Official Report 1067KB pdf
The next item of business is a statement by Neil Gray on winter preparedness and national planning priorities 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.
14:25
Earlier this year, we published our operational improvement plan, service renewal framework and population health framework, which together set out the short, medium and long-term actions that we will take over the next 10 years. Fundamental to our approach is giving greater control to those who best understand our national health service and social care system: the committed workforce that runs those services every day.
Our focus on winter this year is very much in line with that. It involves supporting services to plan for winter pressures in a way that best suits their local circumstances while ensuring consistency across the country through nationally agreed priorities and principles. However, today does not represent the start of our winter planning. On the contrary, we have been working since last winter to learn lessons and support NHS boards and social care partners to plan their own preparedness and response.
We have worked with partners in both the NHS and the Convention of Scottish Local Authorities to agree local plans that are underpinned by our national principles, and I am pleased to share those more widely today through the publication of our document “Surge and Winter Preparedness in Health and Social Care Services—National Planning Priorities and Principles”. That planning document builds on experience of previous years and sets out what matters most: prioritising care for those who need it most; taking preventative measures to keep people well; ensuring that people receive the right care, in the right place at the right time; supporting the mental health and wellbeing of the workforce; and maximising capacity by improving patient flow and access, reducing delayed discharges and tackling long waits.
Those principles will ensure that people continue to receive high-quality care even when demand increases and not only in winter but year round, including during periods of surge demand due to respiratory viruses, heat-related illness or major local events. Every year, when the temperature drops and winter arrives, viruses such as the flu are a concern. As this year’s winter vaccine marketing campaign reminds us,
“For some, flu hits harder”,
and it can be extremely serious. Although it is too early to predict what the dominant flu virus strain will be this season or how the season will evolve, I am paying close attention to the data.
With cases starting to rise and emerging evidence suggesting that this may be another particularly difficult flu season, I urge all those who are eligible for vaccination to come forward and make it a priority to get protected. No matter what, vaccination remains our best defence and one of our most important preventative public health interventions. Almost everyone who is eligible to receive a winter vaccination should now have been contacted with an appointment or a prompt to book one. I encourage anyone who is eligible but who has not yet heard to check the NHS Inform winter vaccines page for more information.
Members will remember that, at the peak of the season last year, we saw emergency hospitalisations increase significantly, with more than 6,500 adults being admitted to hospital as a result of flu. This year, given the early rise in cases among children and teenagers, I specifically encourage parents and carers to support children to have the vaccine when it is offered to them at school. That is also vital in helping to prevent transmission of the virus to older or more vulnerable family members and friends. Contrary to what we have heard in some quarters, vaccines are safe and effective and save lives, and I ask for the support of colleagues from across the chamber to reinforce that message.
The readiness of our services to respond to winter is closely tied to the progress that we are making to strengthen our NHS. Waits, particularly by those who have been waiting for more than a year, are coming down for the fourth month in a row. I know that some in the chamber seek to suggest that we are not making progress, but that does a disservice to the incredibly hard-working staff whose efforts mean that our NHS is turning a corner and delivering tangible improvements.
We are also treating more people, with more than 31,000 more appointments and procedures between April and September this year than in the same period in 2024. Diagnostic backlogs are being tackled by increasing capacity through enhancing radiology services and mobile scanning units so that, by March 2026, 95 per cent of those who are referred will be seen within six weeks. We are expanding the number of hospital at home beds to 2,000, making that Scotland’s largest hospital.
We have increased access to front-door frailty services in accident and emergency departments, improving patient flow and outcomes. I saw that at first hand on my recent visit to Dumfries and Galloway Royal infirmary’s acute frailty unit. The average hospital stay for those who are admitted to that unit is now 3.4 days compared with a typical 17.5-day average hospital stay for frail older patients.
We are rolling out a theatre scheduling tool that is increasing operating theatre productivity by up to 20 per cent for some specialties.
