Official Report 353KB pdf
The next item of business is a statement by Angela Constance on planning for winter and improving hospital flow. Questions will be taken at the end of the statement, so there should be no interventions or interruptions.
14:29
Every year, winter brings significant pressures for our health and social care services, and I want to be clear and transparent that we are facing a difficult period. Our health and care services continue to face significant pressure. It is not a uniquely Scottish issue, but it is important that we take all the steps that we can to prepare for the challenges ahead. That is why I want to update the Parliament today on the actions that are being taken across Scotland to prepare for winter and to ensure that people continue to receive safe and compassionate care.
We know that demand will increase, that our health and care services will face additional pressures and that many people, particularly older people and those with complex conditions, are more vulnerable during winter. We are not and have not been waiting for those pressures to emerge. Preparations have been under way for months. National and local partners are strengthening resilience, supporting capacity and preparing for increased demand.
Our preparations are not simply about plans. They are about people. They are about those who want to get home after a hospital stay. They are about those living with long-term conditions who want to receive care as close to home as possible. They are about families seeking reassurance that their loved ones will receive the right care in the right place at the right time. They are about our dedicated staff across the health and social care services who work tirelessly every day to provide excellent care.
Our approach is already improving how people access and move through health and social care services. This morning, I wrote to the Health, Care and Sport Committee to set out how the £90 million of additional funding that was announced in July will be targeted to drive down long waits for planned appointments and treatment. That includes extra funding to maximise and maintain planned care activity throughout the year, including over winter.
Flow works best when people receive care more quickly, spend less time waiting for treatment and are able to return home when it is safe to do so. In August, we published the “Health and Social Care Improving Flow Plan 2026-2031”, which sets out actions to improve access to care, support timely discharge and reduce avoidable delays across the system. That includes expanding hospital at home services, improving discharge planning from the earliest stages of a hospital stay, introducing new integrated navigation arrangements and strengthening performance oversight to support delivery and improvement across Scotland. We are already progressing those actions, which will help to make a difference this winter.
Fundamentally, we must continue moving towards a system in which more people receive care outside hospital whenever that is appropriate. That is why we continue to expand hospital at home services, allowing more people to receive hospital-level care in their own homes and aiming to have more than 10,000 people benefiting this winter. We are strengthening rehabilitation, recovery and community services, which help people to avoid unnecessary admission, regain independence sooner and return home more quickly. New initiatives such as the enhanced rehabilitation service in Edinburgh are transforming how care is delivered by bringing intensive rehabilitation into people’s homes and reducing the time that people need to spend in hospital. Improving outcomes for patients will release hospital capacity.
Our aim is simple: a community-first approach to help people to receive care earlier, closer to home and in settings that meet their needs. We are already strengthening services in the community, including through initiatives such as the community glaucoma service, to allow people to access care closer to home, which can improve outcomes, prevent problems from escalating and reduce the need for hospital. The approach will be set out in the primary care and community health route map, which will be published later this autumn.
Although progress is being made, challenges remain with delayed discharge. It is unacceptable for anyone to remain in hospital longer than necessary once they are clinically ready for discharge. Although 97 per cent of discharges happen without delay, I am troubled by the current levels, and I am acutely aware of the impact that delayed discharge can have on those who are affected. For many people, home is the best place to recover. Remaining in hospital longer than necessary can affect independence, wellbeing and recovery. It also reduces hospital capacity, causing issues at the front door. Reducing delayed discharge is just one vital component of the picture.
Support begins at the start of the hospital journey, which is why we continue to expand access to acute frailty services. Those services help to ensure that people receive rapid specialist assessment shortly after arriving in hospital. That allows clinicians to identify people who can be safely managed through community services, such as hospital at home, ambulatory pathways or same-day care rather than traditional in-patient admission.
Healthcare Improvement Scotland reports that, at Glasgow royal infirmary, a frailty assessment unit and multidisciplinary frailty pathway reduced average length of stay from 13 days to nine without increasing readmissions. For families, that means knowing that their loved ones are receiving the right care in the right place while avoiding unnecessary prolonged hospital stays.
I must be direct that solving delayed discharge is not entirely within the gift of the Scottish Government. No organisation can solve that challenge alone. Reducing delays requires co-ordinated action across health services, social care, local government, housing and community support, working together to ensure that people can return home safely and promptly with the support that is needed.
It is the statutory duty of local authorities to deliver social care. Decisions about budgeting cannot take precedence over the needs of the very people we were all elected to serve. I will be working closely with the Convention of Scottish Local Authorities through our co-chaired collaborative response and assurance group, but I make it clear to all partners that the status quo on delayed discharge must end.
