Meeting of the Parliament (Hybrid)

Meeting date: Thursday, March 24, 2022

Official Report 1134KB pdf

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NHS Scotland (Pandemic Pressures)

The next item of business is a statement by Humza Yousaf on pandemic pressures on NHS Scotland. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.

15:00  

This week, the number of people in hospital with Covid-19 has reached the highest level since the start of the pandemic, which is having a significant impact on our health and social care services across the entire system, but especially in accident and emergency departments.

Our health board colleagues and those who work on the front line all tell us that the past two weeks have been the toughest in the pandemic so far, and the latest data shows some of the lowest performance against the four-hour A and E target that we have seen.

That level of pressure impacts on patients and staff, and I want to start by thanking our national health service and social care staff, to whom we owe a huge debt of gratitude and who continue to provide vital treatment and optimal patient care during the most challenging times. I have no hesitation in apologising to patients and those who have been in any way inconvenienced, or who are suffering, because of the current pressures for that suffering and inconvenience. I appreciate the patience that every person is showing at this extremely challenging time.

A number of factors are contributing to the impact on A and E services. Those include the fact that a record number of people are in hospital with Covid; the infection prevention and control measures that are currently in place; the exacerbation of workforce pressures by record levels of community transmission; the increased level of attendance at A and E services; the high levels of delayed discharge; and the longer length of hospital stays.

Today, there are 2,322 Covid patients in our hospitals. That number has more than doubled since February, and it is now past the previous peak of last winter, when 2,053 patients were in hospital with Covid in January 2021. Using the latest published Covid-19 modelling, we anticipate that the number might well continue to increase over the next few weeks.

The increase in cases and hospitalisations is largely due to the dominance of the more transmissible omicron BA.2 variant, which accounts for about 90 per cent of all reported cases. The latest Office for National Statistics survey data shows that one in 14, or more than 7 per cent of people in the community in Scotland, would have tested positive for Covid in the week to 12 March. That is the highest estimate that Scotland has had since the survey began in autumn 2020.

Thanks to the excellent progress that has been made on vaccinations, the recent rise in cases and hospitalisations has not—thankfully—translated into an increase in the number of cases of people with severe illness who require intensive care. However, that level of continued pressure is challenging in the context of a health service that has been dealing with sustained and relentless demand and pressure for nearly two years. Unlike in wave 1 of the pandemic, when services were stood down, we are remobilising our national health service.

In addition, infection prevention and control guidance remains in place and is important for maintaining safety in our hospitals. However, that undoubtedly creates additional complexities and inefficiencies when it comes to moving people through the system—for example, patients cannot wait in the discharge lounge or “sit out” to wait for discharge drugs. That means that they must wait in the bed space for longer than required, and that space must then be deep cleaned prior to a new admission. In addition, patients cannot access normal transport and must travel on their own or with other patients with Covid.

I can advise that all four United Kingdom nations are looking to develop an exit strategy from the existing UK winter infection prevention and control guidance and are considering what a return to business as usual would look like. Next steps include a range of changes that, if implemented, would help to relieve some of the pressures that the system is currently experiencing. Ultimately, if we can control community transmission of Covid, we will help to alleviate the current pressures.

The level of absences attributed to NHS staff testing positive for Covid has increased by almost 100 per cent—it has doubled over the past four weeks to almost 4,700. That increase in staff absence puts an incredible strain on the delivery of health services. Healthcare workers who are asymptomatic are asked to test twice weekly. That includes all NHS and independent contractor staff in patient-facing primary care. We are reviewing that regularly as part of the testing transition plan. In the latest week, ending 22 March, an average of 6,000 NHS staff—about 3.4 per cent of the NHS workforce—were reported absent each day for a range of reasons related to Covid-19.

We have worked hard throughout the pandemic to maintain record staffing levels across our NHS. Under this Government, staffing levels are up by more than 28,000 whole-time equivalents to a record high. We have invested in growing our workforce by just under 10 per cent in the past two years to enhance our services’ capacity to deal with the new pressures that they have faced.

