Meeting of the Parliament

Meeting date: Tuesday, October 24, 2023

Official Report 1124KB pdf

---

Health and Social Care (Winter Planning and Resilience)

The next item of business is a statement by Michael Matheson on planning for winter 2023-24 and on-going resilience across health and social care. The cabinet secretary will take questions at the end of his statement, so there should be no interruptions or interventions.

15:17  

We are in no doubt that this winter will be extremely challenging for our health and social care system. We continue to see changes in the demand for health and care services, with the population’s needs and the care packages that are required becoming increasingly complex. That sits alongside the rise in the number of patients with respiratory illnesses and winter-related injuries from falls and accidents that we see every winter.

The winter plan that we are publishing today has been developed jointly with our partners in the Convention of Scottish Local Authorities. It is the articulation of a huge amount of planning and preparatory work that is already well under way across the whole system. Since the end of last winter, the Scottish Government and COSLA have been supporting the system to be as ready as possible for the pressures that it will face, so that people can continue to have access to health and social care services and the support that they need when they need it most.

The winter plan is built around three critical principles. First, the actions that we take must centre around our citizens and the best outcomes for them, so that they can access the right care at the right time and in the right place. Secondly, we are taking a whole-system approach, recognising that pressures in one part of the health and social care system create challenges and pressures elsewhere. Thirdly and finally, we are building on the lessons that we have learned from previous winters so that, consistently and with unwavering focus, we undertake local and national actions that we know work.

There are a number of key differences in our approach to winter planning this year. The planning cycle for this winter started in early spring—earlier than ever before—in recognition of the fact that surges in demand for health and social care services do not happen only in winter. It is our intention that in future years we will undertake surge planning on an on-going basis, given the sustained pressure that the system is under all year round.

We issued a delayed discharge and hospital occupancy action plan to national health service boards and health and social care partnerships in March, and the actions and best practice that it outlines are critical to improving outcomes for patients, flow through the system and capacity in our hospitals. Those fundamentals are reiterated in the winter plan, and I urge system leaders to redouble their efforts to adopt and sustain those actions.

Moreover, in August, we convened the first NHS and social care winter summit, which brought together more than 300 leaders from across Scotland’s health and social care services to share best practice and local plans for this winter. I was particularly pleased that social care providers, local government leaders and the third sector were all present.

In September, we issued a winter preparedness checklist to local systems, and we have subsequently taken action on returns from that checklist, ensuring that we have a clear understanding of the risks to the system, both locally and nationally. We have vastly improved the quality of the data and reporting needed to help us and the system spot issues as they begin to emerge and to allow us to understand when escalation is appropriate.

I want to turn to our highly skilled and committed workforce, who are the cornerstone of our response every winter, both in health and in social care. In order to meet increased demand and provide the best care possible for our citizens, we will continue to focus on recruitment and retention of our workforce and on ensuring that we support our staff’s wellbeing throughout the challenging period that lies ahead and during periods of high demand.

We are pursuing a range of different strategies to nurture and grow the health and social care workforce over the longer term. With regard to our health workforce, for example, I am pleased to say that, as a result of significant Scottish Government investment of more than £15 million, an additional 1,000 nurses, midwives and allied health professionals from overseas have joined NHS Scotland over the past two years to bolster our existing workforce. In addition, we have made £3 million available to support the recruitment of up to a further 250 registered personnel. Recruitment is presently on-going, and many of those staff will be in post this winter.

As for the social care workforce, we are working with partners and have a number of national social care campaigns in place, in addition to an international recruitment pilot. That investment in our workforce will continue.

I am pleased to announce a £50 million funding boost for the Scottish Ambulance Service this year to help support increased demand, particularly ahead of the winter period. Helped in part by that funding, work is presently under way to recruit a further 317 front-line staff, which will increase emergency response capacity as well as provide additional staff in call centres. That builds on the record number of additional staff who have been recruited to the Scottish Ambulance Service, with 1,388 people joining the service in the past three years alone.

