National Health Service (Capacity)
To ask the Scottish Government what assessment it has made of capacity in the NHS, in light of the critical incident declared by NHS Grampian on 28 November 2024. (S6T-02222)
Capacity continues to be challenged across NHS Scotland as we go into winter, as illustrated by the recent critical incident. Supported by NHS and social care partners, NHS Grampian came through that incident as a joined-up system, keeping patient safety paramount. I would like to thank all staff colleagues for their work in doing so.
National improvement and preventative action to maximise capacity is reflected in the winter preparedness plan, which the Government published with the Convention of Scottish Local Authorities. Building on previous experience, the plan helps to ensure that people receive the right care in the right place, while targeting additional investment and focusing on the wellbeing of our workforce.
Tomorrow’s budget will further bolster our plan for the health service.
That rolls off the tongue.
In a damning indictment of the situation leading up to last week’s critical incident, senior NHS Grampian clinicians sounded the alarm in August, stating:
“There is no evidence to support any planned improvement work or capacity changes that will meet the impending increase in demand seen over October and sustained over the winter period.”
The winter crisis has hit health boards, and it is abundantly clear that the health secretary’s winter preparedness plan is not worth the paper it is written on. Today, Audit Scotland has warned that the Scottish National Party Government has “no clear plan” for wider NHS reform. Lives are at risk.
What is the Scottish Government doing now, with health boards across Scotland, to stave off the looming Christmas chaos in the NHS and to protect patients and staff from serious harm?
We have been working with NHS Grampian for some time. Tess White has been raising the situation of ambulance stacking at Aberdeen royal infirmary, and we have been working with NHS Grampian to produce a robust improvement plan that can meet the demand in the system and that can be backed with the requisite resource to relieve the pressure. The situation serves to highlight why we need reform and improvement.
The discussions around reform and improvement, and around how we shift the balance of care from the acute system into primary and community care, have been absolutely clear and are part of the national conversation that we have embarked on.
Those are just words. The British Medical Association in Scotland has described the diversion of ambulances away from Aberdeen royal infirmary as “a major warning light” for the NHS. The reality, however, is that this dire situation will not improve while NHS Grampian has the lowest bed base per head of population in Scotland. Aberdeen royal infirmary has been operating above capacity since 8 September. Increasing capacity and the bed base in NHS Grampian is contingent on the delivery of the delayed Baird and ANCHOR projects. With the service lurching from crisis to crisis, patients and staff have absolutely had enough.
What is the cabinet secretary going to do differently—I emphasise “differently”—after this central belt-obsessed SNP Government has been short-changing NHS Grampian for years?
There are a number of reflections there that I would seek to remark upon. First, I am sorry for everybody in Grampian who had their treatment interrupted over the weekend. We worked with NHS Grampian to get through the critical incident, and it was able to do that on Saturday. I pay tribute to all the staff across the whole system in Grampian who worked to overcome the situation. That was great. Secondly, I am a health secretary who originates from Orkney, and I am surrounded by two ministers who represent rural constituencies, so the accusation about us not representing the entirety of Scotland is unfounded.
Going forward, it is important that we listen to clinicians, staff, trade unions and, of course, patients and academics about how reform can ensure service improvement. We are currently embarked upon that work. However, the areas and principles that I set out clearly in June will come forward through the budget tomorrow. It is about shifting the balance of care, getting through the Covid-related backlog in planned and scheduled care and relieving the pressure within social care so that delayed discharge can be reduced. Those clear fundamentals are what we are embarked upon right now.
At a meeting that I attended on Friday, which the cabinet secretary was also at, the chief executive of NHS Grampian said that
“tons of lessons have been learned”
about the situation, but it seems that lessons have not been learned or staff listened to during the past few months, in the lead-up to the declaration of the critical incident.
What will the cabinet secretary do to ensure that lessons are learned and acted on, and that staff are listened to for the benefit of all patients?
Kevin Stewart is absolutely right that lessons must be learned. The immediate priority following the announcement of the critical incident was to get through it. I met the chief executive of NHS Grampian on Thursday night to discuss matters so that I could be assured about its plan of resilience to get through the critical incident. I asked that MSPs and MPs be given a briefing on Friday at lunchtime to discuss how that was going to be taken forward, and I am grateful to Kevin Stewart and other colleagues from the north-east for participating in that.
Mr Stewart is absolutely right that lessons must be learned. After the process of coming through the weekend, it is now time for an intensive focus on developing a plan that is robust and that ensures that capacity is brought into the system.