We recognise the scale of the improvements required and are working closely with partners to accelerate domestic and international recruitment to Scotland. Our record £300 million of new investment to help services to deal with system pressures over winter led to the introduction of a range of direct workforce investments and new measures to support health boards’ capacity for both domestic and international recruitment.

We are investing £11 million over the next five years in new national and international recruitment campaigns, and we have established a national centre for workforce supply to provide labour market intelligence. We are also recruiting at least 200 registered nurses from overseas, with funding of £4.5 million available to health boards to take that forward. We have asked boards to recruit 1,000 agenda for change staff to provide additional capacity across a variety of health and care services, with funding of up to £15 million. We are working with boards to develop nationally co-ordinated recruitment campaigns to actively recruit nursing and medical staff from within the UK. A band 5 nurse campaign was launched on 18 February. Scotland has, as we know, the best paid NHS staff in the UK, and we have made £12 million available this year to support staff wellbeing.

Increased demand is clearly creating pressure for our acute sites and across our NHS and social care systems. In the latest week, attendances at A and E departments increased to 26,000, which is the highest number in six months. The last time the number of Covid in-patients was above 2,000—which was in January 2021—there were 16,000 attendances at A and E departments in that week. That is an increase of almost 40 per cent, which is putting even more pressure on stretched services.

We also hear that people are presenting with higher acuity. They are sicker when they come to hospital and, as a result, have to spend longer in hospital. The average length of stay is up by about one day, or 16 per cent, which means that there is a greater requirement for beds.

Those issues are not unique to Scotland. Our A and E departments have been the best performing in the UK for the past six years. The latest comparable data for January shows that Scotland’s A and E performance was 11.4 percentage points better than in England and 14.1 points better than in Wales.

Our colleagues in the community are also experiencing challenges. The current spread of Covid in the community is creating significant problems for our workforce. That is felt in social care. I know that our health and social care partnerships are working incredibly hard to support people in the community and those who are coming out of hospital. All partnerships are now involved in our discharge without delay programme to improve discharge planning arrangements and reduce the length of hospital stays.

Regarding planned care, our NHS colleagues are working exceptionally hard to restart elective activity. However, Covid, workforce and bed capacity pressures continue to create challenges, and we are now receiving reports that some restarted elective treatment is again having to be postponed to deal with the increasing pressure that our health boards are facing.

Extended waits for elective treatment increase the risk of deteriorating health and social care outcomes and can have an additional impact on unscheduled care. We are working closely with health boards and partners to support planning and the delivery of the high-level commitments in the NHS recovery plan that was published last summer.

We are also investing in our hospital at home programme. We have enhanced hospital at home services right across Scotland over the past few weeks, with further capacity expected to come on stream by the end of this month. That work is critical as we move into the recovery phase, and we are already beginning to see some of the fruits of that input. During the six-month period between September 2021 and February 2022, 4,500 patients received care from a hospital at home service. That is 4,500 people who, without those services, would have had to go to hospital. That resulted in 26,700 occupied bed days in hospital at home services, so we avoided 26,700 acute hospital bed days.

The redesign of the urgent care programme is incredibly important, too. We have supported it with £23 million this year, and it is another example of the positive work that we are undertaking. Through that programme, we are strengthening alternative services so that those who think that they need to go to A and E, but whose illness is not a critical emergency or life threatening, can be seen or treated at home or in the community.

We are also increasing funding for NHS 24 so that people can get good advice quickly, because I know that some waiting times for NHS 24 have been too long.

I have been up front and honest about the scale of the challenge for our NHS recovery. It will take time. The recovery will not be achieved in a matter of weeks or months—it will take years. We are working closely with boards to deliver a package of measures to support sustainable recovery. How can we insulate that recovery in the event of future Covid-19 waves? That is the work that we are undertaking.

We will continue to fund our national treatment centres through the £400 million for the national treatment centre programme. That will, again, help us in our recovery, particularly with regard to elective care. NHS funding for 2022-23 is at the record level of £18 billion.

