Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, October 5, 2021

Official Report 929KB pdf

---

Health and Social Care (Winter Planning)

I remind members about the Covid-related measures that are in place, and that face coverings should be worn when moving around the chamber and across the Holyrood campus.

The next item of business is a statement by Humza Yousaf on winter planning for health and social care. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.

I am grateful for the opportunity to update members on the action that we are driving forward to support and protect our health and social care services this winter.

Our national health service is under more pressure than it has been at any point in the pandemic, and, quite frankly, that is likely to get worse. That is why I have decided that our NHS will remain on an emergency footing until at least 31 March next year.

Our social care services are dealing with the same level of pressure, and demand is extremely high. For that reason, I am announcing the most significant package of measures and investment since the advent of devolution, to assist our NHS and social care services with winter pressures. The total package of measures that I am announcing today amounts to more than £300 million of additional investment in our NHS and social care services this year.

In addition to the direct support that I will outline, I urge everyone to do whatever we can to protect one another and our services. Health and social care services are open, and I ask people to listen to clinical experts who can advise on the best service for them, and to be kind and respectful to all the staff who continue to provide care for us under extremely challenging circumstances.

Our winter planning preparations consist of four key principles, and they take a whole-systems approach. First, that is about maximising capacity through investment in new staffing, resources and facilities. Secondly, it is about caring for our staff through ensuring that they can continue to work safely and effectively, with timely access to wellbeing support.

Thirdly, it is about ensuring system flow through specific interventions to improve planned discharge from hospitals and increased access to care in a range of community settings. Finally, it is about improving outcomes through our investment in capacity, people and systems to deliver the right care in the right setting.

It is not only about winter planning; it is about how we are building on the approach to recovery and renewal that is set out in our NHS recovery plan, and our continued efforts to improve social care support.

I will now set out the range of measures that we will introduce to bolster the workforce, to build hospital and care capacity, and, importantly, to support staff wellbeing.

Supporting people to be cared for as close to home as possible is essential—I know that members of all parties agree on the value of that. In that regard, multidisciplinary 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 the establishment of new multidisciplinary teams and strengthen existing teams, I can confirm today that I am making available an additional £20 million for the remainder of this financial year. That will be backed by an additional £15 million to recruit 1,000 additional health and care support staff working in those multidisciplinary teams and in hospital settings. The 1,000 additional support staff will work to assist with patient flow and delayed discharge, and within community health teams. To support that recruitment, the Government has already provided £1 million to build additional capacity in recruitment teams across NHS Scotland.

Although multidisciplinary teams will help people to return to and, I hope, stay in their homes, we recognise that we also need to make wider provision to improve access to care at home support in the first place. Therefore, I can confirm to Parliament that I will make available funding of £62 million this financial year to enhance capacity in care at home provision, which will help to address current unmet need and deal with the current surge in demand and complexity of individual needs.

A further underlying reason for some of the challenges that we face in providing social care support in the community is, undoubtedly, staff pay, terms and conditions. Today, I can announce additional funding of £48 million, which will be made available to enable employers to provide an uplift to the hourly rate of pay for staff offering direct care in adult social care. That means that the hourly rate will rise to a minimum £10.02 per hour.

That demonstrates a significant step towards our continued commitment to deliver fair work in the sector, alongside our on-going work with the Convention of Scottish Local Authorities, stakeholders and the fair work in social care implementation group on wider improvements.

To assist with freeing up capacity and, crucially, to help to ensure that everyone gets the right care and treatment at the right time in the right place, we need to ensure that people who no longer need to be in hospital can move to a community setting to complete their recovery. Therefore, I am announcing £40 million for this financial year to enable patients currently in hospital to move into care homes on a short-term basis. That will be an individualised approach, with patients consenting to be discharged to complete their recovery in another setting. I stress that that will be on an interim basis and that they will be discharged to their immediate locality or another suitable location. Crucially, there will be no financial liability for the individual or their family towards the cost.

In addition, we will invest up to a further £28 million in primary care services this year, including in optometry and dentistry. That will underpin a range of measures including accelerated multidisciplinary recruitment to support general practice and targeted funding to tackle the backlog in routine dental care.

I will make two further important points on primary care, which I intend to highlight to all general practitioners in Scotland in a joint letter with the British Medical Association later this week.

