Official Report 975KB pdf
The next item of business is a statement by Neil Gray on the “Health and Social Care Winter Preparedness Plan 2024/25” . 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.
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Our health and social care services provide essential support for people throughout the year. The nature of the demand that they face can shift in the winter months, when we can see an increase in respiratory and weather-related illnesses. That is why, with the Convention of Scottish Local Authorities, we are publishing the “Health and Social Care Winter Preparedness Plan 2024/25”.
I take this opportunity to offer my thanks to all those across the national health service and social care, including the independent, third and voluntary sectors, which support and deliver that work. The national health service and the social care sector plan for winter on an annual basis—after all, winter following autumn each year is far from being a surprise. That is why investment to plan for winter is now baselined into NHS board budgets at the start of the financial year.
The Scottish Government continues to prioritise investment in front-line services, with more than £14.2 billion invested in our NHS boards, with additional funding of more than £0.5 billion, which is a real-terms uplift of almost 3 per cent. The 2024-25 Scottish budget also provided more than £2 billion for social care support.
That means that social care spending has increased by more than £1 billion compared with 2021-22, doubling our investment in Scotland’s care and delivering early on our commitment to increase spending by 25 per cent to more than £840 million in the current parliamentary session.
What is really important, and what the plan is about, is people. Patients and service users are the very reason that our health and social care services exist. That is only made possible by our dedicated workforces, which are at the heart of the excellent care that they provide. I want to put on the record my thanks to the agenda for change unions for agreeing to this year’s pay deal, which sees staff get a 5.5 per cent increase and ensures that Scotland’s nurses and other agenda for change staff are the best paid anywhere in the United Kingdom.
The principles that underpin the plan retain our focus on the individual. We have set those out in our four winter planning priorities that follow a journey through the health and social care system. First, we will prioritise care for people in our communities, enabling them to live well with the support that they choose, utilising effective prevention to keep people well and avoiding the need for hospital care. By reducing the chance that people will need admission into an acute hospital setting, we will not only improve people’s individual health and wellbeing, we will reduce overall demand, which protects our hospital services from being overwhelmed. The prevention and early intervention approach starts by keeping people well in our communities and supporting them to live happy, healthy and independent lives for as long as possible.
Although our first priority is about preventing people from needing additional care in the first place, our second priority is about ensuring that, when they do need support, they receive the care that is right for them in the right place at the right time. We know that people see better outcomes when they receive care at home or as close to home as possible, where it is clinically appropriate.
Our third priority ensures that our integrated health and social care services maximise capacity to meet demand by managing surge pressures effectively. That is a key element of our mission to reduce delayed discharge, which increases capacity by ensuring that people do not remain in hospital longer than is clinically appropriate. Additionally, it is crucial that planned and established care services are protected and that they work to reduce long waits and address unmet needs.
Putting people at the centre of our plan is not just about those who use our services. Our fourth priority therefore focuses on supporting the wellbeing and capacity of our health and social care workforce, and improving retention, as well as recognising and supporting Scotland’s unpaid carers.
Those priorities run throughout our plan to ensure that all the actions within it are part of a cohesive, whole-system approach, with people as the focus. The plan itself sets out those actions in more detail. For example, we will support the provision of excellent care for individuals in their own homes through dedicated care-at-home services. Additional funding of £124 million has been allocated to enhance care-at-home capacity, as well as £3.6 million to support the growth of hospital-at-home services. Such services provide tailored care to the needs of almost 90,000 people across Scotland, enabling people to live as independently as possible in their own homes.
For those who live in care homes, we continue to provide £14 million of funding for NHS boards to enable enhanced support for care in care homes. That has helped to ensure residents get the right care so that they can avoid admission to hospital and get timely discharges from hospital. We know that providing the right care in the right setting, including through hospital at home, prevented more than 10,000 older people from spending time in hospital between April and December 2023, which relieved pressure on accident and emergency services and the Scottish Ambulance Service, and—critically—improved patient outcomes.
All of those efforts go towards helping to develop further resilience in our health and social care system, while recognising that demand is not static. Solidifying targeting our efforts to the right services at the right time means that we are supporting the primary care system to be as resilient as possible heading into winter. A fundamental part of that is ensuring that people are able to access the care that they need within their community, where appropriate. One such example is the Scottish Ambulance Service’s integrated clinical hub, which helps to direct patients to the most appropriate point of care without automatically directing them to accident and emergency.
We are also supporting health boards to make necessary changes to drive the improvement and implementation of key actions, including focusing on increasing alternatives to hospital attendance, reducing the length of stay over 14 days for non-delayed patients and increasing short stays of less than 72 hours to improve occupancy and flow.