We are also seeing progress on urgent and unscheduled care. We are working closely with both NHS 24 and the Scottish Ambulance Service to ensure that they are as resilient as possible ahead of winter. Following a £5 million investment, NHS 24 has implemented new call centre and clinical support systems that are bringing benefits and efficiencies for patients and staff. Over 90 per cent of eligible ambulance requests are now transferred digitally by NHS 24, eliminating manual transcription, reducing errors and significantly speeding up the process for patients.
I am pleased to confirm that the Scottish Ambulance Service will recruit more than 290 new front-line staff this year, including newly qualified paramedics and ambulance care assistants, some of whom I had the great pleasure of meeting when I visited the Queensferry contact centre earlier this week.
To ensure a resilient system that can adapt to the challenges that we face requires a collective effort. That is why I am pleased to confirm today that I am also directing boards to take a new subnational planning approach to some key priorities. On digital care, business systems, emergency access standards and orthopaedic elective services, I expect boards to work together to achieve a significant and measurable impact for patients and communities. That will see us optimise the capacity in our system. In doing that, I want to ensure there are no barriers to boards working collaboratively to deliver high-quality, safe and effective care to patients and communities across Scotland.
Although boards’ geographical boundaries and current accountabilities will remain, there will be new expectations about structured subnational planning and delivery. To deliver that, NHS boards are putting in place two subnational planning structures—one focused on the east of Scotland and one focused on the west of Scotland—building on the good joint working that is already in place. That is about ensuring that the same high-quality care is provided no matter where people live and, in particular, how we ensure that the unique needs of our Highland, rural and island communities are being met.
There will also be a vital role for our special health bodies in engaging with and supporting that new planning approach, and I have been clear that I expect trade unions to be engaged as that work develops. Indeed, our workforce will be pivotal in ensuring that this approach to service planning brings improvements for staff and patients, and I look forward to engaging with staff-side colleagues on the effective implementation of the approach when I meet them next week.
I turn to social care. I recognise that our response to winter must be a whole-system response and that our social care sector has an incredibly important role to play. I acknowledge the real challenges that the sector is facing at the moment—not least the United Kingdom Government’s increase to employer national insurance contributions, which is costing social care providers £84 million, and its increasingly harsh and restrictive approach to international social care workers.
I also acknowledge the historical and systemic issues that the sector is facing when it comes to funding and structure. Although investment has reached record highs, Scotland’s adult social care sector faces strain. There is much more work to do in the longer term, and I reiterated that when I met COSLA’s spokesperson for health and social care, Councillor Paul Kelly, yesterday. I do not shy away from that and neither does he. However, we know that the sustained pressure on the system exacerbates over the winter months, and I am determined to ensure that that pressure is relieved as much as possible.
That is why I confirm today that we have identified up to £20 million to bolster social care capacity and support front-door resilience in the areas where need is most evident. That funding will be delivered through health boards to build on the examples of success that we have seen in NHS Lothian and NHS Forth Valley, where the sharing of resource across the health boards and health and social care partnerships has delivered significant improvement. Investing in social care is the right thing to do, but it will also help to reduce hospital admissions and, ultimately, relieve pressure on our NHS acute services.
The measures that I have outlined today represent only a small slice of the vast amount of work that is already under way. Although I have outlined some of the real progress that we have made so far, I am committed to providing a more comprehensive report for the end of the current session of Parliament. That will include reporting on progress against our operational improvement plan, service renewal framework and population health framework, as well as a final report against our NHS recovery plan for 2021 to 2026.
Taken together, all that will demonstrate how we have progressed recovery from the huge impact of the pandemic and how we are modernising our NHS and social care services for the years ahead. I thank our dedicated NHS staff, who I know will continue to work tirelessly in the coming weeks and months. I will continue to ensure that we are prepared not only for this coming winter but all year round.
The cabinet secretary will now take questions on the issues that were 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 encourage members who wish to ask a question to press their request-to-speak buttons.
