The next item of business is a statement by Neil Gray on the health and social care response to winter.
The Cabinet Secretary for Health and Social Care will take questions at the end of his statement, so there should be no interventions or interruptions.
14:26
I thank the Presiding Officer for this opportunity to update the Scottish Parliament on how our health and social care system is responding to the pressures of winter.
It is clear that our health and social care services and the people that they serve are experiencing the impact of peak winter demand. It is traditionally a challenging period of the year, and this year has been no different. In particular, the national health service continues to see significant numbers of cases of influenza A, which have been, and remain, very high. This extraordinary flu surge of course adds to the normal respiratory issues that we might expect at this time of year. In the face of that particular issue, and the wider winter pressures, I would first like to express how enormously grateful I am—and, I am sure, everyone in the chamber is—to all those working in our health and social care settings for their immense efforts over the busy festive period. The resilience and determination shown by staff in the face of pressures across the health and care sector are inspiring.
There is so much to thank them for. Every part of our health service has gone above and beyond to serve the country during the hardest months of the year. I thank the staff of the Scottish Ambulance Service staff for their sacrifice and devotion to their task in staying at work beyond the end of their shift as they wait to turn around at hospitals. I thank the social care staff who are doing extra shifts to make up for staff being off sick with flu. I thank the general practitioners who are working at the weekends to offer appointments and bolster the resilience of the entire system. I thank hospital staff, such as the porter I met at St John’s hospital in Livingston on Christmas eve who was working extremely hard to turn around beds as quickly as possible. We, in this chamber, often talk about service, but that is the reality of public service: the hard, relentless, skilled, devoted and dedicated work to serve the people who need it most. We owe all of them a debt of gratitude.
In recent days and weeks, I, with the First Minister, have been meeting health boards, representatives from the Scottish Ambulance Service, health and social care partnerships, Public Health Scotland and NHS 24. We have discussed the latest system updates, the high cases of influenza and how the health service is responding to increased demand. I am very encouraged to hear about the collaborative working right across the system, with strong leadership and staff supporting one another. In practice, that co-operation has seen boards working closely with the Scottish Ambulance Service to manage the flow of patients through emergency departments across Scotland.
The Scottish Ambulance Service and board senior clinical managers have been present on hospital sites, assessing risk and prioritising patients who are most in need of urgent treatment. GPs from out-of-hours services have been working in minor injuries departments and helping to treat and discharge patients, where clinically appropriate. The Scottish Ambulance Service’s integrated clinical hub, which receives calls transferred from NHS 24, has calls reviewed by GPs in the call centre. They help to advise self-care, prescribe medication, or refer to out-of-hours services when it is clinically appropriate to do so. That helps more patients to be treated at home or in the community, and prevents unnecessary ambulance conveyance to hospital. That kind of co-ordination has played an important role in protecting resources for those who are most urgently in need.
I express my regret that anyone seeking care has to wait longer than necessary to receive it—as, no doubt, will have happened during this difficult period—but, at this point, thanks to our robust preparation and the dedication and hard work of staff across the health service and the social care sector, our services continue to hold up well in the face of the additional pressures. That has been important, because there is no doubt that Scotland has been hit hard by flu this winter. Although we planned for increases in flu over the winter, the very high levels that we are experiencing inevitably put additional strain on the system.
Data from Public Health Scotland shows that the incidence of influenza in the community in Scotland has continued to increase in the latest week for which figures are available, although the rate of increase has slowed. We have seen the impact of flu in our hospitals, where there have been more than 1,500 influenza-related admissions in the latest week, surpassing the peak of around 1,400 in the winter of 2022-23.
Every year, the demands of winter challenge our health systems. That is why, in preparation, we published our winter plan a month ahead of the equivalent date last year, and earlier than ever before, to allow more time for whole-system preparedness. Published on 24 September, the winter plan was developed with input from the whole health and social care system, in partnership with the Convention of Scottish Local Authorities, bringing together best practice and improvement work to ensure that the most appropriate care is received in the right place and at the right time.?
Our investment in the hospital at home service has paid dividends, as it has enabled patients to spend Christmas in their own homes, with their families, where that is clinically appropriate. That vital service reduces hospital occupancy while still providing high-quality care.