We continue to invest in NHS 24 to bolster capacity and provide the highest level of call handlers on record for the service, and we continue to increase clinical staff, which makes the service more efficient for users. That investment has enabled NHS 24 to expand recruitment opportunities in a number of local areas such as Ayrshire and Arran, Inverness, and Dumfries and Galloway. Those staff will give the organisation capacity to provide clinical supervision for at least 150,000 additional calls per year, which in turn will prevent people from unnecessarily attending accident and emergency departments. It will provide NHS 24 with the additional flexibility and capacity to deal with public holidays, improving service performance on those days.
Our hospitals provide specialist, high-quality, safe clinical care, in which nearly 97 per cent of people are discharged without delay. Unfortunately, some remain in hospital longer than clinically necessary. To address that, we continue to take action to embed good practice for discharge processes and, where necessary, to challenge poor performance. That includes improving effective discharge planning for patients who are admitted to acute or community hospitals, protecting established care-at-home packages and allowing discharge without further delay for assessment. We are offering direct support to systems through a Government-led response team to support areas that are struggling.
It is vital that we involve people and their carers in decisions that relate to their care to enhance choice and control over their support. In hospital, that means engaging the patient, their family and any carers in hospital discharge discussions to ensure that their needs and wants are central to decision making. That will be supported using home-based assessments such as discharge to assess for all home support packages, to ensure accurate person-centred assessments in familiar and homely environments. Crucially, it is important to note that tackling delayed discharge is not just a health issue; it is a whole-system issue that, fundamentally, is about ensuring that people receive the right care in the right place.
Although it is fundamental that we support and safeguard the wellbeing of our health and social care workforce throughout the year, it is particularly vital during periods of increased demand, which might put additional pressures on staff. National workforce policies on supporting work-life balance offer NHS staff a variety of flexible working options. The options support staff in achieving a healthy work-life balance while continuing to deliver and promote the highest standard of care to our patients and service users. We are collaborating with NHS boards to promote part-time work opportunities for healthcare, social care and social work students.
We must ensure that people who provide unpaid care are supported in their caring roles. That means ensuring that carers are supported to look after their own health and wellbeing, alongside engaging in education, training or employment. We are implementing our national carers strategy to drive forward long-term changes to improve the lives of unpaid carers across Scotland.
The plan that we publish today will help our health and social care services to prepare for the challenges that might lie ahead over the coming winter months, recognising that we can never be totally certain how many additional people this year might suffer from respiratory viruses such as flu or Covid, or the extent to which bad winter weather might impact on accidents and falls.
Although the plan will help us to prepare as best we can, there is always the risk that extreme events will overwhelm the available capacity in the system. However, as we have seen in other extreme events, such as Covid, if our preparation is not enough to cope with exceptional surges in demand, we stand prepared to deploy more significant in extremis interventions in partnership with COSLA and the health and social care sector.
I again thank all the people across our health and social care system who will help to turn the actions that are set out in this plan into the reality of services that support and care for the people of Scotland. The Scottish Government and our partners in COSLA are united in our drive to provide person-centred, safe and timely health and social care services for our people, not only over the winter but all year long.
The cabinet secretary will 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 would be grateful if members who wish to put a question were to press their request-to-speak button.
I declare an interest as a practising NHS general practitioner.
There is nothing new here. Everything is rehashed and the spin is dizzying. Summer A and E waiting times are basically the same as those in winter. There is no credible plan here to address winter pressure. After 17 years of Scottish National Party failure, this is the ultimate show of giving up and going through the motions.
We have had two hours in the chamber to debate independence and we have two hours to debate the United Kingdom budget, despite our having nothing to do with either topic in this Parliament. However, we have only 20 minutes to question this lack of a plan to save lives this winter.
I am terrified about what winter will bring: patients in corridors and ambulances queued around the block. The cabinet secretary’s lack of a credible plan will mean that patient safety and staff safety and mental health will be compromised.
Will the cabinet secretary agree to the recording and reporting of instances of patients being cared for in inappropriate areas such as corridors and treatment rooms, or of additional beds being added to wards without the necessary staffing or equipment to ensure patient and staff safety and dignity?
I thank Sandesh Gulhane for his questions and observations.
First, the resourcing of our health service is directly linked to decisions taken by the UK Government, so it is right that we have debate and discussion about the issues that he raises, as well as having the opportunity to interrogate the winter preparedness plan that I have set out.