Our health and social care services continue to face unprecedented pressures—there is simply no denying that. I hope that I have managed to set the context in explaining why they are under such severe pressure. I will work day and night, as I have done since I was appointed to this role, to make sure that we support the men and women who are working so hard in our health and social care system. I will end where I started by thanking them again for their incredible efforts over the course of the pandemic.

The cabinet secretary will now take questions on the issues that were raised in his statement. I intend to allow 20 minutes or thereabouts for questions, given the extra time that the cabinet secretary took for his statement. After that, we will move on to the next item of business.

I would like to start by thanking all the heroic NHS staff who have worked throughout the pandemic and are still working hard now.

In his statement, the cabinet secretary essentially set out a list of excuses and patted himself on the back. How can he possibly do that with the problems that we are facing in the Scottish NHS?

The cabinet secretary talks about spending more per head than in England, but given the Barnett formula, funding here should be billions more. The cabinet secretary continues the self-congratulations by stating that we now have more staff in our NHS. That would be fine if demand were the same as it was even five years ago, but demand is significantly rising, and actually we have record vacancies in our NHS, in areas from nursing to physiotherapy.

That is not all due to Covid. The Government’s lack of credible workforce planning and a flimsy Covid recovery plan have led us to this. What will the cabinet secretary do to tangibly deliver help to us today, not in years? Plus, this statement was originally meant to be on A and E services. What immediate, tangible help will the cabinet secretary give to A and E departments? I ask because I fear that he is making excuses here and that there is nothing to actually tackle the problem.

I am afraid that that is simply incorrect. It is not a list of excuses. I am setting out the context of why we are facing the pressures that we are facing. I would have thought that that would be helpful, given that people are rightly asking why our performance is where it is and why people are having to wait too long.

The member calls our recovery plan “flimsy”, but if it is flimsy, why on earth did his colleagues in London copy it? They imitated our plan—the 10 per cent additional capacity that we will create is a central plank of their recovery plan. It is not a flimsy recovery plan.

What I am trying to say to members across the chamber is that we have to insulate our recovery as well as we possibly can against future shocks and future waves of the pandemic. I have set out already in great detail—for the sake of brevity, I do not intend to rehearse it—all the funding that we are providing to our health boards, from the £300 million winter plan to the £20 million additional funding for our Scottish Ambulance Service.

If we had not made that investment, things would have been far worse than they are, so I am proud that we have higher NHS workforce numbers per head than in England, where the member’s party is in charge. Our A and E outperforms England, where his party is in charge; we have the best paid staff in the UK; we have more GPs per head than in England, where his party is in charge; and we have more dentists per head than where his party is in charge. It is no wonder that the people of Scotland continue to trust the Scottish National Party, not the Conservatives, to run our health service.

That is not a list of excuses. Today, I have demonstrated the context of why we have those challenges and how this Government is stepping up to them.

I welcome the cabinet secretary’s statement, but I look forward to a time when he is not just commenting on the context or how bad the problem is but actually taking action.

The number of patients who are waiting in A and E is at an all-time high. In fact, it is higher than at any time since records began in 2015. Of course, that is assuming that people can get to A and E, that they can get their call answered by NHS 24 or that they can get an ambulance to show up. I thank the staff who are working tirelessly, but they are being let down by this Government. Everyone is waiting for this cabinet secretary to do something, but all he has are the answers that he gave in October 2021. Those initiatives have not worked. Delayed discharge has increased, and is taking up capacity in our hospitals, which has a direct impact on A and E.

As John Thomson, of the Royal College of Emergency Medicine said,

“things cannot continue as they are, more patients will come to harm and staff will face increasing distress”.

Perhaps the NHS would have been more resilient if the cabinet secretary’s predecessors had not cut beds, had fixed the workforce crisis and had sorted social care. However, those problems are not new and they predate the pandemic. The cabinet secretary is playing fast and loose with the lives of Scots. We need more than sticking-plaster solutions and further excuses. When will he come to the chamber with a plan that will actually make a difference?

