Health and social care - surge preparedness: national planning priorities and principles

Executive Summary

National Planning Priorities and Principles

Why This Framework Matters

Scotland's health and social care system continues to face increasing demand driven by demographic change, an ageing population, growing complexity of need, persistent health inequalities and workforce pressures.

While winter remains a predictable period of increased pressure, significant demand surges can occur throughout the year and affect all parts of the health and social care system. We are committed to supporting the health and social care system to continuously improve, including in planning for surge pressures, to ensure people can access the right care, in the right place, at the right time.

This Framework provides a consistent national approach to preparedness, resilience, surge and winter planning. It supports NHS Health Boards, Integration Authorities, Local Authorities and partners to strengthen resilience, improve outcomes and maintain safe, effective and person-centred care during periods of increased demand. It reflects learning from previous winters, operational experience, stakeholder engagement and relevant recommendations arising from the Covid-19 Inquiries.

Preparedness is a year-round responsibility requiring coordinated action across health and social care services, local government, primary care, housing, independent providers, the third sector and unpaid carers.

Our Planning Principles

These principles guide planning, decision-making and delivery during periods of routine operation, increased demand and surge.

1. Person-centred and person-led care

People should be at the centre of decisions affecting their health, care and wellbeing. Services should support dignity, independence, choice, recovery and equitable access to care.

2. Leadership, partnership working and shared accountability

Strong leadership and effective partnership working across health and social care are essential to maintaining resilience, improving outcomes and delivering coordinated responses during periods of pressure.

3. Continuous improvement, preparedness and organisational learning

Planning should be informed by evidence, data, operational experience and learning to strengthen preparedness and resilience. Arrangements should be regularly reviewed, tested and improved.

4. Value-based health and care

Decision-making should focus on improving outcomes that matter most to people, while ensuring resources are used effectively, sustainably and equitably.

Our National Priorities

These priorities set out the key outcomes to be achieved through local preparedness, resilience and surge planning.

1. Prioritise people most at risk

Identify and support people at greatest risk of deterioration, hospital admission or delayed discharge through proactive, person-centred and place-based approaches.

2. Prevention and early intervention

Reduce avoidable deterioration, crisis and admission through anticipatory care, future care planning, vaccination, primary care and community-based support.

3. Support public understanding and access to care

Help people access the right care, in the right place, at the right time through clear communication, effective navigation and awareness of available services.

4. Right care, right place, right time

Embed Home First approaches and maximise care delivered at home, or as close to home as possible, through community-based alternatives to admission.

5. Maximise capacity, flow and system resilience

Improve flow, reduce delayed discharge, strengthen operational intelligence and maintain access to planned and time-critical care during periods of pressure.

6. Strengthen workforce, carer and community resilience

Support workforce wellbeing, sustainability and resilience while recognising the essential contribution of unpaid carers, social care providers, community organisations and the third sector.

Key Changes in the 2026 Refresh

The Framework retains the purpose of the existing publication while strengthening preparedness, resilience and whole-system working. Key enhancements include:

• Stronger emphasis on year-round preparedness and resilience.
• Expanded definition of surge and whole-system pressures.
• New monitoring and escalation indicators to support proactive intervention.
• A new priority focused on public understanding and access to urgent care.
• Greater focus on prevention, population health and future care planning.
• Stronger emphasis on Home First, discharge planning and flow improvement.
• Expanded recognition of unpaid carers and community resilience.
• Enhanced workforce resilience and sustainability expectations.
• Increased use of digital capability, data and operational intelligence.
• Stronger focus on health inequalities and equitable access to care.
• Enhanced alignment with Covid-19 Inquiry recommendations and Emergency Preparedness, Resilience and Response (EPRR) guidance.

Expectations of Local Systems

Plan → Anticipate → Deliver → Support → Prepare

NHS Health Boards, Local Authorities and relevant partners should ensure preparedness and resilience arrangements support the discharge of their statutory responsibilities under the Civil Contingencies Act 2004 and wider Emergency Preparedness, Resilience and Response (EPRR) guidance.

• Plan
  • Embed preparedness within routine planning and service delivery.
• Anticipate
  • Use intelligence, forecasting and risk assessment to identify emerging pressures and risks.
• Deliver
  • Strengthen prevention, improve flow, reduce delays and maximise community resilience.
• Support
  • Promote workforce wellbeing, support carers and maintain strong partnership working across the whole system.
• Prepare
  • Maintain readiness for pandemics, major incidents and civil emergencies through testing, exercising and continuous improvement.

Our Shared Outcome

Right Care | Right Place | Right Time

A resilient, integrated and sustainable health and social care system that improves outcomes, reduces inequalities, supports independence and enables people to receive the care and support they need throughout the year.