The future for nursing and midwifery in Scotland is “exciting”, the country’s most senior nurse has said following the publication of a major report.
Last month, the Scottish Government committed to implementing dozens of recommendations aimed at improving the recruitment and retention of nurses and midwives across the country.
“The taskforce is about making Scotland the best place for nurses and midwives to work, to flourish and to get on in life”
Anne Armstrong
It followed the publication of a much-awaited report by Scotland’s Ministerial Nursing and Midwifery Taskforce, which set out 44 actions for the government to undertake on key issues affecting the professions.
Nursing Times spoke to Scotland’s interim chief nursing officer, Anne Armstrong, about some of the key recommendations in the report, and the renewed momentum in the country to get nursing and midwifery back on their feet.
The taskforce was set up in February 2023 and has been chaired by Scottish cabinet secretary for health and social care, Neil Gray.
Members include the country’s chief nursing and midwifery officers, health union representatives, health board nursing directors, nursing and midwifery educators and other senior figures.
It was established after health unions campaigned during the 2022-23 pay talks to address challenges with recruiting and retaining nurses and midwives in Scotland.
The taskforce was asked to develop a series of short- and long-term recommendations to fix some of the key problems.
The final report was informed by evidence from nurses, midwives and support workers gathered via a listening project.
The 44 recommendations were split into eight categories, including working conditions, work–life balance policies, access to education, safe staffing, productive working relationships and attracting people into the professions.
Ms Armstrong said: “I think they’re all important and all build on top of each other. I think it’s a great piece of work and a real collaborative piece.
“It really has landed well and it’s a real positive step forward.”
The report comes at an interesting time for Scotland. Although vacancy rates across nursing and midwifery dropped by almost half between 2023 and 2024, they remain high.
As such, health boards are still shelling out millions of pounds on temporary staffing to fill gaps.
Although the overall number of nurses and midwives working in the country has slowly been on the rise, the increase has been uneven across areas and specialties.
Further, latest data from the Universities and Colleges Admissions Service has shown that fewer students are applying to, and being accepted onto, undergraduate nursing courses at Scotland’s universities.
Health secretary Neil Gray at the
launch event for the taskforce report
Ms Armstrong refuted claims by health unions that the nursing workforce is in “crisis” in Scotland.
However, she did acknowledge that the increase in the workforce was not happening in line with the needs of the Scottish population, nor Scottish Government plans to renew and refresh the NHS.
As such, Ms Armstrong said: “The taskforce is about making Scotland the best place for nurses and midwives to work, to flourish and to get on in life.
“So, we’re taking that very proactive approach to make sure we’ve got that workforce of the future.”
One recommendation that runs through the report is the need to make nursing and midwifery careers attractive, flexible and accessible for new and existing staff.
The report urged the Scottish Government and others to develop pre-registration degree education delivery and funding models that enable programmes to be structured in a more “contemporary and progressive way”.
This might include blended and distance learning, and a focus on fields of nursing that are hard to recruit into.
It also called for the development of sustainable alternative entry routes, including part-time, earn-as-you-learn, apprenticeship and fast-track models.
“We’re keen to make sure that, as we implement, we listen to our workforce”
Anne Armstrong
Ms Armstrong noted that it “doesn’t suit everyone” to go via a university route.
She said: “I think the more diversification we have… brings different people into a career in nursing, meeting the needs of the population [and] reflecting the population.”
In accepting the report’s recommendations, the Scottish Government has also agreed to explore the advantages and disadvantages of regulating nursing support worker roles and standardising education for them.
When asked if this could be a hint at introducing nursing associates in Scotland, Ms Armstrong said the government “hasn’t come to a conclusion yet” but was “going to explore it”.
She added: “The important thing is we look at the evidence base, we look at Scotland’s needs and we come to a view then.
“But we’re hoping to make a decision around that later in the year.”
It comes after the Scottish Government told Nursing Times last year it was looking into “regulation of the band 4 workforce, including the role of the registered nursing associate”.
