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Winter Planning for Health and Social Care

Letter from Cabinet Secretary for Health and Social Care setting out winter planning details - 27 October 2021

Dear Gillian

WINTER PLANNING FOR HEALTH AND SOCIAL CARE

Following my statement to parliament on the 5th of October, I am writing to set out in detail the range of measures and new investment being put into place nationally to help protect health and social care services over the winter period and to provide longer term improvement in service capacity across our health and social care systems.

Please accept my apologies for the delay in this letter being sent.

This new investment of more than £300 million in recurring funding is a direct response to the intense winter planning and systems pressures work that has taken place over recent weeks with stakeholders, including with health boards, local authorities, integration authorities, trade unions and non-affiliated staff-side representatives.

As I expressed during my statement, I am grateful to the work of staff across the NHS and social care who are working tirelessly to help us navigate through the on-going pandemic and to manage current demands, working in unprecedented circumstances.

All of our winter planning preparations are predicated on four key principles:

1. Maximising capacity– through investment in new staffing, resources, facilities and services.
2. Ensuring staff wellbeing – ensuring that they can continue to work safely and effectively with appropriate guidance and line-management and access to timely physical, practical and emotional wellbeing support.
3. Ensuring system flow – through taking specific interventions now to improve planned discharge from hospital, social work assessment, provide intermediary care and increase access to care in a range of community settings to ensure that people are cared for as close to home as possible.
4. Improving outcomes – through our collective investment in people, capacity and systems to deliver the right care in the right setting.

Collectively, these principles are designed to ensure the action we take now has a lasting and sustainable impact. We are not just planning to build resilience in our health and social care systems to see us through this winter; we are also building on the approach to recovery and renewal set out in the NHS Recovery Plan and through our continued efforts to improve social care support.

It is widely understood and something which I have noted in my engagement with the Committee that we continue to face significant demand across services and that current pressures are likely to further intensify over the winter period.

That is why I set out on 29 September 2021 that the NHS in Scotland will remain on an emergency footing until 31 March 2022. This reflects the demand across the NHS which will likely be even more prevalent during the winter period. Our social care system is experiencing similar challenges, with increased demand and increased complexity in some care needs.

I have written to: all Local Authority Chief Executives; Chief Officers; Chief Social Work Officers; COSLA; Chairs of NHS Territorial Boards; Chief Executives of NHS Territorial Boards; and Directors of Human Resources, Directors of Finance and Nurse Directors within NHS Territorial Boards, setting out the need to work collectively and at pace to deliver the range of measures which I have announced.

In summary, the key measures which I announced to parliament are noted below and further detail is contained within this letter.

• £20 million to enhance Multi-Disciplinary Teams (MDTs) as well as £15 million to support recruitment of 1,000 additional health and social care support staff;
• £40 million to enable patients currently in hospital to move into care homes and other community settings;
• £62 million to build capacity in care at home community-based services;
• Up to £48 million of funding available to enable employers to update the hourly rate of Adult Social Care Staff offering direct care to a minimum of £10.02;
• £28 million for Primary Care services, including in optometry and dentistry;
• £4.5 million to support the recruitment of 200 nurses from overseas by March 2021; and
• An additional £4 million for wellbeing support – access to hot food and drinks and rest factilities to aid rest and recuperation;
• £15 million for incentivisation to build capacity and resilience.

Taking each of these measures in turn, I have provided further detail on the aims of each of the measures.

Multi-Disciplinary Working, including the recruitment of 1,000 Health and Care Staff

Multi-Disciplinary Teams, made up of staff from professional groups across health and social care, are a crucial part of taking rapid action to keep people at home when it is safe to do so.

To enable both the establishment of new multi-disciplinary teams and strengthening of existing teams, I have made available an additional £20 million for the remainder of this financial year. This funding will support discharge from hospital and to ensure that people can be cared for as close to home as possible, reducing avoidable admissions to hospital.

This will be backed by an additional £15 million to recruit 1,000 additional health and care support staff working within those multidisciplinary teams and in hospital settings. The focus of this recruitment is at Agenda for Change bands 3 and 4 to provide additional capacity across a variety of services both in the community and in hospital settings. Boards are also able to recruit to new band 2 roles in acute settings and to support progression of existing staff into promoted posts. I envisage these roles will support hospital services as well as support social care teams to enable discharge from hospital, with the overall aim of reducing delayed discharges.

Across NHS Scotland, the Scottish Government has already provided £1 million of funding in-year to build capacity within recruitment teams and national health boards have offered to provide mutual-aid to territorial boards to manage new volume recruitment. I am confident Boards are well-supported to commence recruitment immediately.

Providing interim care

I have made available £40 million to enable patients currently in hospital to move into care homes or community setting on an interim basis, over a six month period. Local teams will work with patients and their families to explore options, maintaining choice and control. Individuals will be asked for consent to be discharged to a care home on an interim basis for a period of up to six weeks through an expedited process. This is expected to be in their immediate locality or other suitable location. Importantly, there will be no financial liability for the individual or their family towards the costs of the care home.

I expect this offer to be utilised by Health and Social Care Partnerships when they are unable to provide an appropriate care at home package immediately, or when the first choice care home is temporarily unavailable. Alternatively families should also be offered alternative support such as additional flexibility to use self-directed support funding to families to provide interim care in a family home setting until a formal care package can be provided.