I thank the cabinet secretary for advance sight of his statement. Christmas will be on 25 December this year, and Hogmanay will be on 31 December—I mention that to the cabinet secretary because, given the lateness of his statement, I can only assume that the Scottish Government has somehow missed the fact that winter typically comes round once a year, after autumn. If it can miss that, who knows what other annual events might sneak up on it?
Last winter was one of the toughest that Scotland’s NHS has ever faced, and this year looks set to be worse. Patient waits for ambulances can be measured in hours or days, not minutes. Delayed discharge is still a massive issue—a decade after the Scottish National Party pledged to end it—and one in six Scots is on a waiting list. The Scottish Government has announced more funding for general practitioners, but that will come in future years and will not come close to the cuts that have seen GPs’ share of NHS funding fall from 11 to 6 per cent. The Government announced walk-in GP clinics, but the location of the first one has not yet been chosen.
This year’s flu outbreak is predicted to be one of the worst in years, but the vaccination rate among healthcare staff fell to 35 per cent last year. Members of the public who are being offered flu and Covid jabs are being told by health boards that they will not get them until well into December, despite cases of both viruses already being on the rise. That hardly points to any level of preparedness. How does the cabinet secretary propose to properly fund primary care and get more people vaccinated more quickly? Does he accept that it might have been better had he woken up to these entirely predictable issues before November?
On the timing, the statement that I bring to Parliament—as I said in my statement, which Brian Whittle had advance sight of—is not the start of the process for winter planning. That has been under way for months. Indeed, as I said in my statement, it began last winter, when we learned lessons from the seriousness of the situation when, as Brian Whittle describes, there was an unprecedented spike in flu cases. That is why the work that we have done on vaccination leading into this year is so important, why the marketing campaign is directed as it is, why we are explicit in our messaging around ensuring that people who are eligible are getting access to the vaccination programmes, and why we are supporting parents to do so for their children.
Mr Whittle references investment in primary care and GPs, which gives me the opportunity to say that the investment that is coming is the single greatest increase in investment in general practice that has ever been delivered in Scotland. It has been delivered by negotiation and consensus with the Scottish committee of general practitioners of the British Medical Association and the Royal College of General Practitioners. Nor have we waited for that; we have increased investment in general practice this year as well. That is because we recognise—as I know Mr Whittle does—the need to shift the balance of care and move to a more preventative approach, and that starts with primary and community care that is led by general practice.
I thank the cabinet secretary for his statement, but it comes two months later than it did last year, and he knows that every day counts.
A mutated H3N2 flu is heading this way—it has devastated Australia, has closed schools in Japan and is surging in India and mainland Europe. The flu season has already started, more than five weeks early, and vaccination rates are down. There are 400,000 fewer adults vaccinated now than there were this time two years ago. Children’s vaccination rates are also down, and some areas have not even started. In the Highlands and Islands, GPs were promised that they would be able to deliver vaccinations to increase take-up rates, but nothing appears to have happened.
Today, the cabinet secretary and I attended a Royal College of Nursing conference at which we both spoke about the importance of prevention instead of the crisis-driven, sticking-plaster approaches that are so common under this Government. By not delivering vaccinations at pace and scale to protect the population and to protect our NHS from winter pressures, has the cabinet secretary failed at the first hurdle of prevention?
I recognise the potential prevalence of H3N2. I received a briefing on that from the chief medical officer, alongside the First Minister, earlier this week. It is too early to say whether that will be the dominant strain of flu this year, but I recognise Jackie Baillie’s points about the impact that it has had elsewhere in the world. That is also why my statement points to the need to ensure that we are asking people to take up their vaccination appointments, which I hope the member will reiterate in her communications.