He says that there is nothing new in the plan, but that is because we are seeking to provide consistency to systems in order to address the issues that they face. We were asked directly to do that and are seeking to provide consistency. We know what works, which is why we have this plan.
Regarding his wider points, I recognise that there are challenges within many of our accident and emergency services and many of our wards and that we are seeing pressure on the system. That is why I so explicitly referred to the work that is being done to address delayed discharge. I would be more than happy to provide further information about the work to reduce the pressure on acute hospital services and in connection with his point about corridor care.
I thank the cabinet secretary for advance sight of his statement. The reality for our staff and communities is that winter pressures now happen all year round. I will focus on delayed discharge and will use figures to do that, but we must remember that those are about real people and their families, whose lives are on hold.
The most recent monthly data, which is for July, in the middle of summer, revealed that an average of 1,900 beds were occupied each day as a result of delayed discharge and that 61,165 total bed days were lost, which is the highest ever monthly figure.
The Government talks up its joint plan with local government, but that includes no new money and is just not sustainable. Will the cabinet secretary say what it will take for this Government to take clear action on that particular point?
I recognise Carol Mochan’s point about our health service being under year-round pressure. I referred to the fact that the system still faces huge pressure caused by Covid. In July this year, we saw a peak of more than 600 beds being used for Covid patients, which is the equivalent of Wishaw general hospital being utilised for Covid and serves to illustrate the year-round pressure that we face. That is why this is a year-round plan and a surge plan, rather than being a plan purely for winter, and that is why it is funded to give boards a baseline for year-round planning.
Carol Mochan is also right to point to the issue of delayed discharge. As she will know, that is not a Scotland-only phenomenon. We can draw on comparator figures for Wales, which show that around 60 adults per 100,000 are waiting for delayed discharge, compared with 44 in Scotland. I am not saying that we should be comfortable with that position—of course we are not—but that serves to illustrate the pressures on the whole system, in both health and social care, that are shared by Scotland and Wales and to show why it is so important that we see an increase in investment in health and social care from the UK Government, so that both the Welsh and Scottish Governments can respond accordingly to support health and social care services.
I refer members to my entry in the register of members’ interests: I hold a bank nursing contract with Greater Glasgow and Clyde Health Board.
It is crucial to free up capacity in our NHS as we head towards a period of higher demand. Will the cabinet secretary outline what work will be undertaken to improve patient flow and to tackle delayed discharge, and will he say how the efficacy of those interventions will be measured?
I reiterate what I set out in my statement, which is that capacity must be seen as a whole-system issue and that tackling it will be about having people receive the care that they need in the right place. Improving the performance of accident and emergency, enhancing patient flow in our acute hospitals and reducing the number of people being held in hospital unnecessarily will continue to be top priorities for this Government.
The vast majority of people—nearly 97 per cent—are discharged without delay, but the delayed discharge figure is still far too high. Some people remain in hospital after it is clinically necessary for them to be there, which can result in poorer outcomes for them and additional pressure on the system, including on hospital flows, particularly during the winter.
Through our improvement programme, significant work has been undertaken with NHS boards over the past year to identify ways to create capacity in the system, resulting in lower occupancy of people and increased flow, and to ensure that every patient has an effective discharge date. We have agreed through multidisciplinary working that we should avoid people being delayed in hospital once they are clinically fit for discharge.
Finally, we are working closely with COSLA and national and local leaders to support improvement, such as through the discharge without delay programme, which offers direct support to systems through a Government-led response team to support those areas that are struggling to meet delayed discharge targets. Having system leaders across health and social care working closely with national improvement teams is essential to jointly implement and deliver sustainable improvements.
When Shona Robison was health secretary, she promised to eradicate delayed discharge, and she reiterated that commitment last year at First Minister’s question time. In the previous financial year, people spent 666,190 days in hospital because of delayed discharge, which is the highest annual figure that has been reported. Today’s statement mentions only reducing delayed discharge. When will this SNP Government stop papering over the cracks and give primary care, and particularly GP practices in relation to the 2018 contract, the support that they need?
I agree with Tess White that we need to do more with regard to delayed discharge. I set out in both my response to Carol Mochan and my statement that we need to do more. We are seeing a situation where we have too many people on delay in our hospitals. That is bad for them, but it is also bad for our health and social care systems.
We are making progress on the implementation of the GP contract. We have made particular improvements and enhancements around the multidisciplinary team support that is available for GP practices and I continue to engage with the GP committee of the British Medical Association, as well as with the Royal College of General Practitioners, on how we can go further.