I ask that local government, and parliamentarians from across the chamber, work collectively on solutions, because at the heart of delays are people who are separated from their loved ones and who are vulnerable to becoming more unwell the longer the hospital stay. The Scottish Government will work in good faith with all partners who want to improve our system.
Alongside the improving flow plan today, we are publishing a refreshed surge preparedness framework for Scotland. Its purpose is straightforward: to help partners to work together to anticipate pressures, take early action and ensure that people continue to receive the care and support that are needed throughout winter. It provides a shared approach across health and social care services, helping organisations to plan ahead, maintain awareness of emerging pressures and take co-ordinated action when that is needed. Above all, it reinforces the collective responsibility that we all share. Again, no single organisation can deliver that alone.
Success depends on national health service boards, local authorities, integration joint boards, primary care services, social care providers, the third sector and national Government working together with a common purpose. When one part of the system experiences pressure, the impact is felt elsewhere. Equally, when partners work together effectively, people receive better care. That collective effort will be critical over winter.
Finally, there is a role for everyone in Scotland to play. Seasonal illnesses, including flu, are already circulating, and I encourage everyone who is eligible to come forward for vaccination. Vaccination remains one of the most effective ways of protecting ourselves, reducing the risk of serious illness and helping to protect those who are most vulnerable during winter. Last winter, around 5,000 adults and 1,700 children in Scotland were hospitalised with flu. Getting vaccinated protects you and those around you—it really is that simple.
It is also important that people know how and where to access care. Attendance at accident and emergency remains extremely high, and many people could be treated more appropriately in services closer to home. A and E should be used for emergencies. Choosing the right service can help people to receive advice and treatment more quickly, while ensuring that emergency care remains available for those who need it most.
That is why we are launching a new public awareness campaign to ensure that people know where and how to access support, particularly over winter. That campaign is scheduled to go live later this month. It will direct people to the most appropriate service, including pharmacy first, general practice, community dentistry, community optometry and NHS 24, whether online or by telephone, from the comfort of their own home.
There is no doubt that winter will be challenging, but we enter it having planned early. We have strengthened our preparedness arrangements, we are delivering practical actions through the plan that is set out in the improving flow document and we are working closely with partners across Scotland to ensure that services are as resilient as possible. Most importantly, we are doing so with a clear focus on the people who rely on those services.
The measure of our preparedness is not whether pressures arise; it is how effectively we respond to those pressures. Our ambition remains clear that every person should receive the right care in the right place at the right time. Achieving that will require leadership, collaboration and determination across the whole system.
Finally, I place on record my thanks to our health and social care workforce, whose commitment, professionalism and compassion are exceptional. Their dedication, together with the collective efforts of partners across Scotland, means that we enter this winter prepared, focused and determined to deliver the best possible outcomes for the people we serve.
I intend to allow around 20 minutes for questions. A large number of members wish to ask questions, so I appeal for succinct questions and answers.
I thank the cabinet secretary for an advance copy of her statement and very much welcome the public awareness campaign that she announced.
The cabinet secretary will be aware that A and E figures published this week revealed that more than 1,600 patients at Edinburgh Royal infirmary waited more than four hours and that more than 1,200 at Glasgow’s Queen Elizabeth university hospital did so. Those are the worst weekly figures since records began. That pressure on A and E is demonstrated by increasing corridor care, ambulances stacked up outside and staff burnout. That results in poorer outcomes for patients, and we know from modelling that has been done by the Royal College of Emergency Medicine that those delays often have profound consequences, resulting in hundreds of avoidable excess deaths.
The level of delayed discharge remains stubbornly high, and that causes even more pressure on A and E, because hospitals are operating at dangerous levels of capacity.
The cabinet secretary knows that we have these statements every year and it seems that little changes. Therefore, I ask her what she will regard as a measure of success. Will it be a drop in the level of delayed discharge? Will it be meeting the four-hour waiting time standard? Will it be ambulance turnaround times reducing? Will it be ending dangerous corridor care? The cabinet secretary was absolutely right to say that this issue is about people, so what difference will people and staff actually see?
I am grateful to Ms Baillie for her questions. I am always very direct, as I am sure that she knows. I have clearly said that winter will be difficult. There is no downgrading on my part of the messaging that I want to convey.
Ms Baillie rightly quotes statistics, and I am well aware of them. I look at some of those figures on a daily basis and some of them on a weekly basis. The figures that she mentions in relation to A and E waiting times, corridor care, ambulance turnaround times and delayed discharge are all symptoms of the increase in demand that our system continues to face.
