The Patient’s Voice: Psychiatrist Posts in Scotland

Victoria Reid looks into the worrying reports around psychiatrist numbers in Scotland.

On her visit to the Bipolar Scotland office in Paisley in November, MSP Maree Todd, Minister for Social Care, Mental Wellbeing and Sport, gave a very positive account of the numbers currently employed in psychiatry. I was cheered by this, but also somewhat puzzled as it did not chime with what I have been witnessing at a grassroots level facilitating a Glasgow bipolar support group these last seven years. Yes, some of our participants do enjoy continuity of care and prompt access to a psychiatrist at times of crisis, but too often, they don’t.

Then, last month, an item on BBC Scotland’s news programme, The Nine, caught my attention. It highlighted the significant disparity between how consultancy vacancies are calculated officially and on the ground. Alan Robertson, chair of BMA Scotland’s consultants committee, explained how official workforce statistics from the Scottish Government exclude certain categories, namely ‘jobs that are temporarily filled by a locum; jobs not yet advertised; jobs that have remained vacant for so long that they’re no longer being advertised. […] None of these are being counted as a vacancy; but on the ground, they are vacancies.’ Regarding recruitment, he added, ‘psychiatry has been particularly badly hit.’ (The Nine, 18 April).

This issue has come to light thanks to the work of mental health activist Peter Todd. Peter has been involved with Spirit Advocacy for a decade; he receives psychiatric and psychological support at New Craigs Hospital in Inverness; and gave evidence at the historical Child Abuse Inquiry into Cyril Smith and associates in 2019/20. Peter is passionate about giving voice to patients in psychiatry; plugs the charity Vox for its integrating of lived experience into political advocacy; and is pained by the lack of stability given to vulnerable people in need of psychiatric care by a system overdependent on locums, too centralised, and, without a viable long-term workforce vision.

I had the privilege to speak with Peter and learn more of his work at an Assembly meeting organised by the Mental Welfare Commission on 25 April. Peter’s Freedom of Information requests to health boards across the nation reveal broadly one in four (28%) of consultant psychiatrist posts to be vacant. There is no permanent psychiatrist is the health boards of Orkney, Shetland and the Western Isles, nor in a swathe of NHS Highland. Further, they show that currently 117 of the 162 posts currently vacant in Scotland are being filled by locums, i.e. one fifth of all consultant psychiatry staff in Scotland.

An over-reliance on locums is bad. First and foremost, as many of us know, a revolving door of temporary psychiatrists does not give stability to patients. In psychiatry, more than in any other medical area, a good therapeutic relationship is essential and this is something established over time. A patient needs to know their notes will not be compromised or mislaid and that they will not have to recount time and again possibly traumatic events in order to get a stranger up to speed with their case. Two, the costs can be astronomical, taking up too much of a health board’s mental health budget, or causing an overspend. Strikingly, two locums in the Western Isles cost £1.2m a year (The Herald, 10 April). The NHS in Scotland as a whole spent nearly £30m on locum psychiatrists in 2022/23, an increase of 50% in 3 years (Daily Record, 15 April). Three, as Jim Crabb, from the Royal College of Psychiatry in Scotland points out, agency locum psychiatrists do not teach and train junior staff and so cannot lead and develop the team they work in; they simply plug the gap. Four, locums may be used as a means of masking the substantive recruitment crisis in psychiatry, and stopping those with power from addressing this critical issue meaningfully.

Peter is frustrated by political mud-slinging and point-scoring instead of solution-finding for a situation that is dire for many; his campaigning efforts are a-political/pan-political. He has a number of proposals to bolster recruitment and retention in rural areas, particularly the Highlands and Islands. There is a major need, in Peter’s view, for more creative, proactive recruitment. Strategic workforce planning must urgently be improved. Health boards should be better audited and scrutinised to ensure that limited funds are being optimally used. In September, Peter will take this project to the Scottish Parliament’s Petitions Committee with a view to pushing these proposals and also raising some questions, e.g. why is the number of locums used going up? (MSP Rhoda Grant put a question to the new First Minister regarding locums on 9 May.)

His work led to a flurry of media interest, with articles appearing in the John O’Groat Journal (11 Jan; 10 May), The Herald (6 Jan; 10, 17 & 18 April), The Telegraph (4 April), The Times (4 April), The Daily Record (4 April, 15 April), The Guardian (21 April), Stornoway Gazette (27 April) and even The Madras Tribune (21 April). There were also radio features on Care Radio, MFR and its sister stations Northsound, Tay FM, and Greatest Hits Radio for Dumfries & Galloway. He believes that what has captured the imagination of the press on these issues is that the patient’s voice is at the forefront.

So many patients are not given a voice. So many of us need more stability in our care.