Prof Alex McMahon of the Scottish Executive Nurse Directors Group (SEND) says the tools are not perfect but there are ways to evaluate and alter them.

This must be addressed in the bill going forward, he states.

Prof McMahon insists the legislation must not become bureaucratic in nature.

David McArthur of NHS Orkney says the tools will be helpful in that they will provide transparency.

However he expresses concern about the lack of specificity in the bill on the impact on remote and rural areas.

Douglas Fraser
Scotland business & economy editor

The NHS has turned 70, well past the age of having its own bus pass.

While most others can retire at that age, the National Health Service is still working. Indeed, it's having to work flat out, and it's feeling the strain.

Some of that strain comes from more demands being placed on it. Expectations of what it can achieve are completely different to 1948.

Image source, Getty Images

And it has to put up with patients, many of whom do a poor job at looking after themselves. A lot of the strain comes from budgets that keep rising but struggle to keep up with numbers of patients and expectations of what can be done.

But even with lots more money, there's a shortage of people to do the jobs necessary. So-called workforce planning is one of its biggest headaches. I've been looking at many different facets to that workforce planning challenge.

Read Douglas Fraser's analysis.

Image source, bbc

Dr David Chung says the Royal College of Emergency Medicine (Scotland) is broadly supportive of the principles behind the bill.

He explains: "We have an unofficial motto if it is right for the patient it is right for the emergency department."

The RCEM representative points out when patients get a raw deal, like having to wait on a trolley in A&E, it is usually due to a lack of a bed or staff elsewhere.

The concept of the bill is sound, but there must be feedback from clinicians of all stripes to highlight things are not working, he adds.

Dr Chung calls for transparency throughout the process and concludes arguing the legislation should provide greater impetus for the integration of health and social care.

Image source, Thinkstock

The Health and Care (Staffing) (Scotland) Bill seeks to place an existing workforce planning tool onto a statutory footing.

It will also see staff planning methods be used on social care settings, such as care homes.

Health boards are responsible for assessing the needs of their own populations using a set of 12 tools, which have existed since 2004. These are focused on nursing and midwifery.

Should the legislation pass, the tools will become mandatory for health boards and social care providers to use - though it is not yet clear what would happen if they did not meet their duties.

Read more about the bill in the SPICe briefing. , external

Dr Mary Ross-Davie of the Royal College of Midwives says the bill is just one part of a much wider picture on safe staffing levels.

A whole raft of other supports and changes are needed in addition, she states.

There are a range of issues with the current midwifery workforce planning tool, Dr Ross-Davie accepts, but efforts are being made to address these.

Image source, bbc

Ms Cackett argues the legislation does not deal with "real time risk", for example when a nurse turns up and there is not enough staff.

The RCN Scotland representative says there is no accountability on the face of the bill, adding "this has to have teeth".

She calls for public scrutiny when things go seriously wrong.

"Finally we have to ensure there are actually enough staff to care."

Senior charge nurses currently do not have the time to do their job and supply must be added to the legislation, she concludes.

Rachel Cackett from RCN Scotland says the bill must be rooted in positive outcomes for both patients and staff.

There is clear evidence about the link between patient outcomes and nursing staff, she states.

Nursing must have a voice through all elements of this bill and all decisions on staffing must be informed, Ms Cackett tells the committee.

She insists the bill should not be dropped but adds that the tools are only a starting point.

Image source, SPL

The public are being urged to back a campaign for tougher legislation to ensure there are enough nurses to deliver high-quality patient care.

The Royal College of Nursing (RCN) Scotland said the latest NHS workforce data, external showed the highest number of nursing vacancies ever reported.

It said its members were at "breaking point" and it was "time for change".

The Scottish government said the number of nurses and midwives had increased by 5.7% since 2007.

The "Ask for more" campaign is being run by the RCN throughout the autumn as MSPs undertake their initial work on the bill.

Read more.

Image source, bbc

Health committee convener Lewis Macdonald introduces the witnesses.

• Rachel Cackett from the Royal College of Nursing Scotland, external
• Dr Mary Ross-Davie of the Royal College of Midwives, external
• Dr David Chung from the Royal College of Emergency Medicine (Scotland), external
• Professor Alex McMahon, representing the Scottish Executive Nurse Directors Group, external
• David McArthur from NHS Orkney, external

Image source, Getty Images

The number of NHS Scotland consultant posts vacant for over six months rose by almost a quarter in the last year, according to official figures.