As part of the winter plan, we committed to providing additional staffing for NHS 24 to support demand over the winter period. That recruitment programme has been a success, with call handlers now fully established and additional clinical staff in post.
Health boards have ensured the provision of NHS pharmaceutical services, so that people continue to have access to prescribed medicines and to services such as NHS pharmacy first Scotland. That service is available in all community pharmacies, to anyone registered with a GP practice in Scotland. It allows members of the public access to expert healthcare professionals without the need for an appointment.
In making those winter planning efforts, we have learned from previous intense winter pressures and we have built our approach to out-of-hours services, escalation and board delivery support on the basis of our experience. Out-of-hours services have remained resilient and responsive thanks to that approach and to our continued investment in the service and rigorous planning of staff cover for winter.
The flu vaccination programme runs until the end of March and the Covid vaccination programme until the end of January. As of 15 December 2024, we had administered more than 1.2 million adult flu vaccinations. The Scottish Ambulance Service has been instrumental in collaborating with boards during the winter vaccination programme. Its mobile vaccination outreach service has provided accessible vaccination facilities to remote, rural and island communities.
Vaccination offers the best protection against serious illness from flu, so I urge all those who are eligible for vaccinations this winter to come forward as soon as possible, to protect themselves and to support our health and social care services. Beyond vaccination, everyone can reduce the chance of catching flu or spreading it to others by practising good hand hygiene, taking other precautions and staying at home if they have respiratory symptoms.
I have thanked our health and social care workforces and will continue to do so. However, I also take this opportunity to thank the Scottish public for taking heed of our messages about accessing the right care in the right place and for taking steps to slow the spread of infections. As I have stated throughout recent weeks, it is important for everyone to be familiar with the different resources that are available, including NHS Inform’s online tools that can help them to get appropriate health advice as quickly as possible. People should always call 999 in a life-threatening emergency, but if that is not the case they should first visit the nhsinform.scot website or call NHS 24 on 111.
I must thank those who are looking after, or even just looking out for, other people—those who have checked in on elderly relations or friends, helped with getting their messages and provided other support over this, the hardest time of the year. I would also like to recognise the role of unpaid carers the length and breadth of Scotland, who, year round, work to support their loved ones. They are often the overlooked heroes of our health and social care system, and I thank them.
I reiterate the Government’s commitment to supporting general practice during this critical time. On 29 November, I announced an additional £13.6 million investment in general practice for this financial year. That funding is aimed at addressing financial pressures, supporting staff costs and enabling practices to recruit and retain staff. It is a practical response to the challenges that GPs face, especially during this period of high demand.
Our dedicated social care and social work workforce have worked tirelessly throughout the festive period, supporting people to remain well and live independently in their communities. That proactive support reinforces our health service by preventing the need for hospital admissions at a difficult time, while ensuring that individuals are cared for in the most appropriate setting.
Care homes have, of course, been affected by flu and, in some cases, have been required to close, in line with infection control procedures. We have engaged with local systems to make sure that they have the latest guidance and support on infection control, and I know that they are working collaboratively to manage that pressure.
As in previous years, there has been significant work to reduce the level of delayed discharge across the system in advance of Christmas. Health and social care partnerships have been working hard to make sure that as many people as possible who are clinically ready to leave hospital can do that, whether they are returning home or to a care home. That includes maximising the use of discharge to assess, hospital at home and other initiatives that help to make sure that people can get the right care in the right place.
Winter tests every one of us. It tests individual people, families and our healthcare systems. However, this year, thanks to the incredible efforts of NHS staff and sure-handed planning, we are facing winter with resilience and resolve. I am sure that the whole chamber will join me in supporting and once again thanking the staff of our NHS and social care services, who provide so much to this nation in these difficult and challenging times.
The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes for questions, after which we will move on to the next item of business.
I declare an interest as a practising NHS GP who was working over the Christmas period. I thank all staff who provided care for us during the Christmas period. [Interruption.] It seems that people do not like the fact that I was working over the Christmas period, Presiding Officer. [Interruption.]
Please carry on. Members—let us hear Dr Gulhane.
Flu is not simply a cold. It is a serious and potentially fatal illness. I urge anyone who is in a high-risk group to go and get their vaccination.
