The Royal College of Nursing has launched an indicative ballot of members in Scotland on industrial action, a week after health secretary Humza Yousaf announced a £300 million funding boost for the NHS over winter, which representative bodies welcomed but warned would not be enough.
It comes as the Royal College of Emergency Medicine (RCEM) seperately warned today conditions in A&E departments in Scotland have reached “unacceptable and unsafe” levels in some areas, with some patients waiting more than 48 hours for a bed. The Scottish Government target for patients to be admitted or discharged is four hours. Commenting on the pay dispute ballot, Julie Lamberth, Chair of the RCN Scotland Board, said: “After 18 months of bearing the brunt of the response to the Covid-19 pandemic and a decade of being undervalued and under-resourced, more and more nursing staff are saying enough is enough.
“The Scottish government and NHS employers need to stop paying lip service to the immense contribution nursing staff make to health and care services. They need to take very seriously our concerns about what’s happening now and what will happen in the future without effective action."
Colin Poolman, director of nursing union the Royal College of Nursing, said he was concerned about safety across the profession.
“We are hearing on a daily basis from members who are concerned about the impact vacancies and sickness absence are having on staffing levels and patient safety,” he said.
“Nursing is a safety critical profession. Our members go to work to provide the high-quality safe care the people of Scotland deserve. But they are exhausted, frustrated and carrying the burden of being prevented from doing this by the sheer volume of work.”
Wilma Brown, who represents the union UNISON in Fife and works as a nurse in acute wards and emergency departments, said conditions in A&E have been “absolutely awful” recently, with staff “on their knees” and worried about patient safety.
“It’s horrendous. It’s absolutely horrendous,” she said.
"We do see things like this during the very worst of winter periods, but not like this. And this has been going on for a long time now.
“It’s got much, much worse recently, and there’s no let-up. There are hours when it’s a bit quieter, but generally it’s that bad all the time.
“Even when I’m not out on the wards and the units, I have emails, phone calls, text messages, Facebook messages, constantly on a daily basis from staff asking me what we can do to help them.”
Ms Brown said staff frequently report safety concerns to her, and were concerned they could not deliver “safe staffing”.
Patients may be in more pain than necessary if staff don’t have time to check on them, Ms Brown said.
And if confused or elderly patients are left alone too long they may get up and risk a serious fall. She added that medicines may be missed or given late, or new symptoms or a patient’s deteriorating condition may not be spotted.
“The worst thing for staff is that they can't deliver safe staffing and the correct care they would want to deliver to people. That makes them very stressed, very frustrated, very worried about the patients, about themselves, about their registration,” she said.
“It’s a vicious circle, because then you have people going off with stress which leaves the wards even shorter. It’s horrendous.
“I have senior nurses phoning me telling me that they have to try to put in a staffing plan with the bare numbers that they've got, and they're concerned about safety. That's a daily occurrence.”
Dr John Thomson, an emergency consultant at Aberdeen Royal Infirmary and vice president of the RCEM, said A&E waiting times were at their worst on record, and are expected to get even worse over winter.
This raises concerns for patients, Dr Thomson said, as there is evidence which links longer waits for admission to a ward with higher mortality.
“There are some departments in Scotland that have had patients waiting up to 48 hours for a bed, that’s two days. And that’s absolutely unacceptable, undignified and unsafe,” Dr Thomson said.
“The issue is what we call “exit block” - there just isn't the capacity in the hospital at the time that it’s required.
“If you are an individual patient and you need to go to a bed in a speciality - cardiology, respiratory, whichever speciality - and that bed is not available when you are ready to move, then that is a reflection of poor care for the patient, and a very, very poor experience for the patient, who is then on a trolley for long periods of time in the emergency department. That's just unsafe.”
He added: “When we don't have capacity to deal with the next sick child or the next car crash that turns up requiring our specialist expertise because we're continuing to look after patients who should have moved to a ward ten or 12 or 24 hours previously, then it's quite clear why that is felt to be unsafe within the emergency departments of Scotland.”
A spokesperson for the Scottish Government said the £300 million winter funding package will help support the NHS in the coming months.
“We recognise the additional pressure NHS staff are facing as they work tirelessly to respond to the pandemic while continuing to provide vital treatment and safe patient care and we are working proactively with boards to manage pressures and take rapid action to support increased capacity, including expedited recruitment, flexible deployment of existing staffing and supporting mutual aid across the system,” they said.