Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, October 27, 2021

Official Report 1084KB pdf

---

Urgent Question

---

NHS Lothian

To ask the Scottish Government what its response is to the statement that NHS Lothian’s services are under extreme pressure and that patients should not attend the emergency department unless it is life threatening.

Our health and care system is under extreme pressure due to the pandemic, and NHS Lothian, like all health boards, is experiencing significant pressure, including workforce challenges and a high level of delayed discharges, which are, inevitably, affecting waiting times in accident and emergency departments.

We recognise that some people are not getting the service that they or we expect, so I apologise to anyone who has suffered as a result. It is our ambition to ensure that more patients receive person-centred care in the right place at the right time, and in a way that helps staff to deliver high-quality care and treatment. That is why we invested £23 million this year to support development of the redesign of urgent care.

Recently, I announced a £300 million package of winter measures, which includes a focus on bolstering the caring workforce by increasing its numbers and providing additional support.

This morning, along with my senior officials, I met the executive team at NHS Lothian, and we have agreed a set of immediate actions that will support improvements and minimise delays for patients.

The figures that were released yesterday confirm that we have the worst A and E waiting times on record. Since the cabinet secretary’s “NHS Recovery Plan 2021-2026” was published in August, more than 55,000 people have waited more than four hours to be seen in A and E, more than 11,000 of whom were in NHS Lothian.

After last night’s advice from NHS Lothian, there is rightly a lot of concern among people about having to self-diagnose whether something is life threatening. Some injuries are not life threatening, but are serious—for example, a broken ankle might not kill, and a stroke that is left untreated can have life-changing consequences.

Does the cabinet secretary now accept that the Government’s recovery plan was not sufficient, and does he endorse the advice from NHS Lothian? If so, how can people access the treatment that they need?

I thank Sue Webber for her important question.

All health boards and clinicians would say that if a person thinks that their condition is critical or life threatening, they should not hesitate for a second to call 999 or get themselves to the A and E department. If they do not think that their condition is critical or life threatening, there are alternative pathways, such as calling NHS 24. People should err on the side of caution if they feel that their injury or condition, or that of a family member or friend, is critical or life threatening.

It is important that people listen to the advice of clinicians and their health board. I think that we would all accept and understand that the people who are working in hospitals across our national health service only want the best for the people whom they treat. However, I say to Sue Webber that when there is a time of extreme pressure, this Government will continue to invest.

We are facing the most significantly challenging winter that the NHS has ever suffered. Our performance is not where I want it to be; however, it is the case—this will be cold comfort to people who are waiting in A and E departments—that our A and E departments are the best performing A and E departments in the United Kingdom. I mention that just to highlight that, across the UK, we are facing common challenges.

We will continue to invest, and I have previously announced a £300 million winter package. I know that health boards are working round the clock to maximise capacity by safely discharging those for whom discharge back into community settings is clinically safe.

This morning, a constituent of mine texted me. She was too scared and upset to go to work at the Royal infirmary of Edinburgh because she knew that people have been waiting more than 30 hours in A and E due to lack of beds.

In NHS Lothian’s announcement, Calum Campbell, the chief executive, admitted that NHS Lothian hospitals are close to capacity and that the

“hospital system is under extreme duress.”

NHS Lothian has asked for mutual aid to help to ease the sustained pressures on its teams and patients. Will the Government provide that aid? What is the cabinet secretary’s message to hard-working NHS front-life staff who have fears that are similar to those of my constituent?

First and foremost, I thank Sue Webber’s constituent for all that she has done during the pandemic—in particular, during this significant period of challenge.

This morning, I spoke to a clinician who works at one of the Edinburgh hospital sites who reiterated how challenging and pressured the system is. This morning, I also spoke to Calum Campbell and to John Connaghan, who is the chair of NHS Lothian. They have had urgent and rapid discussions with their local authority partners and the health and social care partnerships in the region. They feel that they can make exceptionally good progress in order to discharge safely from hospitals into communities people for whom that is clinically safe. That will free up capacity, which will also help with the flow in hospitals. That is what the winter package is there to help with.

I will not pretend that, even with that increased investment, the winter will be anything but challenging. Performance will continue to be difficult. Where boards ask for aid, and that aid can be provided, we will leave no stone unturned in helping our health boards at this difficult time.