The cabinet secretary has boasted of the number of vaccinations that have been delivered, but that number actually represents a 25 per cent reduction in the number of vaccinations delivered compared with last year.
I have been telling the cabinet secretary that his winter plan is not worth the paper that it was written on, as was shown by November’s accident and emergency waiting times being the worst on record since 2007, when the Scottish National Party came to power.
The cabinet secretary said that recruitment for NHS 24 has been a success, but some desperate people who called NHS 24 had to wait for more than four hours, and more than 100,000 calls were abandoned due to people waiting too long. What is the cabinet secretary doing to ensure that 111 has the capacity to deliver?
Over the past decade, there has been an almost 10 per cent decrease in the number of rural GP practices, despite the cabinet secretary claiming today that accessible treatment is being provided for remote, rural and island communities. What assurances can he provide to rural patients and to my rural GP colleagues that those are not just empty words?
I thank Sandesh Gulhane for his service, along with all those GPs and other health and social care staff who contributed to responding to the health and social care pressures over Christmas. I recognised in my statement that GPs have opened their surgeries at weekends in order to provide support to the whole system, which has helped to make sure that the resilience has been there both in hours and out of hours, as has Dr Gulhane’s service. I also referred to the work that GPs have been doing in supporting the Scottish Ambulance Service and NHS 24, as well as flow navigation services.
Our general practitioners—as I have said before and I say again—are integral to our health and social care system, and I am grateful to all those who worked over the Christmas period to respond to the pressures that we have seen.
Dr Gulhane is right to recognise the severity of flu and the impact that it has had on our system, which has been clear and real. I saw the impact in the visits that I made before Christmas, and the First Minister has seen it in his visits over the weekend.
With regard to the winter plan, I have pointed to many of its successful elements, which have been developed and delivered thanks to the incredible work of our health and social care providers. Those elements include the expansion of the hospital at home service and the work to ensure that flow navigation centres have been able to provide virtual access to accident and emergency services. Our winter plan has worked in a range of areas to ensure that we have been able to respond to the impact on our systems of what I believe to be unprecedented levels of flu in recent years.
With regard to NHS 24 and the statistics that Dr Gulhane quoted in respect of those who choose to relinquish their call, there is a call-back service in place, which will have contributed to some of those people choosing to hang up. Nevertheless, I recognise that some people will have had to wait too long, and I apologise for that. The investment that has been made in NHS 24 to ensure that there is an additional level of staffing available, which I was able to see prior to Christmas, and which the First Minister has been able to see in his visits, has meant that the service has been able to respond well to the increased level of demand over the festive period. I am very grateful to everybody for the work that they have carried out over that difficult and challenging period.
I start by thanking all health and social care staff, including those who work in the third and independent sectors, for their valiant efforts over Christmas and new year, despite the lack of vision and support from the SNP Government.
When the cabinet secretary announced his winter plan, there was not a penny extra for delayed discharge. The latest data, from October, has a record high of 2,000 people stuck in hospital. While I welcome the announcements about the hospital at home service, they relate to the next financial year and will be cold comfort to those who are waiting to get home now.
It is early for a statement on winter pressures, but perhaps the cabinet secretary is trying to get ahead of the statistics on delayed discharge next week. Can he tell us what the level of delayed discharge is today and whether it has gone up or down on his watch?
I turn quickly to the Scottish Ambulance Service. Winter has barely begun and we are seeing real pressure on the system, with ambulances routinely queueing up outside hospitals and a level 4 emergency declared. Can the cabinet secretary tell us what he has done to address that, over and above the winter plan, in order to support our hard-working paramedics?
I am very grateful to Jackie Baillie for referencing, in addition to those staff whom we have already spoken about, the community and voluntary sector staff who contribute so much to our health and social care services by providing access to and reaching those people whom statutory services cannot reach. I recognise that work, and I thank Jackie Baillie for recognising their contribution.
The hospital at home service is operating now, and it has been increased in the current financial year. It is an innovation that is right for patients, as it allows people to remain in their homes, and for our health and social care services.
Should the Scottish Government’s budget be passed, it will mean that, by the end of the next financial year, the number of hospital at home beds will be expanded to provide the largest hospital in Scotland. We are expanding hospital at home because it is an innovation that works.