On education, the taskforce set out that the Scottish Government should commission its own review into student practice learning so it could identify “gaps” in placement provision and make sure there is enough capacity.
This will coincide with a UK-wide review of practice learning currently being undertaken by the Nursing and Midwifery Council (NMC).
Ms Armstrong said: “We’ll link very closely [with the NMC], but this is about ensuring that we have the right placements for people across the country and we’re utilising all of the areas that we can.”
Meanwhile, the Scottish Government has also accepted recommendations dedicated to improving the working lives of nurses and midwives.
The listening project revealed how nurses wanted to better manage their wellbeing, as well as be able to take breaks and get home on time.
As such, the report said employers must make sure they have “appropriate staffing levels” and the mechanisms in place so staff can take the breaks to which they are entitled.
Scotland’s safe staffing legislation, implemented last year, will be central to the delivery of this, argued Ms Armstrong.
The Health and Care (Staffing) (Scotland) Act 2019 places a legal duty on NHS and social care providers to ensure there are always suitably qualified staff working in the right numbers to deliver safe and effective care.
Ms Armstrong said: “That’s exactly about ensuring that we’ll get the right workforce in the right place, with the right skills so that we have enabled staff to take the breaks [and] to get the balance.”
The overall roll-out of the safe staffing law has been “successful”, according to Ms Armstrong.
“We are in a good place, so it is absolutely being implemented across the piece, which I am delighted about,” she added.
More on the safe staffing legislation in Scotland
The Ministerial Nursing and Midwifery Taskforce set out several other important recommendations in its report.
One called on the Scottish Government to develop a toolkit to ensure staff have all their essential needs met at work, while another was about improving how employers respond to staff feedback and manage difficult situations at work.
In addition, the report called on the Scottish Government to create an updated definition of flexible working and develop national rostering guidance that “promotes a culture of flexibility”.
The publication marked the conclusion of phase one of the taskforce’s work.
At the time of writing, phase two – which will look to develop a detailed work plan for implementation, including timescales and a financial framework – was due to kick off at the end of February.
Ms Armstrong said phase two would be about assessing what the “quick wins are” in the report, as well as more medium- and long-term changes that need to be made.
She added: “We’re keen to make sure that, as we implement, we listen to our workforce so that, whatever we do, we’re getting feedback about [whether] it is working.”
“I do think it’s exciting times for nursing and midwifery across Scotland”
Anne Armstrong
Delivering all the recommendations at pace will not be without its challenges.
It comes as the Scottish Government has recently come under fire for postponing previous promises it had made to improve the working lives of nurses and midwives.
Last month, Scotland’s health secretary delayed the implementation of the reduced 36-hour working week for Agenda for Change staff, which had been promised during the 2023-24 pay talks.
While the first 30-minute reduction was enforced last year, Mr Gray announced that the further hour reduction had been pushed back until 1 April 2026.
Meanwhile, health unions have also warned that the April deadline for a 2025-26 pay deal will be missed, due to the Scottish Government’s failure to commit to talks.
Nursing Times pressed Ms Armstrong on whether these delays had set a precedent for the speed at which the Scottish Government might implement the taskforce’s recommendations.
In response, she said: “No, I wouldn’t say that at all.”
Instead, she reiterated that the government was “absolutely committed to delivering the 36-hour working week” but in a way that was “safe and effective” for both patients and staff.
Amid all the challenges and promises, Ms Armstrong’s hopefulness that the report will lead to the necessary changes being made shone through.
She said: “I’m feeling very positive about the future, because I think the report really highlights and signals to our frontline nurses and midwives… ‘We’ve heard you and we’re proactively doing this work. We’re going to do it together’.
“So, I do think it’s exciting times for nursing and midwifery across Scotland.”
When out speaking to nurses and midwives, Ms Armstrong was “picking up the same positivity”, she said, adding: “We’re hearing what they’re saying, and we’re delivering together. We’re going to make a difference.”
