Staff shortage woes spreading across NHS A MEDICAL staffing shortage which has put a Lothian children's ward at risk of permanent closure is set to spread to hit other vital areas of the NHS across the region. The paediatrics ward at St John's Hospital in Livingston shut for three weeks last summer as a result of a staff crisis and health bosses have since been scouring the globe in a desperate bid to fill vacancies after a cut to trainee numbers. But in a stark warning, NHS Lothian's human resources chief has said that workforce issues had emerged in three more key areas - emergency medicine, surgical specialities and obstetrics and gynaecology. The admission led concerned board members to call for immediate action to ensure a similar situation to the one that caused the closure of the children's ward at St John's is not repeated elsewhere. And while plans are being put in place to avert a major threat to services, health board chief executive Tim Davison said that bosses had not yet come up with "all the answers." A reduction in numbers of available staff and skill-mix levels, working time laws and a difficulty in recruiting trainees are factors that have caused a headache for NHS managers. The fact that a larger proportion of women than men are entering the medical workforce has also had an impact, due to increased levels of maternity leave, while requests to work less than full-time hours have become more common. George Walker, a non-executive member of the NHS Lothian board, said: "We reached a very difficult place with paediatrics and the team has done a super job in tackling that. But I wouldn't want to wait until we are in the same position here and I am looking for some reassurance that forward planning is happening. This is being flagged up as a very significant risk. Health chiefs are concerned that they may not be able to fill speciality doctor posts in emergency medicine and all posts in an annual recruitment exercise have not been filled, NHS Lothian's 2013-14 workforce planning document revealed. Significant gaps are emerging in the obstetrics and gynaecology rota across the south- east of Scotland, and recent efforts at recruitment have largely proved unsuccessful. In emergency medicine, more staff are needed to meet tough Scottish Government targets such as the 12-week Treatment Time Guarantee and there have already been problems in filling speciality doctor and trainee posts when gaps have arisen. Mr Davison said new staff in emergency departments had recently been recruited but warned that staffing would continue to be a risk, with shortages in some areas creating difficulties across the UK. "We are all fishing in a small pool and are as active as possible," he said. The generality of the risk is real and we don't have all the answers yet. Increased utilisation of non-medical staff, such as advanced nurse practitioners, is set to be explored as one of the potential solutions to staffing concerns. Alan Boyter, NHS Lothian's HR director, said: "I want to offer reassurances that there is a very thorough process around this. We have not just identified the risks and it begs the question what are we doing about it. We have devised an analysis which we are applying to every single medical speciality across the region. We will be looking at what management will put in place to make sure any fragility will be dealt with in an appropriate and professional manner. We want to bring a paper to the board in May to make some choices about what the responses are. AREAS of "high-risk" highlighted by an NHS Lothian 2013-14 workforce plan document. Across the south-east of Scotland, training rotas have been under "unprecedented pressure." Last summer, the paediatrics ward at St John's Hospital closed temporarily after a cut to trainee numbers, and fears over staffing at the Sick Kids and the ERI's Simpson Centre for Reproductive Health have also been raised. A drive to recruit permanent staff from across the globe has achieved positive results, but in light of a UK-wide shortage of specialists, health chiefs have not guaranteed that the children's ward at St John's will be safe. In November, the Scottish Government announced a training programme for advanced neonatal and paediatric nurse practitioners. After it was announced that specialist trainee numbers in emergency medicine were to be cut by 70 per cent in Lothian, a plan was launched to fill more consultant, speciality doctor and non-medical posts. However, it proved difficult to recruit to the higher speciality posts as part of an annual recruitment exercise, leading to heath bosses admitting there are "significant challenges" in the area. In January, the Evening News revealed that the Scottish Government had granted an 11th-hour reprieve in the planned cut to trainee numbers in emergency medicine. However, the future remains uncertain as NHS Lothian ploughs ahead with its plan to deliver a "more senior trained workforce." "Substantial gaps" have emerged recently in the obstetrics and gynaecology training grade rota, and "considerable workforce pressures" need to be addressed. Currently, there are 21 gaps out of 48 within the south-east of Scotland region. Only seven of the gaps have been filled by locums appointed for training and recent recruitment efforts have proved unsuccessful. Numbers may increase in August following the next wave of recruitment. New consultants have been bought in but if there are insufficient trainees to staff the trainee rota, external locums or trained doctors will be needed. Although there has been no change in trainee numbers, the Scottish Government has bought in a series of tough targets. The Treatment Time Guarantee is now in force, while NHS Lothian is battling to get a backlog of patients under control. Planners have said to meet targets, the workforce needs to increase while increased capacity would allow NHS Lothian to decrease its reliance on the expensive private sector. However, as part of a high-level assessment of key medical speciality areas, recruitment difficulties were noted in filling speciality doctor and trainee posts where gaps had arisen.