The cabinet secretary asked people to think twice before calling an ambulance. Now patients in Lothian are being told to hold off completely unless their condition is “life threatening”.

This winter, the NHS is reaching the crux of years of underresourcing and mismanagement; it is in genuine jeopardy. I do not have a medical degree, so I would be grateful for some advice from the cabinet secretary. What exactly does “life threatening” mean? Does he accept that asking people to judge for themselves whether their condition is life threatening will possibly prove to be deadly?

As I have already said to Sue Webber, if people feel that their condition is critical or life threatening they should, of course, pick up the phone to call 999 and get an ambulance or, if they are able to do so, get someone to transport them to an A and E department.

Other pathways are available if a person’s condition is not critical or life threatening. For example, they can call NHS 24, which is a 24/7 helpline, for assistance. We know that every health board in the country is under pressure. If a person’s condition is not critical or life threatening and we are able to assist by using alternative pathways, we should do so. That advice is being given across the board.

NHS Lothian made it absolutely clear in its most recent briefings to Lothians MSPs that one of the major pressures that its hard-working staff are facing in the enduring pandemic, alongside high levels of staff illness and self-isolation, is acute staff shortages in social care, which is impacting on the whole health and social care system. There are vacancies elsewhere and shortages of European Union workers. What can the recently produced “Adult Social Care Winter Preparedness Plan 2020-21” do to help with the pressures?

I thank Fiona Hyslop for that incredibly important question.

The adult social care winter plan and the winter plan that was produced to progress the £300 million winter package really focus on social care. We know that if we can bolster the social care workforce, we can help at the front and back doors of our acute services. We can, I hope, prevent people from going to hospital if they have the care at home and care home packages that they need, but we can also help at the delayed discharge end by safely discharging people to community settings when, I say again, it is clinically safe to do so.

Of the £300 million that I announced, £48 million is being made available to increase the hourly pay of social care staff. That will match NHS band 2 staff pay and will help in the recruitment of 1,000 additional NHS staff to support multidisciplinary teams. More than £60 million of the investment is to maximise the capacity of care at home services. Significant investment is being made. Although the workforce recruitment that I mentioned will take some time, I know that every single health board is looking to recruit as a matter of urgency.

People urgently need front-line health support, and many are going to A and E because they or members of their family are having health crises and cannot get support locally. For example, I have been inundated with patients from the Riverside medical practice’s area in Musselburgh who have told me heartbreaking stories, pre-dating the pandemic, about not being able to access general practitioner services. The issue has been raised by other constituents across the region, too. Can the cabinet secretary say what he is doing now to ensure that patients have the local medical services that they need, as well as the support that they need when they attempt to access accident and emergency services?

I recently met Colin Beattie MSP, who raised with me the issue of Riverside medical practice. I offered to continue to discuss with him what assistance we can provide, and I extend that offer to Sarah Boyack. Of course, it is for the local health board to deal with such issues.

On local services, I recently wrote a joint letter with the British Medical Association to every general practice in the country, including in the NHS Lothian region, in which I laid out quite explicitly my expectation that, given the changes in guidance, there would be an increase in face-to-face GP appointments, which we know might well help in this regard. I thank GPs for the incredible hard work that they are doing at this time.

The investment that I mentioned will help to bolster other local services and, I hope, take pressure off acute settings.

NHS Lothian’s chief executive has said that the board has requested mutual aid, but I am concerned about the capacity of other health boards to fulfil that request. As we know, the issues facing NHS Lothian are impacting health boards across the country. Just a few days ago, NHS Lanarkshire moved to its highest risk level. What assurance can the cabinet secretary provide that requests for mutual aid can be met, and that health boards that are struggling will be provided with the assistance that they need?

Gillian Mackay is correct: every single health board is under pressure and strain. They can, potentially, get mutual aid by reaching out to the Golden Jubilee national hospital, which can, for example, help with planned care. We know how important it is to address issues with planned care, particularly where there has been postponement of priority level 2, P3 and P4 groups of surgeries. If those backlogs continue to increase, we will just store up problems for the future.

It is for each health board to discuss with other health boards what mutual aid might be available. When a request comes in for other support, such as military support, we will give it serious consideration and will, where it is appropriate and necessary, pass such requests on to the armed forces.