The delayed discharge figures will be published tomorrow; Jackie Baillie will understand why I cannot pre-empt what is to be in them.
With regard to the Scottish Ambulance Service, Jackie Baillie is absolutely right that it has faced unprecedented demands on its services. However, in order for her argument to hold water, she has to pretend that ambulance services elsewhere in the United Kingdom have not also faced unprecedented challenges. The critical incidents that were announced in Wales and in various hospital trusts in England point to those pressures being a shared challenge that has been faced this year because of flu.
I was incredibly heartened by the conversation that I was able to have with Wes Streeting and other health ministers across the four nations just before Christmas about what we need to do on reform and improvement, because I believe that there are shared areas in which we are looking to invest. Those include shifting the balance of care; reducing hospital occupancy; reducing the length of stay in hospitals; and reducing delayed discharge, because that is what is causing our systems to choke, which has meant that our ambulance service staff—to whom, again, I am very grateful—have been struggling to be able to convey patients into hospitals.
I am not absolving myself of responsibility for the situation that is being faced; I am simply trying to point out to Ms Baillie the context, of which I know that she and others across the country will be aware.
I am keen to enable as many members as possible to put questions, so concise questions and responses are required.
Yesterday, I met GPs and the practice manager at the Atrium medical centre in Coatbridge. I was given a demonstration of a typical day at that busy GP practice, and I heard about the pressures that are faced all year, particularly during these difficult winter months.
What support is available for GPs in their role in response to winter pressures? What opportunities will there be for GPs to feed their concerns into Government?
I thank Fulton MacGregor for his engagement with general practice in his constituency, and I am heartened to hear that that engagement is happening.
I also reiterate the Government’s commitment to supporting general practice during this critical time. In answer to Sandesh Gulhane, I referenced the areas where I have seen incredible work by general practitioners over the festive period, for which I am very grateful.
In addition, on 29 November, at the British Medical Association’s Scottish local medical committee conference, I announced an additional £13.6 million investment in general practice for this financial year. That funding is aimed at addressing financial pressures, supporting staff costs and enabling practices to recruit and retain key staff. It is a practical response to the challenges that GPs face.
I frequently meet the BMA, and my officials have regular meetings with the Scottish GP committee. Those meetings provide opportunities for GPs not only to raise their concerns but to discuss the opportunities for reform and improvement, and to shift the balance of care from secondary into primary care.
The cabinet secretary talked about ensuring that as many people as possible who are clinically ready to leave hospital can do so, whether they return home or to a care home. However, care home places have been cut by a fifth, and that is felt especially in rural areas, where, at the same time, many cottage hospitals have been closed. Such a reduction in step-down care has a direct impact on delayed discharge, so it is little wonder that there is a strain on hospital admissions.
One of the key areas in the budget that has been proposed for the next financial year is the £100 million for reform and improvement, which is to support the shifting of the balance of care from secondary care to primary care and to provide greater capacity in social care.
I accept Brian Whittle’s premise that we need to ensure that there is capacity in all aspects of our service, to relieve the current pressure.
In response to Jackie Baillie, I narrated that the central pressure that our Ambulance Service colleagues have faced has been the inability to convey patients from the ambulance into accident and emergency departments: our accident and emergency staff are unable to move patients from emergency departments into hospital because patients are not moving on from hospital.
I encourage members to support the budget, so that we continue to see investment in social care, in order that there is capacity to meet the demands of patients across Scotland.
At the end of last year, constituents of mine—and of colleagues across the chamber—saw at first hand the pressures on A and E services and hospital capacities, when NHS Grampian declared a critical incident. Can the cabinet secretary outline the steps that the Scottish Government is taking to ensure that, should that situation occur again in any area of Scotland, staff and members of the public alike are prepared and—which is important—informed of the best course of action to take to access the care that they need?
I am grateful to Audrey Nicoll for raising that point. The First Minister has chaired meetings with all the representatives whom I mentioned my statement in order to co-ordinate and ensure that there is confidence in the resilience of the system to avoid situation such as the one in NHS Grampian that Audrey Nicoll outlined.