When I met the new chief executive of NHS Borders last week, one of the areas that he suggested that we must address, which could provide additional capacity in the NHS for the winter months, is streamlining of the medical assessment process and better implementation of the reablement model to help to address delayed discharge. Will the cabinet secretary provide an update on the work to achieve those aims?
We are working with NHS boards through our urgent and unscheduled care collaborative to support the implementation of a range of measures to improve processes, increase out-of-hospital-based capacity and drive down accident and emergency waiting times. A key part of that work is to optimise assessment and care in our emergency departments by improving access to same-day services, the use of early and effective triage, rapid decision making and streamlining of assessment areas.
In addition, the collaborative response and assurance oversight group is working to identify and promote good practice that supports system flow. That includes national improvement work to look at system-wide issues and targeted local engagement to support areas that face particular challenges to improve their processes and models. I have seen much of that innovation for myself, including the work in the Borders, which is to be commended.
The statement does not mention rural healthcare once, yet the cabinet secretary knows that delivering on the four winter planning priorities is more challenging in rural areas, where travel issues, the weather and unfilled vacancies add to the chaos. In Highland, elderly and disabled people have often been asked to travel 50 to 100 miles to access their Covid and flu vaccinations because their GP practices are no longer allowed to deliver them. As a consequence, vaccination numbers are falling, which is definitely not keeping people well. What steps is the cabinet secretary taking to ensure that frail elderly people can access vaccination at home or as near to home as possible in order that they are protected this winter?
As someone who grew up in Orkney, I recognise the challenge that exists in delivering health and social care services in rural and island communities. That is part of the reason why I have to contradict Rhoda Grant with regard to NHS Highland’s ability to deliver vaccinations through GPs. There is a flexibility in the contract that allows for that to happen, and I have given NHS Highland a very clear steer, because of the difficulties that it has had with its vaccination programme, to allow it to deliver that through its GPs if that is the best route to do it.
That is happening in some parts of Highland and, as a result, we are seeing an improvement in the vaccination perspective. It is not true to say that vaccination cannot be delivered through the GPs; there just needs to be a clear reason for doing so.
Ensuring that people’s homes are promptly adapted to meet their needs is a crucial part of avoiding unnecessary hospital stays. In a number of cases, my constituents have been let down and discharged to home environments that did not offer them dignity in their personal hygiene needs, or safe mobility. We can intuitively understand the negative impact of that on their rehabilitation—and that it might even cause readmission to hospital. What action will the Scottish Government take to ensure that the NHS, local authorities and housing associations fulfil their obligations to my constituents in that regard?
I absolutely agree with Ruth Maguire on the need to make progress. Anyone who requires adaptations to their home should experience a smooth transition through the pathway of care, which ensures that they receive the right intervention at the right time. It is critically important that people are supported to live safely in their home environment, as that can optimise health, avoid admittance to hospital, reduce falls and support effective discharge home.
In January 2023, we published revised guidance on the provision of equipment and adaptations. The overall aim of that guidance is to deliver a more equitable and accessible approach to the provision of adaptations. We are also working closely with the NHS and local authorities, which have responsibility for delivery, to evaluate whether those local practices are in line with the Scottish Government’s guidance, deliver service improvements and influence future policy development—exactly so that we can meet the needs of Ruth Maguire’s constituents.
The cabinet secretary mentioned opening up work opportunities for students. Although in some ways that will be welcome experience for them, we need to ensure that their studies are not impacted and that their eagerness to help is not exploited. Will the cabinet secretary outline what band those students will be employed on, whether they will be employed on zero-hour contracts and whether there will be oversight of how many shifts they pick up, to ensure that no one is overworked?
I will respond in more detail to Gillian Mackay, because I do not have all that detail in front of me. Obviously, our work will be in line with the Government’s established fair work principles. However, I will get a fuller response to Gillian Mackay on the points that she raised.
It is essential that we focus on the individual. As the cabinet secretary will remember, he recently visited the Borders general hospital with me to learn about hospital at home. The clue is in the name. At that time, 16 patients were opting for that, freeing 16 beds, and there was more than 90 per cent patient satisfaction, mainly from elderly people. Can that be rolled out further, to increase patients’ options?
I thank Christine Grahame for reminding me of the excellent visit that we undertook in her constituency to look at the funding that the Government was releasing to ensure that there was an expansion of hospital-at-home services. I thank again the team in the Borders, which is working so hard on that.