First, we must recognise that general practice has remained open throughout the pandemic and that it is at the forefront of our response to it. I reject any suggestion that general practice has been closed. I thank GPs and their staff for their efforts during the pandemic.

Secondly, even before the pandemic, phone and video consultations had a role to play in treating patients. They will continue to be a part of the hybrid model that we offer to patients for the foreseeable future. However, with recent changes to guidance, and the measures that we are announcing today, I would expect to see an increase in GP face-to-face appointments.

Our health and social care staff have been extraordinary in their response to the unprecedented demands that they face. Their wellbeing must remain a key priority. Earlier this year, the Scottish Government announced an £8 million package to support staff wellbeing, supplementing the local support available. While that has had a positive impact on staff morale and physical and emotional wellbeing, we need to go further.

Today, I am providing an additional package of support of £4 million for this financial year to help staff with their practical needs such as hot drinks, food, access to rest facilities and, importantly, pastoral care and access to psychological support. We have listened to staff and the new support sends a clear message to those who are working so hard to care for us that their wellbeing matters.

International recruitment is a useful lever to alleviate pressures, bringing valuable skills and experience. We have already provided £1 million to health boards to enable them to build the infrastructure to support international recruitment. Today, I am making £4.5 million available to boards to recruit at least 200 registered nurses from overseas by March 2022. We are also accelerating progress with a number of the commitments made in the recovery plan, including developing structures to allow us to directly train international nurses and prepare them for the examinations that they must take to gain United Kingdom registration.

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. In addition to recruiting new workforce, we are also inviting those who have recently retired to return to service, if they would like to do so. Furthermore, using the skills and experience of healthcare students has also addressed some of the workforce challenges during the pandemic. A national offer will be made to healthcare students, through their colleges and universities, signposting them to the availability of fixed-term and bank work as healthcare support workers.

In addition to those measures, we continue to work with staff and employers on further options to maximise capacity, such as through targeted incentivisation payments, and we have identified in-year funding of up to £15 million to support that. We will work with employers to ensure that any targeted measures that are introduced are right for them, buy additional capacity and support service resilience.

The measures that I have set out today, backed by additional recurring funding of more than £300 million, demonstrate our commitment to ensuring that we have a well-staffed, well-supported and resilient health and social care system. We have already taken action over the past few months to help to bolster our NHS and social care services. We expect the additional investment to make a significant impact over the course of the winter.

That being said, it is important for me to be up front and honest with the public and to recognise that this winter is likely to be the most challenging that we have ever faced. We have been engaged in extensive discussions with stakeholders about the winter pressures that we are likely to face. I hope that many of the actions that I have outlined today will have a positive impact in the coming weeks.

If we can continue to control Covid transmission—the signs are positive—and can safely discharge people and keep them in community settings with the additional investment that I have just announced, we will create additional bed capacity within our hospitals that will be vital in managing winter pressures. By investing in our workforce and increasing capacity, we will be able to better support our health and care system through what is set to be an unprecedented winter.

To conclude, I have previously said in the chamber that the Government will be there to support our NHS during its hour of greatest need. My statement and announcements today demonstrate that we are true to our word. I end where I started, by giving sincere and heartfelt thanks once again to our exceptional NHS and social care staff who have made an incredible contribution to keeping us safe throughout the pandemic. I know that they will keep us safe during the extremely challenging winter that lies ahead.

Thank you, cabinet secretary. I ask members who wish to ask a question to press their request-to-speak button now.

I thank the cabinet secretary for advance sight of his statement and echo his gratitude for the continuing and exceptional contribution of all our health and social care workers.

The Scottish Conservatives have called, repeatedly and for weeks, for a detailed winter plan due to the growing crisis in our NHS. It appears that we are still waiting. In the past few days, we have seen statistics showing that accident and emergency waiting times are at the worst level since 2007, reports from the police that they are filling in for ambulance crews by transporting patients to hospital, a U-turn on the closure of our drop-in vaccination clinics, and a health board apologising for a 1-mile-long queue outside a vaccination clinic where older and vulnerable patients were having to stand outside in the terrible weather conditions—which we have here today, as well—some having travelled miles to get there. All that is before we have even reached peak winter.