In practice, there has been incredibly strong co-operation among national and regional boards, which have been working closely with the Scottish Ambulance Service to manage the flow of patients through emergency departments across Scotland.
GPs from out-of-hours services have been working in minor injuries departments to help to treat and discharge patients, and the Scottish Ambulance Service’s integrated clinical hub, which receives calls that are transferred from NHS 24, has been having its calls reviewed by GPs in the call centre, so that they can advise about self-care, prescribe medication or refer patients to out-of-hours services.
With regard to critical incidents, health boards operate their own escalation policies for management of in-patient capacity. That includes well-established processes, with locally agreed trigger points, for maintaining a safe service and ensuring patient safety. Actions are widely communicated with staff to ensure that they know the appropriate course of action to take to respond to pressures, and boards can, of course, ask the Government for advice as and when it is required.
The cabinet secretary said that services are holding up well this winter, but those words are of little reassurance to many staff and patients, including my constituent who is in his 80s who had an emergency urology problem on new year’s day but was told that no urology services would be available at the Queen Elizabeth university hospital until at least the following week. After phoning around, he was advised to attend Glasgow Royal infirmary’s A and E department, but no ambulances were available for six hours, so he had to take a taxi. He was admitted and an emergency urologist was called in, but that was after hours of agonising pain, confusion and frustration for my constituent.
What assurance can the cabinet secretary offer to elderly constituents, such as mine, who are understandably frustrated about the lack of provision of specialist services over the Christmas period, when many of them are at their most vulnerable?
I thank Paul Sweeney for raising the case of his 80-year-old constituent, and I apologise for the situation that he faced. In my statement, I recognised the fact that too many people will have waited too long over the festive period. As I referenced, prioritisation and escalation, through the winter plan, have allowed the system to hold up well in the face of what I believe to be unprecedented levels of flu in the system, compared with recent years.
However, I recognise that too many people will have waited too long. I would be more than happy to receive more information about the situation that Mr Sweeney’s constituent faced and to ask for more information from NHS Greater Glasgow and Clyde so that he can have full information about what happened in that situation.
I understand that a record number of NHS 24 call handlers will support the public to access the most appropriate care this winter, as services deal with increased demand. Will the cabinet secretary highlight how effective that has been so far this winter and how the Scottish Government will continue to support that service to ensure that patients receive the right care in the right place at the right time?
I thank Stuart McMillan for raising that point. As part of the winter plan, we committed to providing NHS 24 with additional staff to support demand over the winter period. That recruitment has been successful, with call handler numbers now at full establishment and additional clinical staff being in post. This winter, a record number of NHS 24 call handlers have been available to direct people to the most appropriate care, and that has helped to reduce the number of unnecessary accident and emergency department attendances. As of September 2024, NHS 24 had in post a total of 1,492.3 whole-time equivalent staff, and the number of staff in post in NHS 24 has increased by 54.5 per cent over the past 10 years.
During my most recent visit to NHS 24, before Christmas, in addition to the direct service that NHS 24 provides, I heard about the work that the breathing space team provides in supporting people who find the festive period to be incredibly challenging from a mental health perspective. I am grateful to all those who have been working across NHS 24 for the work that they have done under the considerable pressure that has resulted from demand across the system.
In the past few weeks, winter pressures have meant that we have heard several warnings from health boards not to come to A and E departments unless it is an emergency. For many people, the alternative minor injuries unit is not as close as their local A and E department. That includes my constituents in Falkirk, for whom the nearest minor injuries unit is in Stirling. For some people, going to that unit means their passing two hospitals, including an A and E department. For many people, that is just not an option. Has the cabinet secretary assessed what benefit there might be in opening a minor injuries unit in Falkirk to help to relieve pressure, especially during the winter months?
I thank Gillian Mackay for raising that point. I reiterate the point that I made in my statement about ensuring that people access the right care in the right place and that they utilise the services that are available through NHS Inform and NHS 24. I hear the point that she has made about minor injuries units. Such a decision would be for NHS Forth Valley to take, and I would be more than happy to facilitate a discussion between it and Gillian Mackay on that potential option.
I echo the words of the cabinet secretary and give thanks to all those who worked over the festive period.
