultant psychiatrists whether they are locum or not should meet the high standards of training set by the College.

“But to fix our broken mental health system, we need properly trained and qualified consultant psychiatrists who can teach and train junior staff.

“These clinicians need to be prepared to lead and develop the teams they work in and ensure safety standards are maintained. Some NHS locums do teach and are valuable to our services, but agency locums by definition – do not do any of these things.

“They simply plug a short-term gap in our services and cost many, many times more than permanent doctors to employ.

“Using agency locums to patch up the gaping wounds in NHS is like using a sticking plaster made out of gold. It’s a massively expensive patch up job that doesn’t fix the problem.

“We need a proper grown-up strategy to ensure there are enough permanent consultant psychiatrists for the NHS in Scotland for the benefit of our mental health services as well as for the patients we treat.”

Scottish Lib Dem MSP Willie Rennie said: “What we have seen over many years is that mental health remains a second class service within the NHS.

“A long term refusal to invest in staffing and capacity has left us with a situation where, particularly in rural and island areas, the only way to have any kind of staff presence at all is to pay through the nose for it in the form of locums. That has left health boards like NHS Fife paying vast bills for fewer staff than they could employ on permanent contracts.

“That’s bad news for patients as continuity of care is hugely important in mental health cases.

“It is all very well for ministers to pay lip service to mental health but the proof is in the pudding when it comes to budget time. Alongside training more staff, there also needs to be a serious look at how we attract and secure staff to work in every type of community so that everyone can access mental health support no matter where they live.”

Scottish Labour Health spokesperson Jackie Baillie said “Our NHS is stretched to breaking point but eye-watering sums of money are being wasted plugging gaps created by SNP incompetence.

“While almost 1 in 6 Scots are stuck on an NHS waiting list, millions are being squandered every year as a result of the SNP’s failed workforce planning.

“The SNP must set out a real workforce plan to end this waste and ensure that communities across Scotland have the psychiatric care they need.”

NHS Tayside said a shortage of consultant psychiatrists nationwide and locally meant it “has engaged locum consultants to fill crucial service gaps”.

NHS Grampian said it “would of course prefer to recruit to posts permanently and we believe working and living in Grampian is an attractive prospect. However, we have a duty to ensure the service continues, therefore we use locums.”

NHS Greater Glasgow and Clyde said: “As is the case nationally, we have been experiencing a shortage of psychiatrists. Where required, locum psychiatrists have been engaged to meet patient needs.”

A Scottish Government spokesperson said “We are working with colleagues across NHS Scotland to explore how we can reduce our reliance on medical locums.

“Recruitment into Core Psychiatry has improved in recent years, and under this government the number of Psychiatric Specialties consultants working in NHS Scotland has increased by 18.5%.

“We are currently 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.”

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