That investment will help reduce the need for people to go to hospital by increasing the number of clinicians working in the service’s integrated clinical hub, improving triage for patients who might not require an emergency response and enabling people to receive the right care for them in the right place. Crucially, we are encouraging the system to adopt a home-first approach when it is clinically appropriate to do so. Assessing and providing care in a home setting is better for people, their families and carers, and frees up workforce capacity not only in our hospitals but across the social care sector.

We are supporting our services to deliver that improvement in care delivery. The Scottish Government is significantly increasing investment in the hospital at home initiative, which provides more personalised acute care to patients in their own home. That way of delivering care is preferred by the majority of people who seek support, with improved levels of patient satisfaction, and it consistently achieves equivalent or better results. We are already investing an additional £3.6 million this financial year for local systems to expand that service and increase the number of patients being treated in that way.

I can announce today additional funding of up to £12 million to expand our hospital at home service. The funding will be targeted at expanding hospital at home during this financial year, with the anticipated delivery of at least 380 more hospital at home beds this winter to significantly increase capacity in our system. That will have the knock-on impact of reducing the need for emergency admissions every single week, which, in turn, will reduce pressure on accident and emergency services and throughout the system. That will, of course, be better for those who need acute care.

The winter plan clearly seeks to address the specific operational pressures that are experienced across the health and social care system over the winter, with actions already under way to improve services. However, we know that longer-term solutions are needed, and we continue to engage separately with local government, the NHS, trade unions and other key partners on the wider improvements that are needed in the development of the national care service.

As for the longer term, there is our joint work on establishing the national care service, which will be a key means of delivering sustained change and responding to the challenge that we know our social care system faces this winter and beyond. Even with the significant effort across the whole system over the past few months, winter remains a concern. If we arrive at a point where the measures set out in the winter plan are simply not enough to cope with surges in demand for health and social care services, we will not hesitate to act to support the system, working closely with our partners in COSLA and beyond.

The winter plan is not a starting point for action; it is the articulation of many months of whole-system collaboration for this winter. It builds on the lessons learned from previous years and on partners working together to deliver the best care for the people of Scotland. The Scottish Government and COSLA have been working tirelessly to create the conditions needed for the whole system to deliver, and we are united in our resolve to provide safe and timely access to health and social care services over the winter period.

Thank you, cabinet secretary.

Members will not be surprised to hear that we are now, for obvious reasons, somewhat tight for time for the rest of the afternoon. I intend to allow up to 20 minutes for questions, after which we will need to move on to the next item of business.

I refer to my entry in the register of members’ interests as a practising NHS general practitioner.

This morning, new figures were published revealing that, last winter, more than 24,000 people died, the highest number in over 30 years. The news, although sobering, will be of little surprise to anyone who had to wait for hours to be seen at accident and emergency last winter, to those who were unable to be seen by their GPs and to thousands more who were left languishing on NHS waiting lists, despite the heroic efforts of clinical staff. That makes it all the more important for the Scottish National Party Government to get things right this winter and all year round so that patients are never again subjected to such conditions

However, all the signs are once again pointing to another disastrous winter for our NHS under the SNP. John-Paul Loughrey of the Royal College of Emergency Medicine told the Health, Social Care and Sport Committee

“that this is no longer a winter problem but an ‘NHS in crisis’ problem, and that short-term winter reactions are”

only

“crisis mitigation.”—[Official Report, Health, Social Care and Sport Committee, 5 September 2023, c 5.]

Does the cabinet secretary agree that we need to take a more holistic approach to secondary care instead of simply moving from one crisis to the next?

On Mr Gulhane’s first point, which was about mortality rates, I am sure that he will recognise that there is a variety of reasons for mortality rates appearing to have increased not just here in Scotland but across the UK, as was noted in the publication issued this morning. To see that as a reflection of present A and E performance would be inaccurate and would not give people the correct impression of why mortality rates have increased.

Mr Gulhane’s second point was about the need for a holistic approach. As I acknowledged in my statement—and, indeed, as the winter plan acknowledges—the system is under pressure throughout the year. The situation becomes acute during the winter months for particular reasons, such as the increase in respiratory conditions and weather that can have an impact on health. All of those factors add pressures. I do accept the need for a holistic approach, which is why we are taking a whole-system approach this winter and doing everything that we can—not just in healthcare but in wider social care—to give more support to the system in what will be a challenging period for those who work in it and those who use it.