Expanding Care at Home capacity


As I noted at the outset, there is a suge in demand for social care and an increase in the complexity of individual needs. That is why I have allocated £62 million for to build capacity in care at home community-based services.

I expect this funding will be spent on the following areas:

• Expanding existing services, by: recruiting internal staff; providing long-term security to existing staff; Enabling additional resources for social work to support complex assessments, reviews and rehabilitation; commissioning additional hours of care; commissioning other necessary supports depending on assessed need; enabling unpaid carers to have breaks.

• Funding a range of approaches to preventing care needs from escalating, such as intermediate care, rehabilitation or re-enablement.
• Technology-Enabled Care (TEC), equipment and adaptations, which can contribute significantly to the streamlining of service responses and pathways, and support wider agendas – including prevention and early intervention.

Social Care Pay Uplift

Up to £48 million of funding will be made available to enable employers to update the hourly rate of Adult Social Care Staff offering direct care. The funding will enable an increase from at least £9.50 per hour to at least £10.02 per hour, which will take effect from 1st December 2021. This funding is critical to support retaining and recruiting staff in the sector and to alleviate the immediate pressures in Social Care and NHS/ Community based health services.

International Recruitment

We know international recruitment is a useful lever to alleviate pressures and as such are supporting Boards to increase the use of international recruitment through a number of measures. The Scottish Government has provided new recurring funding of £1 million to develop capacity within recruitment teams to support international recruitment.

I have announced funding totalling £4.5 million to enable Health Boards to recruit at least 200 registered nurses from overseas by March 2022. The funding will offset direct recruitment costs and can be used to support prospective candidates, including the provision of temporary accommodation for incoming recruits, and other reasonable out-of-pocket expenses.

We are also establishing OSCE training provision and training support in Scotland which will offer a comprehensive training programme either directly to Boards or as facility to train local trainers to prepare candidates to sit their OSCE exam to gain NMC registration. This will expedite the process of gaining NMC registration and significantly reduce the burden of training and preparing a candidate to Boards.

In addition, we are establishing the NHS Scotland Centre for Workforce Supply based in NES to identify further labour markets, build relationships with a range of recruitment agencies, promote the use in Scotland of Government to Government agreements for international recruitment and to support Boards and candidates where appropriate with on-boarding.

Healthcare Students

The utilisation of the skills and experience of healthcare students has been an important step in addressing some of the workforce challenges. Whilst the Scottish Government does not believe it is appropriate to disrupt healthcare students’ programmes through authorising full-time student deployment at this time, I do believe the deployment of healthcare students (apart from dental students) in appropriate part-time support roles will be beneficial to support boards’ workforce capacity.

A national offer via an open letter has been made to healthcare students – including nursing, midwifery, AHP students and undergraduate medics – through their colleges and universities signposting them to the availability of fixed term and bank work as healthcare support workers.

Incentivisation

I continue to explore opportunities to maximise capacity across the health service and as such have identified £15 million of in-year funding to enable work to continue with staff and employers on further options to realise this, such as through targeted incentivisation payments. The Scottish Government will work with employers and staff side to ensure that any targeted measures introduced are right for them, and support both capacity improvements and service resilience.

Professional Regulators’ Emergency Covid-19 Registers

Throughout the pandemic we have seen a large number of retirees returning to support their colleagues. I am deeply grateful to them for their support and am encouraging them and others to return to support the service through winter.

The Scottish Government’s chief health professions officers, including the Deputy Chief Medical Officer, Deputy Chief Nursing Officer, Chief Allied Health Professions Officer and Chief Pharmaceutical Officer wrote on 27 September to remaining registrants on the professional regulators’ emergency Covid-19 registers. This communication encourages registrants to apply for vacancies on the NHS Scotland Jobs website and, where relevant, to consider returning to service via board Banks.

Wellbeing

Of significant importance is the wellbeing of our health and social care workforce, wherever they work, and this remains a key priority for the Scottish Government. We are working to ensure that the right level of support is offered across the system.

Earlier this year, the Scottish Government announced an £8 million package to support staff wellbeing, supplementing the local support available. We are actively listening to colleagues to understand where the pressures are and what actions can be taken to mitigate the resulting impact on staff. I am providing an additional package of support of £4 million for staff wellbeing focusing on people’s physical and emotional needs. We have outlined to Chief Executives and Chief Officers that now more than ever it is critical that staff are supported to look after their wellbeing and take the rest breaks and leave to which they are entitled.

We want to support workplaces in ensuring that ‘the basics’ are taken care of and send a clear message to those working so hard to care for us that we care for them and that their wellbeing matters.

Primary Care

We will also invest up to a further £28 million in Primary Care this year, including in optometry and £8 million for dentistry. This will underpin a range of measures including accelerated multi-disciplinary recruitment to aid General Practice and targeted funding to tackle the backlog in routine dental care.

In my statement to parliament, I was also clear of the need to recognise the contribution of GPs to the pandemic response – ensuring services were maintained. In addition, phone and video consultations had a role to play in treating patients, they will continue to be a part of the hybrid model we offer to patients for the foreseeable future.

However, with recent changes to guidance and the measures I have announced, I would expect to see an increase in GP face-to-face appointments.

Finally, I reiterate my assessment of the pressure we are facing across our health and social care systems – a pressure likely to be exacerbated by winter. My announcements of new funding to introduce immediate measures will go some way in alleviating the challenges and supporting our staff working tirelessly to keep services open and operating.

Humza Yousaf
Cabinet Secretary for Health and Social Care