Mental health campaigners have protested about the significant use of temporary locum psychiatrists in Scotland, alleging it leads to substandard and harmful medical care.
Peter Todd, a campaigner based in Caithness in the north of Scotland, said the heavy reliance on locum psychiatrists by the NHS was evidence of a growing crisis in mental health services across the country.
Scotland’s NHS boards told him they have spent more than £125m since 2019 paying for locums to fill in for the scores of consultants who have either retired, quit the NHS or not been recruited.
Todd said that in his experience, which has been echoed by other patients in his area, the heavy reliance on locums led to poor continuity of care and badly maintained notes. A survivor of child sexual abuse, he said each new psychiatrist meant rehearsing his lifetime experiences and medical issues; a process that amplified the trauma.
“When you see a permanent psychiatrist, you only have to explain once, but if you’re seeing locum after locum after locum, you feel like you’re a tape recorder having to repeat yourself and repeat yourself,” he said.
NHS Tayside, which has faced a series of significant deficits, has spent more than £29.8m on locum psychiatrists since April 2019; NHS Grampian £22.3m, and NHS Fife £17m over the four years from 2019 to 2023.
The true cost of the crisis emerged earlier this month when NHS Western Isles confirmed it spent more than £1.2m in 2022/23 on locums to fill two psychiatry posts at its general hospital in Stornoway, paying them by the hour.
With a population of 26,600 people, it has had to spend more than £4.3m on freelance psychiatrists to cover those posts since the 2019/20 financial year.
In common with other rural health boards, NHS Western Isles struggles to recruit doctors on current pay scales, forcing them to pay well above normal. Last month it offered new GPs salaries of up to £150,000 to work a 40-hour week, 40% higher than normal.
The Scottish Liberal Democrats said NHS data showed that in October last year there were 117 locum psychiatrists working, compared to 462 staff psychiatrists, with up to 46% of posts unfilled in some boards.
NHS Grampian said the Covid pandemic was not a cause of the crisis. “Recruitment and retention was an issue pre-pandemic, and this persists,” it said in a statement.
“Some clinicians have opted for early retirement, in part due to a change in their pension rules, and there are fewer suitably trained psychiatrists coming into the job market. This is not an issue unique to Grampian.”
Dr Jim Crabb, from the Royal College of Psychiatrists, said far more needed to be done by the NHS and Scottish government to incentivise and value psychiatry. Mental health had not had the 10% of health spending it had been promised, and was being cut by 5% a year.
“Funding has always been bad,” he said. “Despite serious illnesses such as schizophrenia, depression and anxiety costing economically developed societies more than conditions such as asthma and arthritis far less is spent on mental health compared to physical health care.”
NHS Tayside said they faced significant recruitment challenges; it takes 13 to 15 years to train to become a consultant psychiatrist. Data showed that 42% of consultant psychiatrists were over 50 years old, with many intending to retire early.
“This peak in retirements will far exceed the number of new consultants,” it said, so it was working hard to recruit doctors from the local area.
“Despite these efforts, trainee numbers are relatively low and this coupled with the length of training, means recovery from the current position of high locum usage in psychiatry will take a number of years to achieve,” it said.
Willie Rennie, a Scottish Liberal Democrat MSP who campaigns on mental health funding, said: “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.”
A Scottish government spokesperson said recruitment had been improving recently, but they agreed more needed to be done “to secure best value” for health spending.
“We are 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,” they said.