I welcome the cabinet secretary’s statement and thank him for an advance copy. I also thank the many staff in our NHS and social care services who support us all year round.

I, too, will raise the report from National Records of Scotland that revealed that 24,427 people died in Scotland last winter. That is a staggering 11 per cent jump on the previous year’s figure and is the highest number of winter deaths in more than 30 years. At the same time, the delayed discharge figures last winter were the highest that they have ever been, which will have affected the mortality rate.

Does the cabinet secretary acknowledge that the Scottish Government failed to deliver a comprehensive winter plan last year, which resulted in a last-minute scramble to roll out additional support in January? Given that the delayed discharge figure was sitting at 1,700 in August, if we assume that his plan will work, what does he expect that number to be in January?

The increase in mortality rates is not peculiar to Scotland; mortality rates have increased significantly across the UK for a variety of reasons, as the report recognises. One of the biggest drivers of the increase in mortality rates over the past decade has been austerity policy, which is literally killing people because of its direct impact on services. We have only to look at the report that the Glasgow Centre for Population Health published earlier this year, which highlighted the impact that austerity is having on our most deprived communities in driving up inequalities and mortality rates overall.

On Jackie Baillie’s point about the need to have appropriate planning, I have been keen to ensure that this year’s plan looks at all aspects of the system—at their interrelated nature and at how the health service depends on social care and social care depends on the healthcare system. As the plan acknowledges and as I have set out, we have learned the lessons from last year and we have implemented the actions that we can take to address some of the challenges that we faced last year.

However, I would not be foolish enough to come here and suggest that that will resolve all the issues—that the winter plan will ensure that we have no pressures in the system and that everything goes perfectly. There will be difficulties and challenges in the system, but the winter plan puts in place a mechanism to deal with them as effectively as we can in the different parts of the system that can do so.

Jackie Baillie’s final point was about delayed discharges, where the challenges are not so much about the figure in itself as they are about the increase in the time that patients are staying in hospital and the increase in acuity. As a consequence, there is pressure across the whole system. Individuals whose discharge is delayed will end up having harm caused to them because they cannot get discharged into the community early enough.

Dealing with the pressure on the system is critical to addressing the issue. The most effective means to do that is through a national care service, which would achieve a consistent approach across the country. We can see that performance is good in some health and social care partnerships and not good in other areas. That is why we need to move to a service that will allow us to deal with the issues more effectively across the country.

Thank you, cabinet secretary. I am going to need a bit more brevity with the responses.

I note that the cabinet secretary’s statement referred to an increase in weather-related injuries from falls and accidents. I have read the winter plan, but the humble word “pavements” does not appear there. That is not a frivolous observation, because avoidable falls on icy pavements are obvious contributors to winter pressures at all levels of our health and social care service. In the discussions with COSLA, has any progress been made on, for example, providing self-service sand and salt bins by street—say, on request? If not, could that be progressed? It might sound like a silly observation, but there is nothing silly about it. Many people fall on icy pavements.

Thank you, Ms Grahame. Cabinet secretary—

I think that such an approach would be cost effective.

I recognise that, historically, there have been challenges during winter months when the weather has been adverse and there have been icy periods when accident and emergency departments have been busy with individuals who have slipped and fallen, and have broken wrists, hips, ankles and so on. It has been a long-standing issue.

The aim of the winter plan is to deal with issues in the health and social care system. We need to ensure that local authorities do everything that they can to provide communities with resources to allow them, where necessary, to be able to distribute salt in their local streets or wherever else it is provided. I encourage local authorities to play their part in helping us to take the right actions to ensure that pavements are safe during periods of adverse weather.

I, too, pay tribute to our hard-working NHS staff. In February this year, Aberdeen royal infirmary declared a major incident due to a perfect storm of staffing pressures, bed blocking and ambulance stacking. Other hospitals were on the brink of doing the same. The reality is that our healthcare system is already at breaking point even before the pressures of winter put greater strain on services and staff whose morale is at rock bottom. How can the Scottish National Party Government expect things to be different this time round when the wheels are already off the bus?