I expect that everyone who is eligible for a vaccination has now received an appointment. If they have not, they should contact NHS Inform and seek the advice that they need. I encourage everyone to take up the vaccine and parents to enable their children to take up the vaccine. We know that H3N2 has initially been most prevalent in children and teenagers. In order to prevent the spread from becoming more critical for adults, which happened last year, we need to ensure that immunity is provided, and that is exactly what we are investing in across Scotland.
I recognise the importance of the Scottish Government’s hospital at home service, which prevented 15,470 people from spending time in hospital in 2024-25. I note that the cabinet secretary referenced the use of frailty services in A and E wards. Those services are crucial during the colder period. Can the cabinet secretary outline how the Scottish Government will ensure that the work of those services is supported and enhanced going forward?
Rona Mackay is absolutely right: we have made strong progress to ensure that every health board has frailty services in its A and E departments. Implementation is at different stages, and all boards continue to develop their services. The service will particularly help older patients, with the average length of hospital stay reduced by around 14 days and no increase in readmissions. We have been speaking about the preventative approach that we need to shift to, and that is exactly the type of preventative approach that is proven to work. We are also on track to deliver 2,000 hospital at home beds by December next year. We are shifting the balance of care from acute hospital-based settings into the community and into people’s homes whenever possible, ensuring that people get the right care in the right place and at the right time. That is underpinned by £200 million of record funding going into the health service.
NHS Grampian is already in crisis. Despite the best efforts of hard-working crews who are doing their absolute best, the average emergency ambulance turnaround time at Aberdeen royal infirmary is now almost two hours, and one in 10 ambulances are stacked for over four hours. That is in the context of a £68 million overspend this year. Incredibly, neither the cabinet secretary nor his overdue plan even mention NHS Grampian. What precisely will the cabinet secretary and his overdue, last-minute plan do to guarantee that ambulance response times will not get even worse for the people of the north-east this winter?
I met Ambulance Service staff last month, when I visited the ARI, and I heard directly from them the concerns that they have and about the incredible work that has been done by the hospital ambulance liaison officer—HALO—staff at the front door of our hospitals. I pay tribute to them for that work. I am also impressed by the work that is being done by Ambulance Service colleagues and by our unscheduled care leadership in NHS Grampian to come forward with an improvement plan for the health board. That is being overseen by the oversight board and the assurance board, which is relevant to NHS Grampian’s escalation status. We have committed additional funding to NHS Grampian for its unscheduled care pathway work.
Approximately one in three people over the age of 65 in Scotland fall each year, while about half of those who are over 80 fall at least once a year. Falls are the most common reason for an ambulance being called for an older person, and they are a leading cause of hospital admissions for unintentional injuries. In winter, slips on untreated pavements increase the number of falls, but the cost to the NHS, the Ambulance Service and accident and emergency departments of hospitalisations and perhaps social care after hospitalisation can be reduced. Gritting pavements is the responsibility of local authorities, but will the cabinet secretary consider authorising NHS boards to provide funding to local authorities specifically to help them to grit pavements? I have no doubt that that would prevent at least some falls, which have a cost not just for the individuals’ health but for the public purse. Why not pilot that approach and see whether I am right?
I absolutely agree with the premise of Christine Grahame’s question. She is absolutely right that slips, trips and falls are a significant reason why we have increased admissions to hospital over winter. I can assure her that part of the reason why the plan is jointly published with the Convention of Scottish Local Authorities is that we recognise that many of the drivers of poor health and admissions to our health system involve issues beyond the health service, including, as she points out, gritting pavements and ensuring that walkways are cleared. I am more than happy to continue my discussions with COSLA colleagues, to ensure that they are taking those responsibilities seriously.
On Saturday morning, I spoke to a nurse who had just finished her night shift at Glasgow royal infirmary’s A and E department. She said that the corridors in that department are already filling up with elderly patients who are stuck on trolleys and are unable to be admitted to wards, and that she and her colleagues are terrified that the situation is only going to get worse as the winter deepens, given that it is only mid-November. From conversations that she has had with colleagues from other hospitals, she knows that corridor care is the norm in many hospitals across Scotland. Will the cabinet secretary give a personal guarantee to my constituent and her colleagues at Glasgow royal infirmary that this winter preparedness plan will finally end the disgrace of corridor care in Scottish hospitals?