Listening to Jackie Baillie, people would not realise that we are in the midst of a global pandemic. Not only are we in the midst of that global pandemic—

Excuse!

She is shouting “Excuse!”, but we have the highest number of people in hospital with Covid, the highest level of community transmission because of Covid, and there are high levels of workforce absence because people are testing positive for Covid. As much as I and, I suspect, Jackie Baillie would like to, we cannot just magic away the pandemic.

We are taking action. She asked what action we are taking and I can again go through the list of funding that we have provided. On top of that, our immediate action includes additional funding for the hospital at home programme. For example, I have just given her details of how we managed to save 26,700 acute hospital occupied bed days. She is right that delayed discharge numbers have been going in the wrong direction but, of course, when we have many outbreaks in many care homes, it becomes more difficult to discharge people into the community.

In some areas, we are making progress. When I met the City of Edinburgh Council and Edinburgh health and social care partnership, I learned that, since the end of January, they have managed to achieve a reduction in standard delays, so some health boards, local authorities and health and social care partnerships are moving in the right direction. Of course, keeping Covid under control would be our best tool in order to aid recovery.

As we move on from front-bench questions, I would seek more succinct questions and answers.

General practitioner receptionists are trained to guide callers to the best option for their health care needs, especially because it is not always the GP who is best placed to help. However, many GP receptionists, including those in my constituency, have reported an increase in abuse when they are doing their best to help. With the very stark figures that were announced today, it is likely that GP services will see an increase in people looking for an appointment. Will the cabinet secretary join me in urging callers to take guidance from GPs’ receptionists, because they play an important role in getting people to care in the right place? Will he join me in thanking those receptionists—in my constituency and throughout Scotland—for the incredible dedication and commitment that they have shown in the past two years and beyond? Will he also join me in saying that that kind of behaviour from the public is unacceptable?

I agree whole-heartedly with David Torrance. I thank all GP staff, from the GPs to the receptionists and all the multidisciplinary team members that work in a GP practice. Abuse towards any of our NHS or social care staff is completely unacceptable.

I do not at all buy into the narrative that GPs and their staff are not working hard to see patients. They are working extremely hard to see patients, which probably why, in his blog, the chair of the British Medical Association’s general practitioners committee congratulated the Scottish Government on the approach that it has taken, which is in very stark contrast to the approach that the UK Government has taken.

Sue Webber joins us remotely.

Yesterday afternoon, the cross-party group on women’s health heard that midwives are leaving the profession in droves. They cannot cope with the stress that is placed on them by workforce pressures. Right across the sector, there are simply not enough of the right skilled staff on duty at any one time. Midwives are underfunded and overworked, and are, quite simply, burnt out.

The statement offers nothing new for them—no additional support and no additional funding. At what point will the health secretary cease his self-congratulatory tone, move out of his echo chamber and bring forward a credible plan to relieve the long-standing pressures on the midwifery profession—pressures that long predate the pandemic?

I disagree with a few of those characterisations. There is nothing self-congratulatory; all that this Government and I have done is set the context of why we are in the challenging position that we are in.

Where I agree with Sue Webber is that the wellbeing of our staff is absolutely central. Every clinician and member of staff in our NHS and social care I speak to is, frankly, knackered, which is why I and the Government have brought forward funding to address staff wellbeing.

What I would say to Sue Webber is what I said to Jackie Baillie and Sandesh Gulhane: if we can control community transmission of Covid, that will significantly help us to alleviate pressure.

Let me place on record my thanks for the excellent work that midwives do right across Scotland.

Vaccines are the best line of defence. Fortunately, although we are seeing very high numbers of people in hospital, the vaccine is clearly having an impact on the number of lives lost to Covid.

Is the cabinet secretary optimistic that the uptake of the spring booster among those who are eligible will have as widespread and positive an effect as the previous booster?