The challenges and pressures that our NHS faces in Grampian are similar to those that it faces across the whole of Scotland and, in fact, across the whole of the UK. The member made reference to the pressures on accident and emergency services in Grampian. The data on accident and emergency performance in Scotland shows that, for the past eight years, our services have outperformed those across the whole of the UK. I know that that will be cold comfort to people who go to accident and emergency and do not receive the service that they would wish to. However, if we look at the performance figures, we see that our accident and emergency performance is almost 9 per cent ahead of that in England when it comes to four-hour waits, and we are almost 10 per cent above the figure for Wales and significantly above that for Northern Ireland.

We are putting in resources to support key services where we can. Today, I have announced £50 million of investment in the Scottish Ambulance Service and another £12 million—making a total of £15.6 million this year alone—in the hospital at home service. We are providing funding that is the equivalent of that for another Aberdeen royal infirmary to support our NHS, take demand away from the front end of our hospitals, support people in their communities and ensure that people are treated through the Ambulance Service or diverted to primary care or minor injury units where that is appropriate. We will keep taking the action that is necessary to support the first-class staff in our NHS. Our approach, together with the provision of that funding, demonstrates that. Our record over the past 16 years demonstrates our commitment to ensuring that we provide the best possible healthcare that we can.

Aberdeen city health and social care partnership had intended to expand its hospital at home service from 37 beds to 55 beds by the end of March 2024, to ensure maximum efficient use of the current capacity, to help to provide acute care closer to people’s homes, to support early discharge from hospital and to provide alternatives to admission. I welcome today’s announcement on the hospital at home service. Does the cabinet secretary envisage that, with the additional £12 million of funding, the expansion of the service in Aberdeen and other places can now go further and faster for the benefit of our people?

As a result of the funding that we provided to partners earlier this year, NHS Grampian and Aberdeen city health and social care partnership have been able to expand the hospital at home service, as Kevin Stewart mentioned. With the additional funding, they will, over the winter period, be able to further expand the service, which provides patients who require acute care with support at home, when that is clinically appropriate.

I should point out to Kevin Stewart that although the hospital at home service is largely for older people, services in different parts of the country have expanded and provide support to younger people and to those who have respiratory conditions. The expansion of the hospital at home service that I have announced today will allow us to provide at least an extra 380 beds in the community, which, alongside what we have already provided, will represent, as I mentioned earlier, a 50 per cent increase in capacity. That will make a significant difference in helping to manage some of the challenges that we will face this winter.

Cabinet secretary, we need briefer responses as well as briefer questions.

The cabinet secretary referenced the recruitment of 1,000 nurses, midwives and allied health professionals over the past two years. That is welcome, but 7,000 vacancies in our NHS remain unfilled. Recruitment means little without a long-term retention strategy, so how does he plan to ensure that the new NHS workers stay in post, and how does the Government plan to fill the other 7,000 vacancies?

I recognise the need to not only recruit but retain staff in our NHS. That is why the nursing and midwifery task force, which I chair, has very specific actions in looking at how we can tackle both issues—how we can recruit more people into our NHS and how we can retain staff in the NHS. The task force has already taken forward work that will help to address those issues. The task force includes partners from trade unions, education and the NHS, and they are supporting that work to ensure that we have a long-term plan to support retention and recruitment in the NHS.

Rural areas face additional challenges in winter, such as longer journeys and greater disruption due to poor weather. How will the Scottish Government ensure that those challenges are accounted for?

I recognise that there can be specific challenges in rural areas. Hospital at home is a very good example of a service that can be deployed in rural communities to support people to remain in their home environment. We have also expanded the pharmacy first service, which can be deployed in rural areas, and NHS 24, which provides a range of services to individuals over the phone, including direct clinical support to individuals at home. Again, that can support people in rural communities such as Evelyn Tweed’s during the winter months and throughout the rest of the year.