I pay tribute to the work that has been done by Mr Sweeney’s constituent and many others, not just in Glasgow royal infirmary but elsewhere in NHS Greater Glasgow and Clyde and across the health service in Scotland.
As Mr Sweeney knows, corridor care is not a phenomenon solely in Scotland but is a challenge that all hospitals face—I have family members in the north of England who see a very serious situation in that regard at present. That is not to say that I do not accept the challenge that is before us—of course I do. I see it when I go out, and I hear it from staff. I do not accept that the situation is either an inevitability or a norm. It is one that we must tackle, which is why I will work with our staff and health boards to ensure that improvements are made.
The Scottish Ambulance Service is a vital component of emergency care throughout the year, but particularly in winter, and Scotland is not unique with regard to the pressures that ambulance teams face. I note that, under the Labour Government in England, the category 1 and 2 ambulance response times in September were the slowest since February, while the category 3 and 4 response times were the slowest since December 2024. I welcome the steps that the cabinet secretary announced in his statement to shore up Scotland’s ambulance service, and I welcome the news this week of an increase in the number of call handlers for the service and NHS 24. Will the cabinet secretary outline how those changes will bring benefits for patients over the winter months?
Clare Haughey puts on the record important context relating to the challenge that is being faced in all parts of the United Kingdom, despite what Labour colleagues here might say.
As I set out in my statement, we are increasing investment to strengthen the Scottish Ambulance Service and NHS 24 ahead of winter. More staff will help to address capacity challenges, improve care for those who need urgent treatment and ease pressure on accident and emergency departments. Additional roles in the Ambulance Service’s integrated clinical hub mean that more patients can be treated without unnecessary hospital visits, freeing up crews to deal with life-threatening emergencies.
Likewise, the recruitment of new NHS 24 staff will reduce call handling times, manage rising demand and enhance clinical supervision, ensuring faster and safer triage for patients. We have also significantly increased the number of paramedics in recent years, and those changes will deliver tangible benefits for people across Scotland during the busiest months. I pay tribute to our Scottish Ambulance Service staff and thank them for the work that they do.
The winter period will place extra pressure on unpaid carers as well as paid staff. I note that the “National Planning Priorities and Principles for Surge and Winter Preparedness in Health and Social Care” document states:
“support for the wellbeing ... of … carers should be embedded in surge planning”.
Will the cabinet secretary provide more detail about what that support should entail and how unpaid carers can find out what extra assistance they might be entitled to?
I thank Maggie Chapman for raising a critical issue. All MSPs know well the critical role that our unpaid carers play. In my area, the Lanarkshire Carers centre provides phenomenal advice and support to local unpaid carers. I expect those types of services to pass on the type of advice and support that Maggie Chapman is looking for, and I will provide further detail on where those services are in writing to Ms Chapman following my statement.
This morning, the cabinet secretary and I attended a conference that was organised by the RCN for nurse activists. He will remember the moral injury that was etched into the faces of the nurses at that conference—caused by things such as corridor care and not being able to provide timeous support to patients, some of whom have been languishing on waiting lists, along with 800,000 of our fellow Scots.
Does the cabinet secretary recognise that, for as long as 2,000 Scots are stuck in hospital, well enough to go home but too frail to do so without investment in social care in our communities—without either a care bed to receive them or a care package to bring them home—the problem will only get worse as the winter months draw in?
I accept the premise of Alex Cole-Hamilton’s question, as I did at the RCN conference this morning. Later this morning, I set out to the Royal College of Midwives my gratitude to staff for the work that they are doing. I want to address the challenges that staff raised and celebrate the remarkable contribution that they deliver. Too often, their contributions and individual innovation and service delivery go unnoticed, to the detriment of their work, in favour of people outlining only the challenges in the system.