Yes, I am confident, and I agree with Evelyn Tweed’s articulation that vaccines have been a game changer. I would encourage anybody who has not had any of the doses for which they are eligible—their first, second or third dose, or their booster—to please come forward, because vaccines are our number 1 tool in the fight against the virus.

This week, NHS Greater Glasgow and Clyde once again issued a warning not to attend A and E unless the situation is life threatening. The board has used that warning repeatedly since August. People have been advised to use NHS 24 instead, but we know that, from September to January, 24,000 calls went unanswered.

That leaves people in a precarious position and not knowing where to turn, often in very serious situations. I note the statement’s reannouncement of the opening of the Dundee contact centre. Can the cabinet secretary clarify how many additional staff are required to meet the demands on NHS 24 and how many have been recruited, in order to ensure that people are not put at risk when they are being told not to attend A and E, and ensure that their call is answered by NHS 24?

I am certain that Paul O’Kane accepts this, but nobody who takes the decisions that have been taken by NHS Greater Glasgow and Clyde and any other health board that has taken them does so lightly. They do not put out messaging such as that on a whim. It is difficult to decide to do so but, ultimately, those decisions are made because of the pressure that health boards are under.

I have visited the NHS 24 site in Dundee. The recruitment is on-going, and it is taking place to help us meet that demand. NHS 24 is focused on ensuring that patients receive the correct advice immediately, without being required to be placed in a queue, and it has consistently exceeded the 90 per cent target for care delivered at the first point of contact. In fact, the 20 March statistics show that the number was up to 95.4 per cent. We are making progress, and the recruitment that we are undertaking will help to alleviate some of that pressure.

Everybody understands the acute pressure on the NHS, which will clearly have real consequences, not least for the capacity of our Scottish Ambulance Service to quickly get to those in need. I welcome the cabinet secretary’s engagement on a case that I raised with him recently. Will the cabinet secretary provide an update on how the Scottish Government will improve waiting times for ambulances?

I thank Siobhian Brown for raising that case with me recently.

I reiterate what I said at the beginning of my statement: if anybody has to wait too long for an ambulance and suffers as a result of that, I make no hesitation in apologising to them for that inconvenience and any suffering that they have experienced.

Siobhian Brown is right. Our NHS and social care systems are interconnected, and therefore the pressures that are being faced in A and E are having an effect on the Scottish Ambulance Service. However, despite the challenges, including managing staff abstraction due to Covid, and serving in some of the most rural areas in the UK, in 2020-21, our ambulance crews responded to more than 70 per cent of the highest priority calls in under 10 minutes, and to 99 per cent in under 30 minutes. Ambulance crews are saving more critically unwell patients than ever before. Figures show that the 30-day survival rate for the sickest patients is at its highest rate, with a survival rate of 53.8 per cent.

I know that quoting the improvements that have been made and the significant efforts of our Ambulance Service may be cold comfort for those who have to wait a long time, which is why, in the summer of last year, I took action to ensure that there was more additional funding for our Ambulance Service.

Like others, I pay tribute to all those working in our health and care services.

In January, I asked the Government when self-referrals for the over-70s to the breast cancer screening programme would resume. There was no mention of the resumption of self-referrals in the statement, despite the commitment in January to consider accelerating the timetable.

Can the cabinet secretary provide a clear timetable for when that service for the over-70s will resume, and an assurance that those who need or wish to be screened, including those in Orkney, who are reliant on a mobile screening unit visiting once every four years, can be seen without fear of lengthy delays?

I have been actively engaging with our screening colleagues on that very question. I have gone back to them to ask whether we can accelerate the referral route for those who are 71 and over. I think that I said to the member in January that there is a difficulty there. If we were to do that now, it would probably extend the gap between cycles for those who are between 50 and 70. In looking at the benefits versus the risks, it may be that extending the gap would be beneficial for those who are 71 and over, in terms of self-referral. We are looking at the issue, and I would hope to have an update, if not in a matter of weeks, certainly in the near future. I will ensure that Liam McArthur is kept updated on those discussions.