The Scottish Government has continued to invest in the development of its hospital-at-home programme, which, in recent years, has expanded into additional pathways, such as out-patient parenteral antibiotic therapy and respiratory and, more recently, heart failure and paediatric services. In particular, in the past year alone, the older people’s programme has delivered 495 older people or acute beds across Scotland—58 per cent more than in the previous year—and has treated almost 14,500 patients, which makes it the largest provider of geriatric beds in Scotland and the country’s 12th-largest hospital.
By increasing hospital-at-home capacity, we have been able to directly impact pressures on our hospitals as well as reduce the demand on the Scottish Ambulance Service and improve patient satisfaction. As an alternative to admission, hospital at home also avoids the creation of delayed discharges and enables significant financial savings. This year, £3.6 million has already been provided to 13 boards to establish new services for older people and increase the maturity and efficiency of the 20 or so services that are already in operation across the country. That has enabled more areas than ever to have a hospital-at-home service, and it demonstrates that the Scottish Government is committed to hospital at home and that that is a top priority for us here in Scotland.
It was reported last week that another care home—in Fort William in the Highlands—is set to close, with the loss of 39 care spaces. At the moment, nobody seems to have an answer as to what happens next, but it is highly likely that some of the residents will be transferred to hospitals, which will impact on the health board’s ability to prepare for winter. The loss of perhaps as many as 20 care homes in Highland Council during the past decade is forcing people to leave their communities for care placements that can be as far as 100 miles away, with delayed discharges already through the roof.
Does the health secretary agree that the extra challenges of delivering care in remote and rural health areas—particularly during winter—and the journey times, cost of care and ability to attract care staff mean that the care crisis will only compound the challenge of preparing for winter, and will he say what his plan is to fix it?
I accept the premise of Alex Cole-Hamilton’s question. The difficulties in some parts of the care sector have an impact not only on individuals, who are at the heart of everything that we do, but on health services. That is why we have been working with the Convention of Scottish Local Authorities weekly on the charging for residential accommodation guidance to try to address the delayed discharge issue that we face.
It is true to say that there are some common issues but, because we are able to see variation between partnerships within the same health board area, we know that there are also local issues. As I said in my statement, we are working through providing support with that.
Alex Cole-Hamilton referenced the situation with HC1 forms in Fort William and Stornoway. We are aware of that and we are working with NHS Highland and NHS Western Isles on resilience options and what might be possible in those homes. I will revert to him in due course.
Cabinet secretary,
“Health and social care is a disgrace.”
Those are the words of my constituent Eric Drummond, who called me in a state of distress yesterday. He is largely housebound and has issues with his prostate that have left him incontinent. We heard today about putting people at the centre of the plan, so that when they need support they receive the care that is right for them, in the right place at the right time. However, Mr Drummond will have to wait 16 weeks for a nurse specialist to visit him. How will the plan deal with the challenges ahead when the health service is not prepared for tomorrow—let alone winter?
I thank Sue Webber for raising Eric Drummond’s case. If she wishes to pass on the details, I am more than happy to look at it and see what other intervention or support might be available.
I set out in the statement the work that we are doing and what is involved in the plan, as well as the investments that we are making to reduce the pressure on our health and social care systems. I do not think that it is unique to Scotland that we have increased demand, increased complexity and waiting times in our health service. As regrettable as it is to me—and of course it is, because I want to have the best-performing health service—the fact that we have common pressures resulting from the pandemic and on-going issues regarding continued austerity means that those issues are common to all of us and are becoming more challenging to address.
I am sure that many members will recognise the brutal impact that cold weather can have on our elderly population. Will the cabinet secretary outline the Scottish Government’s assessment of how the UK Labour Government’s cruel decision to cut the winter fuel payment from 860,000 Scottish pensioners will impact not only on the health of our elderly but on the capacity of health services all over the country?
Rona Mackay raised an important issue, which is pertinent to thousands of people across Scotland this winter. If people cannot keep warm at home in the winter, they are at increased risk of ill health, which can put additional pressure on our health and social care services. The UK Government’s decision to restrict eligibility for winter fuel payments, which was taken without consulting the Scottish Government, will have a devastating impact on Scotland by removing entitlement from around 900,000 pensioners, just as Ofgem warned that bills will go up by 10 per cent this winter, thanks to the UK Government failing to intervene, and thus breaking a pre-election promise twice with regard to pensioners.
The Scottish Government is committed to tackling fuel poverty and has consistently supported vulnerable households through a range of actions, including our winter heating payment, which, in contrast to the UK Government’s cold weather payment, guarantees a reliable payment of £58.75 each winter to people on low incomes, including those pensioners who are in receipt of pension credit.
That concludes the ministerial statement on health and social care.
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