I have three priorities as we move through winter and beyond. First, we must absolutely remain focused on improving performance and we must not lose track of that—hence the additional investment.
Secondly, we must respond to the winter pressures. Of course, we are having the statement on winter preparedness a bit earlier than usual this year. As a former resilience minister, I know that preparedness and resilience require year-round activity. We can predict the demands of winter, but we know that a surge in demand can occur at any time, irrespective of the season.
Thirdly, we must carry out our public service reform plans. We all have to recognise that, at the end of the day, we want to change all those figures and measures of performance. They have to be moved to go in the right direction. Fundamentally, we all want a system that is more integrated and works better for patients.
The one message that I want to give Parliament is that we have a shared ambition of achieving resilience, a more integrated system and a sustainable health and social care system. However, we also have to recognise that operational improvement and long-term public sector reform are mutually reinforcing. I believe that that is demonstrated by the hospital flow plan and the revised preparedness document that has been produced this week.
I thank the cabinet secretary for her statement. She said:
“It is the statutory duty of local authorities to deliver social care. Decisions about budgeting cannot take precedence over the needs of the very people we were all elected to serve.”
Local authorities have been cutting their services year on year as they have to balance their budgets, so will she tell us what additional funding will be available to them?
The cabinet secretary’s statement also said:
“Success depends on NHS Boards, local authorities, Integration Joint Boards, primary care services, social care providers, the third sector and national government working together with a common purpose.”
We have met many third sector organisations that are collapsing under the cost of energy, rates and staffing issues. What additional funding will be available to them to help in this endeavour?
I acknowledge that the third sector, like local and national Government, continues to live with the consequences of austerity, Brexit and a cost of living crisis. Supporting the third sector is a cross-Government endeavour. Shirley-Anne Somerville has led that work, and many of us—whether it is Mr Gray, me or other Cabinet colleagues—have moved forward with a fairer funding model for the third sector to give continuity of funding over the medium term and get out of the cycle of yearly funding.
Any time we discuss social care, it is the default position for various stakeholders or MSPs to talk about funding. I have never demurred from debates or questions about quantum, but I put it on record that the Scottish Government is investing significantly in social care, as we are in local health boards. It is for integrated partnerships to allocate funding from their core resources. I can track my health and social care portfolio funding; it is often harder to track funding elsewhere in the system.
As a former social worker, I am well aware of the statutory responsibilities of local government and chief social work officers. I go back to where I started: it has to be a collective responsibility. We have to work together, and the default position should not always be to ask about resource, important though it is. We will also have to work differently, because the status quo in social care is no longer tenable.
I appeal for shorter answers if possible, cabinet secretary, as a large number of members wish to come in.
The cabinet secretary will recall speaking with me and other north-east MSPs the other week about the recent incident at Dr Gray’s hospital and Aberdeen royal infirmary. It was a concerning incident for my constituents. I welcome the fact that the situation has improved, but will the cabinet secretary say more about the action that the Government is taking to try to avoid any further incidents of that nature during the winter months?
I am grateful to Ms Mitchell for her question and to her and other MSPs who have worked and engaged with me closely on the matter.
I put on record my thanks for the significant efforts by staff at Dr Gray’s hospital and Aberdeen royal infirmary. During that particularly difficult weekend, they continued to be there for the people who needed them.
That incident demonstrated the pressures across the whole health and social care system. If Ms Mitchell and other colleagues refer to the national hospital flow plan, they will see immediate actions and more medium-term to longer-term actions.
The national hospital flow plan is, in essence, about improving accident and emergency performance and addressing issues such as delayed discharge. Very specific actions are being pursued this winter; for example, we are beginning to roll out the good practice of discharge without delay and other initiatives in that field, such as the expansion of hospital at home. It is also worth remembering that hospital at home is not just a service that is available for older people; there is, of course, the paediatric service as well.
A range of actions are being taken this winter, but we should always remember that we need to deploy all the solutions. There is no silver bullet, so it is about putting our shoulders to the wheel and ensuring that all the solutions are deployed with consistency across the country.
I welcome the focus on community care in the cabinet secretary’s statement. Pharmacy first is a fantastic initiative that is undoubtedly diverting people from general practice, but it can be strengthened. Currently, pharmacists do not have access to sufficient patient records to prescribe with confidence, which often means that people are turned away. That risks undermining the programme and forcing people back to the general practitioner or, indeed, into A and E. Will the cabinet secretary tell us what work is under way to improve patient record sharing with pharmacists in order to improve the pharmacy first service and encourage more people to use it?