The warnings from NHS workers are as bad as they have ever been. The Scottish Government is putting those workers in a situation that is as desperate as it is dangerous. The British Medical Association says that already-exhausted staff find it “demoralising” and “incredibly insulting” to listen to Government assurances on staffing. The latest statistics bear that out, with 5,600 vacancies in nursing and midwifery and consultant vacancies at sky-high levels. Any plan to recover the NHS, to tackle horrendous waiting lists and to get people treatment will fall flat without enough staff, so does the cabinet secretary recognise that there are simply not enough staff to meet the challenge of the winter ahead?

I recognise that there are NHS staffing challenges in Scotland, as there are across the whole of the UK. Alex Cole-Hamilton will be aware that there are a variety of reasons for why that is the case.

What are we doing to address those challenges? We have increased our training provision in order to recruit more people into NHS staff training programmes, whether those be medical courses or courses for AHPs or nurses. We have done that to ensure that we have a sufficient throughput of training places to support the NHS. We will continue to work with professional groups to ensure that we get the training balance right in order to recruit as many people as we can into the NHS and support our staff.

I will finish on this point. One of the things that underscores the difference in the approach to staff retention and recruitment that we have taken in Scotland relates to pay. Pay for NHS staff in Scotland is higher than it is for staff in any other part of the UK. We have avoided industrial action because of our direct interaction with trade unions and because we pay our staff the wages that they deserve in order to ensure that they continue to provide the first-class services that they provide right across the country.

Four members still wish to ask a question, and we have four minutes to go. I intend to get everybody in, but they will need to be brief.

Following the First Minister’s recent announcement of additional investment to tackle waiting lists, can the cabinet secretary outline how the £100 million annual package will improve services in East Kilbride and across Scotland while benefiting patients and staff and helping to ensure the NHS’s resilience over the often challenging winter period?

I recognise that there are patients who are waiting too long for the treatment that they require, which is why we have the additional £100 million a year—the £300 million over the next three years. That is new investment that will go into tackling the issues with waiting lists, and it is estimated that it will allow us to treat an additional 100,000 patients over the next three years. That is a demonstration of the Government’s determination to ensure that people receive the treatment that they require at the earliest possible point in the appropriate setting.

NHS Forth Valley, which is in my region, has faced extreme pressure on its accident and emergency department in previous winters, affecting patients and staff alike. What action can the Government take to provide targeted support to health boards that face particularly acute pressures?

For health boards or health and social care partnerships where there are particular challenges, we work directly in partnership with the health and social care partnership to ensure that it takes forward a range of actions to address the pressures and challenges that it faces. In my statement, I mentioned the winter preparedness checklist that has been issued. That has allowed us to draw in a lot of information on preparations that are in place in areas such as Forth Valley, which covers my constituency, to look at their state of preparation and to address areas where further actions need to be taken.

That is the type of action that we are taking with health boards such as NHS Forth Valley and their partners to try to ensure that they are doing everything that they can to be prepared for the winter pressures that they will face.

Substantial and sustained improvement on delayed discharge depends significantly on addressing social work and social care workforce issues. In response to the winter planning 2023-24 inquiry in the Scottish Parliament, Social Work Scotland highlighted the issue with non-recurring funding and the detrimental impact that it has on recruitment and retention of staff. There is difficulty filling posts due to the short-term nature of the contract, which is leading to the unintended consequence of greater insecurity in the sector.

Ask a question.

What action will the cabinet secretary take to stop the on-going deterioration of the workforce situation?

We are taking forward a range of work to improve social work services, including making available additional funding to increase recruitment of social workers. Alongside that, we are taking forward work to encourage people into the social care setting, to make it an attractive place for people to pursue their caring career. That work will take time, but it is already in action in order to address the challenges that we face in the social care setting.

The additional funding for the Scottish Ambulance Service this year to support increased demand is very welcome. Will the cabinet secretary say more about how that investment will be directed to improve things for patients and to reduce winter pressures on our health services?

A key part of the £50 million of investment that we are putting into the Scottish Ambulance Service is to allow it to recruit an extra 317 front-line staff to help to increase emergency response capacity. Alongside that, the investment will provide 18 additional clinicians who will work in the Ambulance Service call centre hubs and will be able to provide additional triage services. When an issue is not time critical and does not require an emergency response, those clinicians will provide patients with advice and information on actions that people can take to deal with their condition or circumstances appropriately.