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

Section 1: Introduction and Strategic Context

Purpose of the Framework

Effective preparedness, resilience and planning are essential to ensuring people can access the right care, in the right place, at the right time, particularly during periods of increased demand.

This Framework provides a consistent national approach to preparedness, resilience, surge and winter planning across Scotland's health and social care system. It establishes a shared set of principles, priorities and expectations to support planning, decision-making and partnership working, while enabling flexibility to respond to local circumstances, risks and population needs.

Responsibility for preparedness, resilience and surge planning sits primarily at a local level. NHS Health Boards, Integration Authorities and Local Government should work with wider partners to coordinate arrangements across their local systems.

For many organisations, these arrangements also support the discharge of responsibilities under the Civil Contingencies Act 2004 and wider Emergency Preparedness, Resilience and Response (EPRR) guidance.

The Framework applies across health and social care and should be used alongside statutory duties, national guidance, local plans and partnership arrangements to support a coordinated, whole-system approach to preparedness and resilience.

Strategic Context

Scotland's health and social care system continues to operate in an increasingly complex environment. Demographic change, rising demand, increasing complexity of need, persistent health inequalities and workforce challenges continue to place pressure on services across health, social care and community settings.

These pressures are interconnected, with challenges in one part of the system often affecting capacity, flow and service delivery elsewhere. Addressing them requires a whole-system approach involving health, social care, local government, communities, the third sector, independent providers and unpaid carers.

Alongside these ongoing pressures, systems must also be prepared to respond to periods of increased demand and disruptive events, including infectious disease outbreaks, severe weather, major incidents, cyber incidents and infrastructure disruption. While many pressures require long-term improvement, systems must also be able to respond effectively when demand escalates or unexpected events place additional strain on services.

Recent experience, including the Covid-19 pandemic, demonstrated the importance of preparedness, resilience, effective decision-making and strong partnership working. Learning from operational experience and the Covid-19 inquiries reinforces the need for robust arrangements that support both routine resilience and large-scale emergency response.

In this context, preparedness is not solely a response to winter pressures. It requires a continuous focus on prevention, resilience, flow, workforce sustainability, organisational readiness and partnership working to ensure services can anticipate, prepare for, respond to and recover from periods of both routine and exceptional pressure while continuing to deliver safe, effective and person-centred care.

Core Planning Assumptions

The following assumptions should inform preparedness, resilience, surge and winter planning across Scotland:

Preparedness is a Year-Round Responsibility

Periods of increased demand can occur at any time of year. While winter remains the most predictable period of sustained pressure, preparedness and resilience should be embedded within routine planning, governance and service delivery arrangements throughout the year.

Surge is a Whole-System Challenge

Surge should be understood as a whole-system issue rather than solely a hospital issue. Pressures experienced within one part of the system can rapidly affect capacity, access and flow elsewhere. Effective preparedness therefore requires coordinated planning and action across health, social care, primary care, housing, independent providers, the third sector and community partners.

Prevention and Early Intervention are Fundamental

Reducing avoidable deterioration, crisis and admission is central to improving outcomes and strengthening resilience. Preparedness arrangements should support prevention, anticipatory care, future care planning, vaccination, self-management and early intervention approaches that help people remain well and independent for longer.

Home First Should Remain the Default Approach

People generally achieve better outcomes when supported to remain at home or return home as soon as clinically appropriate. Planning should support Home First principles and maximise opportunities to deliver care within homes, communities and other community-based settings wherever possible.

Community Capacity is Critical to System Resilience

Social care, housing, primary care, independent providers, the third sector, community organisations and unpaid carers make a significant contribution to population wellbeing and system resilience. Preparedness arrangements should recognise and support these contributions as core components of local resilience planning.

Planning Should Support Equity and Reduce Inequalities

Planning should reflect population need and seek to reduce inequalities by improving equitable access and outcomes for all communities.