Ms Mackay is correct to sing the praises of the pharmacist community—I have a member of that community sitting right next to me. I declare an interest in that I am a frequent user of pharmacy first.
Pharmacists want to do more, and we should take full advantage of that. Pharmacy is an area in our health system, and a profession within it, in which there is room for more innovation. In particular, I point to the work on digital prescribing.
A massive piece of work is required on patient records across health boards and the wider health and social care system. One of the reasons why I am an advocate of NHS simplification and reducing the number of territorial health boards is that it would allow us to move to a single system of information governance. Having 14 different systems of information governance is more of a barrier than a help.
Corridor care is becoming the norm in our NHS and, anecdotally, we know that the situation is at its worst during the winter months. Fundamentally, care delivered in corridors and other inappropriate places is unsafe for patients and those treating them. It increases the risk of infection, robs patients of their dignity and increases the likelihood of negative health outcomes.
Does the cabinet secretary agree with the Royal College of Nursing’s call today for the Scottish Government to follow the UK Government and commit to recording and reporting incidents of care in inappropriate places this winter?
I very much welcome the RCN’s report today. I agree that we need to come quickly to a view on the definition of “corridor care”. Like many things in the world of health, there is no single definition, so we need to resolve that quickly. We also need to be able to measure it, because corridor care is unacceptable and should absolutely not become the norm.
I want to achieve a method of measurement that is proportionate but has people’s confidence. I can turn to many people who can develop very good and comprehensive measurement systems, but I do not want that to take a huge amount of time. I want it to be workable in the real world, so that we do not place an additional burden on our hard-pressed system. I am in agreement with the RCN and I was also in agreement with the Liberal amendment that we debated and agreed to not so long ago in this Parliament.
As we have just heard, the Parliament—including the cabinet secretary—voted last month for my amendment that called for the number of instances of corridor care to be measured, monitored and reported on. The cabinet secretary did not mention it in her statement, but I am glad to hear that she is open to doing that.
Patients should never be treated in corridors; they should be treated in wards. We cannot allow that to become a new normal in our NHS. Ahead of what we know will be an incredibly difficult winter, which doctors have described as “terrifying”, and now that the cabinet secretary has committed to recording and publishing that data, will she commit to a timeline so that it can be done as a matter of urgency?
Adam Harley is correct that corridor care is distressing for patients. It is not right—it is not in their best interests. That is not the appropriate place to provide care. It has an impact on people’s privacy and dignity, and it is also distressing for family members and staff. Staff do not want to provide care in non-clinical environments.
The member mentioned emergency doctors. For the record, I met the Royal College of Emergency Medicine last week.
Mr Harley will forgive me, but I will come back to him on the timeline. I am interrogating that. I have a proposition in front of me that includes a timeline, and I want to see what I can do to shorten it. However, I would be happy to have further discussion on the issue.
The latest figures show that Dundee has one of the best records in Scotland for discharging patients without delay. Clearly, there is a key role for the NHS and national Government in preparing for winter, but, as the cabinet secretary has already said, it is clear that there is also a role for local government. What conversations has the Scottish Government had with local government, including Dundee City Council, to ensure that people can access the social care packages that they need? How can good practice in areas such as Dundee be shared across the country?
Heather Anderson is correct to highlight the good performance of Dundee. I am well acquainted with the discharge without delay model that has been pioneered in Tayside. I continue to work closely with our partner, the Convention of Scottish Local Authorities, on delayed discharge.
As I said, it is unacceptable for anyone to have a delayed discharge, and the outcomes for patients whose discharges are delayed can be poor. The issue is a shared one. Alongside Councillor Kelly, from COSLA, I co-chair the collaborative response and assurance group, which is a forum to consider local issues and ensure that there is national oversight.
The median wait for delayed discharge in Scotland is currently 33 days. That is unacceptable. In the worst area, the median wait is up to 60 days. When I look at the variation across Scotland, I see that, as the member says, the figure in Dundee is good and, in Renfrewshire, it is very good—it tends to perform best. We need to resolve that geographical variation, because it is unacceptable.
I thank the cabinet secretary for advance sight of her statement.
The health issues that some groups face are more serious in the winter. Homeless people, older people and those with addictions or mental illness feel the human cost of the cold. The number of people in Scotland who are waiting for care plans has risen by 5 per cent, and the number of homeless people is at an all-time high. Does the Government have plans to address the risks facing those groups beyond the hospital’s doors?