The NHS Scotland workforce report, external shows there are 422 unfilled posts across the country.

More than half of those have remained vacant for more than six months.

Then Health Secretary Shona Robison said NHS Scotland's workforce had increased to "historically high levels" under the current government.

Read more.

The second panels comprises:

• Rachel Cackett from the Royal College of Nursing Scotland, external
• Dr Mary Ross-Davie of the Royal College of Midwives, external
• Dr David Chung from the Royal College of Emergency Medicine (Scotland), external
• Professor Alex McMahon, representing the Scottish Executive Nurse Directors Group, external
• David McArthur from NHS Orkney, external

SNP MSP Emma Harper asks if the bill supports better training and use of related tools for AHPs.

"The short answer is no, it does feel like that's going to happen," responds Ms Hartley Kean.

The bill does allow training for specific staff groups, but the tools already in place are not used extensively which suggests they may not work very well she adds.

Dr Gosling says the tools which underpin legislation are acute focused and there is little confidence in their use for community care.

Patricia Cassidy, representing the Chief Officers Group for Health and Social Care Scotland, insists we need to be sure the impact of any legislative tool improves outcomes.

SNP MSP Emma Harper replies, as far as she is aware, the tools are being revised.

Patricia Cassidy argues the different agencies must work together and it is key that people can be kept in care homes or at home, to avoid unnecessary hospital admission.

Mr Whittle says there is a danger of divergence of development in this bill.

Ms Cassidy accepts this and adds working together is key to meeting the needs of people.

District nurses must speak to carers and other AHP workers and pull in other professionals if that is required, she adds.

Highlighting the preventative agenda, Tory MSP Brian Whittle asks about AHPs role in this.

Kim Hartley Kean, who is also from the Royal College of Speech and Language Therapists Scotland, uses dementia patients as an example, saying ability to swallow safely will be impaired at some point in the condition.

SLTs work with the individuals and carers to make recommendations on eating safety, which avoid hospital admission, she explains.

Dr Gosling points to physiotherapists increasingly being used within primary care, which can reduce referrals to hospitals.

A man paralysed from the neck down has urged health bosses to reconsider after his 24-hour care package was removed.

Ron Fraser, from Dingwall, has been diagnosed with clinical depression since his help was cut to four-and-a-half hours a day in July.

His GP says this is "directly attributable" to changes to his care.

NHS Highland said it was a complex case and it was in ongoing discussions with Mr Fraser about future care.

Read more.

Image source, bbc

Lib Dem MSP Alex Cole-Hamilton asks if the bill achieves what it sets out to and is it needed.

Mr Cole-Hamilton also raises the "horrific case" of a paralysed man in the Highlands who lost his 24-hour care package.

Kim Hartley Kean answers that "it is broken at the moment and we do need massive improvement in the way we are planning our workforce".

The AHPFS representative concludes saying the bill is needed.

Patricia Cassidy asserts there is no need for legislation but accepts more must be done with regards to workforce planning for AHPs.

Lib Dem MSP Alex Cole-Hamilton expresses concerns that the legislation flies in the fact of the integration agenda as it puts primary care in a silo.

"Do we need to tear this up and start again?"

Kim Hartley Kean says the bill is a foundation but it needs to be "radically changed".

She suggests removing the reference to the tools used for nursing and midwifery.

Image source, bbc

Kim Hartley Kean points out the financial memorandum of the bill says the tools will be focused on nursing, which would mean there are not multidisciplinary tools for ten years.

Mr Kean adds: "That's ten years for people waiting for adequate AHP services," and waiting to establish the vision of enabling people to stay at home.

"That's totally against the grain of what we are trying to do."

The bill as it stands would take ten years, but it doesn't have to be like that, the AHPFS representative insists.

Labour MSP David Stewart wonders about recruitment and retention issues outside of nursing and midwifery.

The Chartered Society of Physotherapy's Dr Sally Gosling says she is not convinced the bill will address this.

She notes many AHPs come via postgraduate degrees, most of whom are self-funded, suggesting this should be opened up.

Ms Hartley Kean suggests opportunity for career development is in doubt and the bill does nothing to address that.