The best way that we can address moral harm and injury is by improving access to our health service and reducing waiting times. We are turning a corner in that regard, thanks to the investment in the budget that Mr Cole-Hamilton supported, as well as the incredible endeavours of our staff. I agree with him on the situation regarding delayed discharge and social care. That is why, as I said in my statement, I have allocated additional resources for social care.
The recent media reports about the upcoming flu season are very concerning, as the cabinet secretary has said. Will he outline the measures that will be taken to ensure a high level of uptake of flu vaccinations as we approach the colder weather, when flu becomes more prevalent in our communities? What more can members across the Parliament do to encourage uptake in our communities?
I thank Fulton MacGregor for giving me the opportunity to put on the record the importance of vaccination as part of our preparedness for winter. Experts in Public Health Scotland and the Scottish Government are closely monitoring the flu situation, but vaccination remains the best protection against flu. That is not just my message—the message of experts is clear that everyone who is eligible should come forward for vaccination.
We are working with health boards to make access easy and convenient, supported by a national campaign and engagement with trusted community voices to highlight the seriousness of flu. In concert with the chief medical officer, I have written to all NHS chief executives and social care providers in Scotland to ask them to set out how they are supporting health and social care workers to get vaccinated. Digital reminders have been introduced, and health and social care staff are receiving prompts to get vaccinated. Boards are also offering drop-in clinics and appointments that can be booked in any health board area, making it simpler for people with busy lives.
Presiding Officer, like you, the cabinet secretary is understandably proud of his Orkney roots—he often mentions that when he explains how he understands rural issues—so you can understand my surprise and disappointment that the national planning priorities make no explicit mention of rural health challenges.
Across health and social care in Dumfries and Galloway, there is a combined funding gap of £58 million. Given that and the unique pressures in areas such as Dumfries and Galloway, including workforce shortages, long travel times and limited access to specialist care, how will the cabinet secretary ensure that rural communities are not disadvantaged? How will he ensure that, in practice, the new planning structures to optimise capacity address the distinct needs of rural and remote communities, rather than resources being focused on urban centres, where economies of scale are achieved?
Finlay Carson is absolutely right. In my discussions with colleagues on moving to a subnational planning structure for planned care activity, for instance, I have been explicit that I expect there to be support for rural and island communities to ensure that they are treated equitably. I do not expect our system to move forward with transportation happening in only one direction. NHS Highland’s national treatment centre is evidence of people travelling from the central belt to a Highland resource. That demonstrates that we are looking to ensure better equity both in the provision of healthcare and in who we expect to travel where.
The cabinet secretary will share my concerns about the pressures that Scotland’s social care sector faces this winter—pressures that have been exacerbated by Labour’s increase to employer national insurance contributions. We know that social care workers play an invaluable role in our communities, so will the cabinet secretary outline what steps the Scottish Government is taking to ensure that NHS boards improve flow from hospitals to social care settings, and set out what additional support is being put in place to support the social care sector?
Social care providers face real financial pressures from the UK Government’s increase to employer national insurance contributions, as Stuart McMillan highlighted, which is expected to cost the sector an additional £84 million. That is coupled with workforce shortages across the care sector that have been exacerbated by a significant decline in the number of health and care visas that are being granted by the Home Office—there was a 77 per cent drop in the year to June 2025.
We are working closely with partners to understand the impact of those issues, to identify further mitigating actions and, at the same time, to improve hospital flow and reduce delayed discharge. That is critical.
The money that we are announcing today will be targeted at the local systems that are most in need in order to deliver faster discharge and better integration with social care. Alongside that, record funding of £15 billion for local authorities in 2025-26 will help to strengthen resilience.
That concludes this item of business. Before we move to the next item, there will be a brief pause to allow a change of front-bench members.