Tess White referenced the Baird and ANCHOR set of projects, which can make a difference to flexibility in the bed base in Grampian. My officials and I have been liaising daily with NHS Grampian to clear the incident. We will now direct our time to a joint and urgent focus on a sustainable plan. That will mobilise all the learning and available resources, and it will include listening to clinical and improvement support staff not just from NHS Grampian but from the centre for sustainable delivery, who visited the board on Monday as part of our intensive progress to resilient services. I expect MSP colleagues such as Kevin Stewart to be kept updated on that progress.
There is much interest in the question, so I am keen to allow in as many members as possible. If we could be concise, that would be appreciated.
To see a hospital declaring a critical incident this early in the winter is a matter of significant concern for my constituents in Aberdeen. Was the cabinet secretary warned that that might be a possibility? Can he assure me today that all possible capacity within the ARI was being utilised? Can he give assurances that, at the point when the critical incident was declared and patients were being treated in corridors, all standard and unfunded beds in the hospital were being utilised?
The situation in Aberdeen royal infirmary was critical at the end of last week. There was far too much corridor care. I do not want to see corridor care happening anywhere. Everybody understands the need for that to be resolved.
There was very serious pressure on Aberdeen royal infirmary on Wednesday night into Thursday, and it was clear that an issue needed to be resolved.
I regret very much the fact that the critical incident happened, not least for the patients and staff who were involved. In response to Michael Marra’s point, the important thing now is to ensure that all possible capacity and beds, not just in Aberdeen royal infirmary but in NHS Grampian, are being utilised.
As I said in response to Kevin Stewart, we will be working with board colleagues and the centre for sustainable delivery to ensure that a plan comes forward that means that we have the capacity in place and the beds available to respond to such a situation. It is not just about acute beds; we will also make sure that there is resilience in community, primary and social care, so that the need for people to present at hospital at all is avoided as far as possible. That is my expectation of NHS Grampian’s improvement plan.
Does the cabinet secretary have confidence in the NHS Grampian board?
Yes, I do. I believe that the board has been working through incredibly difficult circumstances. As I said in response to Michael Marra, I regret the fact that the incident happened, not least for the patients and staff who were involved.
As I said in response to the member’s question at the meeting on Friday, now that we are through the immediate critical incident, it is important that our attention turns to ensuring that the model of care and service delivery in NHS Grampian is robust and has the capacity to avoid such situations happening again.
I put on record my thanks to all those who worked so hard to deal with the critical incident at the ARI last week. We know that medical and surgical procedures will need to be rescheduled as a consequence of it, which will put further strain on a system that already has no spare capacity. What assurances can the cabinet secretary provide to those patients who have already had procedures delayed and to others who fear that they, too, will face delays if such a thing happens again in the coming winter months?
Not all scheduled care appointments at the ARI were cancelled. Many specialties, including cancer specialties, were given priority on Thursday and Friday. Nevertheless, I recognise Maggie Chapman’s point.
I further underline my thanks—which I have given in a number of answers—to the staff of the ARI, who have performed above and beyond in order to overcome the critical incident and who will undertake the rescheduling of appointments. I fully expect NHS Grampian to reschedule those appointments and to ensure that it is responsive to care needs. That will be done on the basis of clinical decision making, as the member would expect.
I am also very grateful to the Scottish Ambulance Service and neighbouring regional boards for the support that they provided in overcoming the initial incident and for the work that they continue to do to support NHS Grampian.
The critical incident that was declared at the Aberdeen royal infirmary had a huge impact on patients in Moray, because so many of those attending Dr Gray’s hospital in Elgin are transferred through to the ARI—travelling, of course, along the A96. What is the cabinet secretary doing, and what does he expect from NHS Grampian, in order to see more services and specialisms delivered in Elgin, at Dr Gray’s hospital, in order to save Moray patients having to travel and to take some pressure off the ARI?
I recognise the impact that the situation has had on Dr Gray’s hospital and on Mr Ross’s constituents in Moray. I also recognise the distance that people have had to travel between Dr Gray’s hospital and the ARI in order to access services, as well as the travel involved for those who were diverted from the ARI to Ninewells or Raigmore. I recognise the need for us to ensure that we are informed, where possible, by clinical advice as to the best location for services.
Service delivery is an issue for us not just in rural communities but more widely with regard to the reform and improvement agenda. We need to consider where it is clinically safest to provide services and where we have the necessary capacity to deliver services to optimal levels in order to meet the needs of our constituents. We also need to balance that with the need to provide those services as close to home as possible.
As I said in my answer to Tess White, I am originally from Orkney, so I understand what it means to travel to access services, and I recognise the difficulties faced by Mr Ross’s constituents and the constituents of many other members. Those difficulties are why reform and improvement discussions need to be informed not just by clinicians but by patients, to ensure that we get the services right for them.
That concludes topical question time.
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