I welcome the £300 million investment in the NHS that the cabinet secretary outlined and his comments about investing in our workforce and increasing capacity. Most of that will understandably take some time, but we continue to need urgent action now. I ask the cabinet secretary once again: what is being done to drive down A and E waiting times right now? Will he promise that we will not see a repeat of scenes from the weekend with long queues outside vaccination clinics as we move further into winter?

Ms Webber talks about the winter plan. I have just spent the past 10 minutes outlining how we will spend £300 million of investment. If she is looking for a manicured and varnished document, we can spend our time on that but, ultimately, we are making announcements, getting on with the work and releasing the funds to health boards, local government or integration joint boards so that they can get on with the action. That is what people want. They want us to step up with ideas, funding, investment and innovation. That is what we intend to do over the winter.

On the more general comments that Ms Webber makes, none of us wants to see long queues outside vaccination centres. That should not happen. It is for local health boards to make the decisions on what vaccination facilities they have open and do not have open. As we vaccinate more and more people and the unvaccinated cohort gets smaller—thankfully, very few people in the eligible population remain unvaccinated—it is important to let health boards find the balance between providing ample opportunity for people who want to get vaccinated to do that at a time when they want and not having 15 or 20 nurses sitting in a vaccination centre when only a trickle of people are coming through the door. That would not be the best use of the time of the staff involved, given the pressures that we face. We have to find the right balance, but I accept Ms Webber’s point that none of us wants to see long queues.

Nobody is sitting here not having acted—whether the action was taken by me or by my predecessor, because winter planning starts months and months ahead. In the spring and summer, we worked hard to invest in dealing with the pressures that we have faced for a number of months, whether that is the £1.9 billion that we have already invested to deal with Covid pressures, the £12 million that I announced in July to help with non-Covid pressures, or the additional £40 million in year that we announced for the Scottish Ambulance Service—not just the £20 million that I announced recently but the £20 million that was announced before that.

We will invest where we can and, as soon as we have some clarity about the consequentials that we have received, I will, having discussed the matter intently with partners, announce how we can make a significant contribution to the winter months.

I cannot promise Ms Webber that things will not get more difficult and more challenging. She asked me to do that, but I am afraid that I cannot, because we are still in the midst of a global pandemic and still face the indirect and direct pressures of that pandemic. However, I promise that, whatever good ideas come from around the chamber, my door will be open to listening to those suggestions.

Thank you, cabinet secretary. Perhaps we could have slightly shorter answers.

I thank the cabinet secretary for advance sight of his statement, but it feels like a sticking plaster for a much more profound problem.

What additional bed capacity is being planned for our hospitals over the winter? Will elective surgery continue to be postponed? More than 96,000 people were on waiting lists for operations, but that figure has increased as the number of cancelled operations has increased.

The uplift for social care staff is insufficient. Working at the checkout at Aldi pays more. We will not retain or recruit staff if we continue to pay them low wages. When will the pay rise start and when will the cabinet secretary pay social care staff the £15 per hour that they richly deserve?

I welcome any additional funding for unmet need in social care, but will the cabinet secretary confirm that the money will recur in the next financial year? Will he also guarantee that the cutting of care services that is taking place in Glasgow, in Lothian and throughout Scotland will be reversed so that the burden will not fall to the 759,000 adult carers in Scotland who, to be frank, are exhausted?

I find it astounding that the announcements that I have made in such detail today and the significance of the investment can be described as “a sticking plaster”. I do not accept that characterisation. Our recovery plan goes into detail about how we will reform the service during this session of Parliament. I suspect that all of us tend to agree with Jackie Baillie that reform, where it is needed, should be part of a longer-term project. We are dealing with an immediate challenge that has often been described—and I agree with this—as a crisis. This is probably the most significant crisis that our NHS has faced in its 73-year existence. I must deal with the immediate challenge that is in front of me by making an immediate investment.

To answer Ms Baillie’s question, I expect additional capacity to be created, although I will not pluck a figure out of the air. If we, as a Government, can control community transmission of Covid, that will in itself free up beds in the coming weeks and months. We are also working rapidly with local government to try to discharge people safely from hospitals and into community settings, including to care at home. That will create extremely welcome capacity in the system.