The cabinet secretary mentioned the importance of controlling community transmission of Covid. In one sense, community means the world; it does not just mean Scotland. Can the cabinet secretary say anything about what Scotland can do, either directly or through the UK Government, to help other countries through Covid?

That is a fundamentally important point. Time and again, throughout the pandemic, we have said that nobody is safe until everybody is safe. That is absolutely true. Although we are not officially a member of the Covid-19 vaccines global access—COVAX—initiative, we have been in touch with the UK Government regularly on how we can help the vaccination effort across the world. We have asked how we can particularly focus some of our efforts on Malawi and Zambia, where we have important people-to-people relationships. I want John Mason to know that the Scottish Government is very keen to play its part as a global leader and a member of the global community in relation to vaccinations across the world.

In the week ending 13 March, 51.9 per cent of people attending A and E in NHS Forth Valley were seen within four hours. That is the lowest figure of any health board in Scotland. I know that staff at Forth Valley have been working incredibly hard to improve waiting times, and that January saw remarkable improvement, so it is concerning that the figure dropped again. Forth Valley has one A and E unit, and demand is simply outstripping capacity. What more support can the Scottish Government provide to Forth Valley and other health boards that are experiencing similar pressures?

The member is right that there have been concerns about Forth Valley. As she can imagine, I have spoken to the chief executive and chair of Forth Valley. However, on other metrics, Forth Valley performs well. For example, it has managed to protect some element of elective capacity, whereas other health boards have perhaps been unable to do so.

As I have said to every other member, the best thing that we can do, on top of the additional investment that I have announced, is to ensure that we get Covid transmission under control. In the period last year between the delta wave and the omicron wave—between October and November—when we had Covid transmission under control, there was a significant increase in scheduled operations. Our NHS has the ability to recover, and recover quickly, but we have to control Covid.

The cabinet secretary’s statement, like his previous announcements, has lots of words but very few actions. He claims that the problems in Scotland’s health service are largely down to pressures that are caused by the unprecedented number of patients who are in hospital with Covid. Can he say how many of the 2,322 Covid-positive patients are in hospital because of Covid and not only with Covid, and does he have data on the number of people who are admitted without Covid but go on to acquire it once in hospital? If he does not know basic things such as those, how on earth will the Government set about implementing its flimsy NHS recovery plan or set a new clinical route map to get the NHS back to business as usual?

The member calls it a “flimsy” recovery plan, but it is a plan that his colleagues in Westminster copied. They copied our 10 per cent target and must have thought that it was a very good plan, so I am not sure why he chooses to call it “flimsy”. If we had listened to the Tories, who demanded that we lift protective measures a long time ago, goodness knows how much more difficult the pressure from Covid would have been.

In relation to his question, I have asked NHS Greater Glasgow and Clyde to do another audit, similar to what it did during the original omicron wave, to determine whether we can get greater detail about those who are in hospital with or because of Covid. As important as that data undoubtedly is, regardless of whether someone is in hospital with or because of Covid, the infection prevention and control measures around them remain, and that is what is putting significant pressure on our NHS.

Due to the success of the vaccination programme, we can move away from legal restrictions and rely on other behaviours. We know the value of appropriate face coverings in preventing the spread of Covid-19 but, with the possibility of that restriction being lifted soon, what assessment has been made of the need for people, especially those in vulnerable groups, to wear higher protecting FFP2 or equivalent masks when in clinical settings or crowded public places?

To be brief, the Cabinet will have a discussion and come to a decision on potentially lifting the legal requirement to wear a face covering. That decision has not been made and will be debated in Cabinet on Tuesday, as you imagine, with the best and most up-to-date clinical advice that we receive.

In relation to the member’s substantive point about FFP2 masks, I confirm that we are looking closely with our clinicians at whether higher protection could be afforded to those at highest risk through the use of FFP2 masks. The issue of the wearing of face coverings, including the grade of face covering, is kept under regular review.

That concludes the statement on NHS Scotland pandemic pressures. There will be a short pause before we move on to the next item of business.