‘At no point’ has NHS Scotland had enough nurses for ‘safe care’ – RCN report

Scotland’s NHS has “at no point” employed sufficient nursing staff to be able to deliver safe and effective care, a report has claimed – despite legislation on safe staffing coming into force in 2024.

The Health and Care (Staffing) (Scotland) Act came into force from April 1 last year, but the Royal College of Nursing Scotland said issues with staffing predated that.

In a report on the nursing workforce, the RCN said: “At no point has NHS Scotland employed the number of nursing staff needed to deliver safe and effective care.”

These “ongoing concerns about unsafe staffing levels continue to have an impact on patient safety and staff morale”, it added.

It comes as the report highlighted the “increasing normalisation of unsafe care being delivered in inappropriate settings” – what is often described as “corridor care”.

The RCN report described this as a “symptom of this state of crisis”.

Meanwhile it told how the “pressures on Scotland’s health and care system and the ongoing nursing workforce crisis have shown little sign of improvement” since last year’s report.

The latest publication from the nursing union told how “demand for health and care services is far outstripping capacity in hospital, community and social care settings”.

And it said: “The nursing workforce continues to be under intense pressure, reporting significant staff shortages and the effects of years of feeling undervalued.”

The Nursing Workforce in Scotland 2025 report stressed that “safe and effective levels of registered nurse staffing are critical to patient safety, outcomes and experience”.

The RCN acknowledged that over the last year NHS Scotland has increased nursing staff in post and reduced the number of vacancies.

But while it said “this growth in the nursing workforce is much needed”, it said this was not “the whole story”.

While the report said the whole time equivalent number of nursing staff had increased, it added that a 30-minute reduction in the working week, which was introduced from April 2024, “means that more staff are needed”.

It added: “The net effect is that the number of available nursing hours did not increase.

“Given that a further one-hour reduction in the working week will be applied from April 2026, NHS boards should be over-recruiting nursing staff to ensure they can accommodate this change without an impact on service delivery.”

It comes as the report made a series of recommendations, including for nurses working for both the NHS and in social care to have “fair pay and good employment terms and conditions that reflect their safety critical role”.

It also suggested workforce planning tools used to calculate the number of staff needed to factor in an increase in predicted absence levels, as well as time for breaks.

RCN Scotland director Colin Poolman said “delivering and supporting a sustainable nursing workforce will be key to delivering improvements”.

He added: “Our report demonstrates the challenges that need to be overcome.

“Our recommendations reflect the need for the Scottish Government to follow through on its existing commitments and to take the action to allow the nursing profession to grow, develop and maximise its contribution to the health and wellbeing of the nation.”

Scottish Labour health spokesperson Dame Jackie Baillie said “This damning report shows that the SNP’s NHS crisis is driving skilled nurses out of the profession.

“Nurses have gone above and beyond to protect patients from the SNP-made chaos in our health service, but they are being badly let down.

“It’s no wonder so many nurses are walking away when they are constantly being asked to do the impossible by this inept SNP Government.”

Health Secretary Neil Gray said: “Nurses and midwives are at the very heart of our NHS and the Scottish Government is committed to supporting this hugely important group of staff while working through challenges together.

“It’s encouraging to see that staffing is now at a record high – up by over 19% since 2006 – with 67,882 whole-time equivalent staff working in NHS Scotland as of December 2024.

“We also now have nine qualified nurses and midwives per 1,000 people in Scotland – this has increased from 8.1 per 1,000 population over the last decade.”

But he added: “We know there is more to do, and we’re taking meaningful steps to improve recruitment, retention and wellbeing across the workforce.

“The Health and Care (Staffing) (Scotland) Act, which came into force in April 2024, is a key part of this, ensuring that the right staff, with the right skills, are in place to deliver safe, effective care at the right time and in the right place.

“Through the Nursing and Midwifery Taskforce, we are working closely with partners to drive forward lasting change and support this crucial group of professionals.

“We remain absolutely committed to backing our nurses and midwives, and to building a sustainable, skilled workforce for the future.”