I know that health boards may have made decisions about pausing elective surgery. They do not do so lightly. I know from having spoken regularly to every health board chief executive and chair that they will resume elective surgery as soon as the local circumstances are right.

The uplift in pay for social care staff will begin from 1 December. I am happy to explore bringing that date forward. Ms Baillie has asked us to go further and to pay £15 per hour, but she will have to come up with a source to fund the recurring cost of that, which would be many hundreds of millions of pounds in future years. That could be part of a budget discussion. The funding for recruitment that I announced in my statement will be recurring.

I appreciate that the questions from the two front-bench speakers were multifaceted and required responses to each point. We must finish questions on the statement at 16:20 and a number of members wish to ask questions. Please be succinct with questions and with answers.

Social care staff do not always have access to parking permits and have fallen foul of local restrictions. As we head into winter, parking two or three streets away from a patient’s house will not be advantageous. What discussions have taken place between the Scottish Government and COSLA to find a solution that will assist social care workers in going about their vital work without penalty, particularly in the months ahead?

That is an important point. I am in discussion with COSLA and have had intense discussions in the past few weeks. I am happy to give a degree of flexibility in the funding that we provide in order to tackle some of those ancillary challenges that staff face, which make recruitment, retention and just doing their jobs a bit more difficult. I will continue those discussions with COSLA.

In 2015, the Scottish National Party Government said that it would eradicate delayed discharge. Today we discovered that, in August, 46,171 days were spent in hospital by people whose discharge was delayed. Other than ministerial incompetence, why is the Government failing so badly to reduce delayed discharge? It cannot simply be down to Covid.

We cannot ignore the impact of Covid. My predecessor Jeane Freeman had managed to drive down the delayed discharge figures, but that is a challenge that we face with an ageing demographic. That challenge comes from social care, which is why it would be helpful if the member got behind our national care service, which will look to provide consistency in care.

We hope that the measures that I have announced today will lead to a significant reduction in delayed discharge over the winter, which will free up bed capacity and help us with those winter pressures.

Step-down care home beds have been used in previous winters to improve the flow of patients through hospitals and to get people the care that they need in the right place. Will the cabinet secretary outline how today’s announcement will help people whose discharge has been delayed into a more appropriate care setting?

I hope that the point that I was trying to make in my statement came across. We must take a whole-systems approach. If we invest in social care, that can help acute and primary care services, too. As Emma Harper says, step-down care has been used before. The investment that we make will help to bolster the staff. The uplift in pay should also help us to retain staff and therefore, along with the investment in multidisciplinary teams that I have announced, allow us to get people rapidly but safely into a community setting. As I said to other members, that will help us to free up the bed capacity that is so much needed in acute settings.

At present, councils across Scotland, including in the Lothians and Glasgow, are scaling back care packages and asking families to take on more support. The cabinet secretary has committed to increasing capacity in multidisciplinary teams, but the Government missed its deadline of April this year to embed multidisciplinary teams in general practices, and year-on-year cuts to local government—

Question, please.

—have made things perilous. With the onset of winter—

Question, please, Mr O’Kane.

—does the cabinet secretary accept that councils and partners must straight away be provided with funding to recruit more carers?

That is what I have announced. I am sure that there was a welcome somewhere in Paul O’Kane’s question. We have announced an additional £300 million of funding, which, I am sure, COSLA and partners will welcome. It will be released immediately. That announcement was the purpose of my statement. I hope that the funding will make a difference in the ways in which Paul O’Kane articulates questions.

St Michael’s hospital for elderly nursing care and respite in my Linlithgow constituency has been subject to temporary closure since the summer due to wider healthcare staff shortages in Lothian resulting from staff illness and self-isolation. I note that West Lothian still has one of the highest rates of Covid infection. Can the cabinet secretary assure me that when the position is reviewed by West Lothian Health and Social Care Partnership he will encourage it to make community-based elderly nursing care and respite in the north of the county a priority for services, using the resources that he has announced today?

In short, I will do that. Ultimately, of course, it will be a decision for local stakeholders including the HSCP to make, but I will stress that point in my regular engagement with local partners.