This morning, we learned that only 58.4 per cent of people who attended A and E departments in the last week of December were seen within the four-hour waiting time target. More than 3,000 people waited over eight hours to be seen. That is not just intolerable for the patients and staff in our emergency care departments; it is causing ambulances that are unable to discharge their patients to stack up outside, and it is causing delays to getting emergency care to people in our communities who urgently need it. People are dying as a result. Will the cabinet secretary finally instruct an inquiry into deaths that have been caused by the emergency care crisis?
I recognise the challenge that exists in the system. As I said in response to Jackie Baillie, Sandesh Gulhane and others, we need to make the investment that is in the proposed budget, which would allow for greater capacity in social care and primary care and thereby avoid people being admitted to hospital in the first place. That would also provide the capacity that would enable our accident and emergency departments to deal with patients and our Scottish Ambulance Service to convey patients.
It is about dealing with hospital occupancy, length of stay and delayed discharge. We have prioritised spending in the budget to enable that to happen. I look forward to members of the Scottish Parliament from all parties supporting the budget so that we can provide for improvement of our services.
I agree with Alex Cole-Hamilton: the situation with regard to our four-hour standard is not good enough. It is not one that I accept and we need to see improvement. That will happen by creating capacity, and that will come through the investment that is set out in the budget.
I remind members that I am employed as a bank nurse by NHS Greater Glasgow and Clyde.
I recognise that there has been increased concern, not just in Scotland but across the United Kingdom, about the high level of flu infections in all age groups this winter. Will the cabinet secretary outline what work has been done to encourage uptake of the flu vaccination and say what the current rate of uptake is?
I thank Clare Haughey for highlighting a critical area. Again, I encourage anyone who is eligible for a flu vaccination, or who is part of any of the vaccination programmes this winter, to take up the opportunity to be vaccinated.
As of 15 December 2024, we had administered more than 1.2 million adult flu vaccinations and more than 517,000 child flu vaccinations. Uptake in the highest-risk groups, such as people who are living in care homes and those aged 75 and over, remains strong—although it is slightly lower than we achieved in the winter of 2023—with 82 per cent of care home residents and 78 per cent of those aged 75 and over having been vaccinated against flu this winter.
Health boards have been heavily advertising their drop-in clinics, with many citizens accessing vaccination over Christmas and new year. Therefore, we expect the figures to have increased when Public Health Scotland publishes the next round of data later this week.
A range of tailored resources and promotional materials have been prepared by PHS and disseminated through partners, including local NHS boards and the community and voluntary sectors, as well as the Government, to encourage uptake by all who are eligible.
What is the cabinet secretary’s assessment of the availability of flu vaccine and appointments for people under 65 and not within the at-risk groups who want to be vaccinated but have simply been unable to do so?
We have been working with all health boards to ensure that they are providing ready access to people who are eligible to receive a vaccine and to ensure that barriers to their doing so are removed. I was heartened to hear that many health boards are seeking to provide vaccination clinics for staff, for instance, to increase their access to vaccination.
If Annie Wells has specific examples of where that has been an issue, I would be more than happy to hear about them and to raise the matter with NHS Greater Glasgow and Clyde—or, indeed, with any other health board where that is perceived to be an issue.
We know that one of the best ways to reduce the risk of flu and other viruses is for people to take steps to protect themselves. The cabinet secretary has already mentioned uptake of vaccines. I remind members that my previous role was as a clinical educator in NHS Dumfries and Galloway. What further public health messaging will the Scottish Government utilise to re-emphasise how people can keep themselves safe from flu and other viruses? I am thinking about infection control and prevention measures, as well.
Again, I refer Emma Harper and colleagues to the work that has been provided by Public Health Scotland, as well as that which is provided by the Government through the right care, right place guidance and the important messaging about people utilising the opportunity to get a vaccination.
That is the right thing to do for oneself in order to avoid critical illness—we heard from Sandesh Gulhane about how serious influenza is—but it is also important for our health and social care services. Social care services in particular have been impacted by staff absences because of flu. That is partly why I encourage anyone who is eligible for vaccination to take every possible step to ensure that they utilise that opportunity before 31 March.
That concludes the ministerial statement. There will be a moment or two for members on the front benches to organise themselves for the next item of business.
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