Scottish health boards have paid up to £837 an hour to locum psychiatrists to help deal with a widening mental health workforce shortage crisis.
Dozens of private healthcare companies have charged them more than £130 million to provide temporary psychiatrists over the past five years, including one now owned by two Texas billionaires.
The Royal College of Psychiatrists and NHS executives said Scotland’s mental health system was now at breaking point due to severe staff shortages, which was damaging patient care and forcing experienced counselors to quit.
Scottish hospitals are now so dependent on agencies to underwrite their mental health services that health boards are forced to pay hourly rates significantly higher than the salaries of NHS consultants.
Dr. Jane Morris, chair of the college’s Scottish branch, said adult psychiatry is the worst-hit branch of the NHS, with a vacancy rate of 25% across Scotland. “There simply aren’t enough of us,” she said. “I think the whole agency monitor issue reflects a real crisis in the Scottish psychiatric workforce.”
The rising cost of locums led to a “vicious cycle,” she said. It put greater pressure on NHS consultants to manage services and take on heavier cases; they felt overworked and undervalued, so they acquiesced, which exacerbated the crisis.
A joint investigation by the Guardian and BBC Scotland found:
-
Annual spending by Scotland’s fourteen health boards on local psychiatrists was almost £35 million last year, up from £20 million five years ago.
-
NHS Tayside has spent more than £30 million since 2019, and NHS Fife almost £26 million.
-
One company charged NHS Lothian almost £350,000 for 416 hours of cover in 2019, at an average hourly rate of £837.
-
NHS Western Isles paid £27,000 for a week of 24-hour cover in April 2023.
NHS executives said hospitals and GP practices often needed locums to cover staff holidays or illness, or in emergencies. In some cases this was done by NHS staff who were paid overtime or for working while on holiday.
Agencies charge hourly rates ranging from €85 to as much as €473. That included administration and professional costs, and a VAT of 20%. For comparison, a junior NHS consultant would earn around £50 per hour.
One company, Brookson Solutions, which was bought in 2022 by two US billionaire investors, David Bonderman and James Coulter, has made more than £19 million supplying locumen to NHS Tayside and NHS Fife.
The company said it provided payroll and compliance services and did not directly recruit the locums used by Tayside.
Morris said that in some cases hospitals in Scotland were so dependent on locums that they hired psychiatrists who were not fully qualified or who were not members of the Royal College of Psychiatrists, the profession’s governing body.
Some observers provided remote online consultations from cities outside Scotland, in Britain or abroad including India – a service the royal council considers substandard unless it also includes face-to-face follow-ups.
Dr. Amanda Cotton, deputy medical director for mental health at NHS Borders and spokesperson for the Senior Medical Managers in Psychiatry group, said the shortage of psychiatrists raised serious questions about the ability of hospitals to provide cover.
after newsletter promotion
“The cracks are definitely starting to show,” she said. “That’s one of the reasons we’re seeing locum bills rise, because we’re faced with a stark choice. Do we see that positions remain unfilled and do we see that the service is not sustainable, or do we still appoint these doctors despite the enormous costs?”
Gordon Jamieson, the chief executive of NHS Western Isles, one of Scotland’s smallest boards, said locums were putting the biggest pressure on its budget and that his board had diverted money from other parts of the budget to pay for it.
Some charges were “eye-wateringly high,” he said. “When you get into the locum market, it’s such a volatile market that you’re basically at the mercy of the market,” he said. “If you don’t respond to market costs, you don’t have service.”
Cotton and Morris said it was essential that the Scottish Government reversed cuts to mental health funding. In 2021, ministers promised to ensure 10% of NHS spending went to mental health, but instead this had fallen to around 8%.
In August’s emergency budget, the Scottish Government cut a further £19 million from national mental health spending. Cotton said this has led to standards and quality being “eroded over time… We are moving backwards rather than in the right direction”.
The Scottish Government said it would convene a working group later this month to discuss solutions to the locums crisis with the royal council and Cotton’s group, and provide more psychiatric training places.
“Ensuring high-quality and safe patient care is our priority, and it is also critical that we ensure the best value in the delivery of mental health services, allowing us to maximize the impact of investments,” said Maree Todd, Minister of Mental Health. .
“To support wider recruitment and retention issues facing psychiatry, we are exploring how we can attract new or existing psychiatrists to posts in Scotland.”