I note the cabinet secretary’s comments on international recruitment, which I welcome. However, the numbers of Scottish students who apply for places in midwifery, nursing, physiotherapy, occupational health and other allied health professions consistently far outstrip the numbers of places that are available. Does the cabinet secretary accept that that, along with the Scottish Government’s cap on Scottish students applying to medical schools, highlights a long-standing staffing issue that has been exacerbated by Covid? Will he commit to opening up more opportunities for Scottish medical students?

I am thankful that we are seeing in our undergraduate programme more and more students filling places. When it comes to training, the fill percentage rate has increased this year, which is also positive. There are some professions—Brian Whittle highlighted some—in which we still find it a challenge to fill posts. We are doing everything we can on that and will continue to work with partners on it.

The Royal College of Nursing told me in June that the NHS workforce had upwards of 4,000 vacancies in nursing and midwifery. The crisis does not come from nowhere; it follows years of Scottish National Party mismanagement of the workforce. Will the cabinet secretary commit to an updated workforce management plan, and annual workforce management plans thereafter, so that a workforce crisis of this scale is not repeated, given that he has announced today that only 200 registered nurses from overseas will be recruited by March 2022?

It is important to put on the record for context and, perhaps, balance, that we have a record number of staff in our NHS, and they are the best paid staff in the UK. That is an important point to make.

On nursing vacancies, I too have spoken to the RCN—most recently, just a few days ago—about a range of issues that affect our nursing colleagues. I will commit to a workforce plan. We have already said that we intend to make that available and to do the work on it before the end of the year.

The Scottish Greens’ co-operation deal with the Scottish Government includes progress on fair work for the social care workforce as a priority, so I am pleased to see swift action being taken to ensure that the workforce gets more than the living wage, and that there are vital funds to support the wellbeing of our front-line NHS workers. [Interruption.]

Can the cabinet secretary confirm that the uplift in social care pay is just the first step in establishing parity between health and social care workers, and that we will look to improve pay and working conditions further as we work to establish the national care service?

I am not sure why Labour members were heckling Gillian Mackay during her question. She welcomed, as I expect they do, the pay uplift for people who are not paid as highly as we want them to be, and who have done an incredible job during the pandemic. I am not sure why there was heckling about that welcome move.

Gillian Mackay is absolutely right. It is an additional step; I would not say that it is the “first step”, because we have already invested money to ensure that social care staff are being paid £9.50 an hour. It is, however, another step in the right direction in increasing pay. We have made a commitment to make sure that those staff are paid £12.50 an hour by the end of the current session.

Pay is one element; I have also had good discussions with people including Andy Kerr, who is leading much of our work on fair work, about how we can improve terms and conditions.

I call Kenneth Gibson. He will be followed by John Mason, who will be the last questioner.

Because of the increase in Covid-19 admissions and staff sickness absences, and rising accident and emergency attendances, NHS Ayrshire and Arran is under tremendous pressure. From the very welcome £300 million that the cabinet secretary has announced, what initial support will be provided across NHS Ayrshire and Arran and its aligned health and social care partnerships to reduce further escalation as winter begins?

It will be a challenging winter and we have not even hit the flu season yet. There could, therefore, be even more significant challenges ahead. Furthermore, as members will imagine, we are planning for the 26th United Nations climate change conference of the parties—COP26. Although that will be focused in and around Glasgow, many other local authorities will have to manage some its challenges. The point that I am trying to make is that additional pressures are coming down the line for NHS Ayrshire and Arran.

I expect that the funding that I have announced will mean that there will be additional workforce in sites across NHS Ayrshire and Arran. That will not happen just in acute sites; social care will also be bolstered.

Will the cabinet secretary say more about the international recruitment that he announced and how it will happen?

I will say only that we expect that recruitment to happen immediately. Previously—prior to making the statement—I announced investment to create more capacity within human resources departments in health boards to ensure that provision is in place for recruitment and registration of international nurses as soon as they arrive. We have done a lot of the preparatory work, and I have just announced additional investment to help in getting those international recruits.

We are also working with the Yeovil District Hospital NHS Foundation Trust in England, which has expertise in international recruitment. A lot of the preparatory work has been done, and investment now follows.

Thank you. That concludes that item of business. Before we move on to the next item, I remind members of the Covid-related measures that are in place, and that face coverings should be worn when you are moving around the chamber and across the Holyrood campus.