Irshad Ahmed raises an important issue about vulnerability in our communities. For example, we often narrate delayed discharge in terms of its effect on older people. There is particular vulnerability in our more deprived communities. That is another area on which the Government is focused, because the performance in relation to delayed discharge can be worse in those communities.
I am also cognisant of the increase in adult social protection investigations. That speaks to the level of complexity of the care needs in our communities and also to the level of vulnerability. That is why the Government says that, if it expects services to be joined up and to co-operate, it needs to mirror that.
I assure the member that we are all focused on that, and we are working together to address the large, structural issues in social work. That includes Neil Gray, with his justice hat on, and Màiri McAllan, with her education and children’s hat on. The issues could include poverty or the social work profession.
We are running short of time. I will try to call as many members as I can.
The cabinet secretary will be aware of the age demographics in Inverclyde and the importance of improving hospital flow to free up capacity. What additional resources can be implemented at Inverclyde royal hospital to free up capacity at other hospitals in the NHS Greater Glasgow and Clyde area, so that there is improved hospital flow?
Given Inverclyde’s ageing population, key opportunities include expanding hospital at home services, strengthening frailty pathways, increasing the use of acute frailty units, accelerating discharge without delay and home first approaches and making more use of virtual and remote monitoring. Those measures can reduce the number of avoidable admissions and support earlier discharge, and they will help to manage demand and capacity across acute sites.
The cabinet secretary rightly focused on hospital flow, and I welcome the surge preparedness framework.
Although I have an interest, as I am an NHS employee in a secondary care role, I must advocate that general practice should remain the NHS’s first line of defence in winter for operational capacity. What assurances can the cabinet secretary give to Scotland’s patients that GPs will receive adequate support and clear escalation pathways this winter to prevent additional pressures on hospital services?
That is an important point. GPs are a crucial up-front part of the system. We are supporting GPs with additional funding, over and above the core primary care funding, of more than £500 million over three years. We are doing that to enhance and get more stability and strength in GP infrastructure. That additional investment was not down to me; my predecessor, Neil Gray, secured it.
Mr Currie will be aware of our programme for walk-in centres. I will give an example that shows the benefits of GP walk-in services. Through the GP walk-in service in Lochee, there is provision for patients from the Lochee practice to register. Compared with the same period in the previous year, the number of referrals to A and E from that practice has reduced by 30 per cent. That shows that there is benefit to GP walk-in services, as well as the fundamental importance of investment in GP primary care services.
I remind members of my entry in the register of members’ interests. I hold a bank nurse contract with NHS Greater Glasgow and Clyde.
Getting a vaccination is one of the easiest and most effective ways for people, particularly our most vulnerable, to protect themselves this flu season. Not only that, but it can alleviate pressures on our health and social care services. At the peak last year, in a single week, almost 1,000 people were admitted to hospital due to influenza. Will the cabinet secretary outline the work that is being done to improve uptake of flu vaccinations?
Building on progress that was made last year, we are taking a range of actions to improve uptake of flu vaccinations this winter. That includes the refreshed national awareness campaign and—to pick up on Mr Ahmed’s point—targeted engagement with groups that have lower uptake rates, along with making vaccination as accessible as possible.
NHS boards know their local populations best and are best placed to tailor their services and engagement to reach the targeted audience. Vaccinations are being delivered through a range of accessible settings, including community clinics, care homes, pharmacies and outreach services, and NHS boards and other partners are focusing on targeted work to improve uptake.
I appreciate that the cabinet secretary’s statement was very much about preparing for a crisis, but things will continue to get worse if we do not push more resources towards prevention. Many of those who have experienced corridor care or delayed discharge could have avoided being brought into hospital in the first place, so that is where we must act. How will the Government directly fund prevention in the next year, to ensure that physical and mental wellbeing and local treatment are prioritised?
Our strategies for winter preparedness, the principles behind them and the national flow plan all have prevention at their very heart. That will come from the community first programme, from investment in primary care, from the pharmacy first approach and from recognising that different communities have different needs and act in different ways to access care.
Our focus is on preventing avoidable hospital admissions and on ensuring that, if people have to be admitted to hospital, they do not stay there longer than is clinically required. That applies not only to hospital services for older people. The emergency medicine doctors I met last week made the important point that there is a need for other specialties to ensure that all their patients are discharged once their clinical needs have been met. Preventing avoidable admissions in the first place must be a whole-hospital endeavour.
That concludes the ministerial statement. I apologise to members whose questions I was unable to take.
We will pause for a few moments to allow those on the front benches to change seats.
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