Scottish NHS pays £1.2m a year for just two locum consultants
The NHS in Scotland is spending more than a million pounds a year to employ two locum consultants, an employment tribunal has heard.
The bill of almost £1.2 million is for a pair of senior psychiatrists to cover the Western Isles and is an increase of £100,000 on the previous year, according to figures presented to the hearing.
The Isle of Lewis-based health board told the tribunal it struggles to fill the positions with permanent doctors and that overspending on temporary staff – who are looking to “maximise” their earnings – has an impact on other patients’ care.
An individual locum can cost the health service £600,000 a year compared with £200,000 for a doctor who takes on a permanent role, the hearing was told.
The financial disclosures were made during a case involving consultant psychiatrist Denitza Mihaylova, who was sacked after she fell ill and was unable to fulfil her on-call commitments at night.
Over almost two years, the NHS paid locums to cover her while she was off sick, but sacked her after concluding that funding this arrangement was “no longer viable”.
Health board sued
Ms Mihaylova sued the health board for disability discrimination and unfair dismissal, but her case was rejected after the tribunal found the health board had to manage its budget responsibly.
The hearing in Stornoway was told that Ms Mihaylova started work for the Western Isles NHS in September 2020 as one of two specialists providing 24/7 psychiatric services.
This involved an on-call rota and regular visits to Uist and Barra as well as home visits to patients in crisis on Harris and Lewis.
“The second full-time permanent consultant psychiatrist had retired in 2018,” the tribunal was told. “[The health board] had been unable to recruit a full-time replacement.
“Between 2021 and 2023 the vacant post for a consultant psychiatrist was advertised eight times with no applicants. Accordingly, that post was filled from 2018 with locums.
“Consultant psychiatrists are in short supply in Scotland, there being a 60 per cent vacancy rate at this time. General psychiatry is the specialism with the most vacancies across Scotland.
“It is therefore difficult to recruit consultant psychiatrists particularly for remote, island-based locations. This means that the board must rely on locums.”
Difficulties finding doctors
The tribunal heard that although there are agreements with some agencies to supply locums at a capped cost, because of the difficulties in finding doctors, health boards have to go “off framework” and recruit using other agencies at higher costs.
The tribunal was told that in September 2021 Ms Mihaylova was diagnosed with the spinal condition myelopathy, leading her to be off sick for 150 days over the next 22 months.
To cover her absence, the health board had to pay for an additional locum consultant, the hearing was told.
In March 2022, Ms Mihaylova began a phased return to work following surgery and by August she had returned to full-time duties.
However, she raised concerns about responding to night time calls as the pain medication she had to take – which the tribunal heard she may have to be on permanently – made her “sedated”.
An occupational health adviser recommended she not do overnight on calls, the hearing was told.
No longer viable
In September Ms Mihaylova was told by bosses that funding long-term locum cover for her on-call duties – at a cost of £325,000 – was no longer viable.
She was also told the health board anticipated running a £1.6m budget deficit – with locum costs a “considerable part of that” – despite Scottish Government rules forbidding this.
In addition, bosses said that “the adjustment to cover on-call could not continue for financial reasons without a known time frame when she could safely resume on-call”.
In January 2023 the figure for the cost of the second locum consultant to cover her absence had increased to £366,000 a year, the hearing was told.
In March, Ms Mihaylova – who by that time was on sick leave – was sacked because of her absences from work and the health board being unable to say with certainty that she could ever return to work full time.
As part of the evidence presented to the tribunal, the health board produced figures which showed that the total budget for mental health services for 2022-23 was £2,843,881 and from that for psychiatry the budget was £520,986.
Budget increases
However, locum costs for 2022-23 were actually £1,073,308 for two doctors, including the second locum to cover for Ms Mihaylova.
The tribunal was told that the budget for mental health services for 2023-24 had increased to £4,314,314, with a psychiatry budget of £611,775.
The projected cost of employing two locum consultant psychiatrists employed since her dismissal was put at £1,179,076.
“Overspend in mental health services has consequences for service provision and the financial impact on other aspects of the service, because it requires efficiency savings elsewhere in the organisation,” the tribunal was told.
“The requirement to secure locums, and changing locums, creates significant disruption with direct impact on both inpatient and community care, specifically in terms of continuity of care, functioning of local multidisciplinary team arrangements and decision making in relation to complex patient presentation.”
Despite sympathising with Ms Mihaylova, the tribunal rejected her claims.
‘Extremely unfortunate’
“The circumstances of this case are extremely unfortunate,” said Muriel Robison, an employment judge who chaired the tribunal.
“The [health board] has difficulty recruiting consultant psychiatrists and having recruited [Ms Mihaylova], who clearly enjoyed her job and living on the island, she became ill such that she could not perform all of her duties.
“It must be a matter of great regret to both parties that the arrangement could not continue. For those reasons, this was a difficult case, but ultimately we accepted that the adjustments made could not continue without an end in sight given the respondent’s budgetary responsibilities.”
