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

Section 2: Understanding Surge

Purpose

Understanding the nature, causes and impact of surge is fundamental to effective preparedness and resilience planning. Early identification of emerging pressures enables local systems to take proactive action, protect access to care and minimise disruption to services. While winter remains the most predictable period of sustained pressure, surges in demand can occur at any time of year and may affect individual services, organisations, local systems, regions or the whole of Scotland.

Surge should be viewed as a whole-system challenge rather than solely a hospital issue. Pressures experienced in one part of the health and social care system can quickly affect access, flow, capacity and performance elsewhere. Effective preparedness therefore requires coordinated planning, monitoring and response across health, social care and community services.

Defining a Surge

A surge in demand occurs when actual or anticipated demand exceeds, or is likely to exceed, the level of activity that services routinely plan to manage. Surge may develop rapidly over hours or days, or emerge gradually over a longer period. It can place sustained pressure on staff, services and resources, requiring additional actions to maintain safe, effective and person-centred care

Surges are typically time-limited periods of exceptional demand or disruption. They often occur against a backdrop of wider system pressures, including workforce challenges, increasing complexity of need, reduced social care capacity and delays in flow. Effective preparedness therefore requires both immediate operational responses and longer-term action to strengthen resilience.

Triggers of Surge Events

Periods of surge may be triggered or exacerbated by factors such as:

• Seasonal respiratory infections and infectious disease outbreaks
• Increased urgent and unscheduled care demand
• Severe weather events
• Major incidents, cyber incidents and civil emergencies
• Population health emergencies
• Local outbreaks affecting care homes or community settings

The causes of surge may vary between local systems and over time. Understanding the drivers of pressure is important in determining the scale, duration and nature of the response required.

Examples of Surge Events

Examples of surge events include:

• Winter respiratory infection surges associated with influenza, Covid-19 and other seasonal viruses.
• Severe weather events affecting demand, infrastructure and workforce availability.
• Local or national infectious disease outbreaks.
• Major incidents, cyber incidents and other emergencies requiring activation of resilience arrangements.
• Population health emergencies placing exceptional pressure on services.

Debriefing incidents, exercises and periods of significant pressure, and acting on lessons identified, can help local systems understand vulnerabilities, strengthen resilience and improve future preparedness.

Monitoring and Escalation Indicators

Effective preparedness requires early identification of emerging pressures and a shared understanding of system performance. Local systems should monitor a combination of quantitative and qualitative indicators, supported by operational intelligence and professional judgement, to inform timely intervention and escalation decisions.

Local systems should monitor indicators that provide insight into:

• Urgent and unscheduled care demand, including activity, access and service pressures.
• Hospital capacity and flow, including occupancy, delayed discharge and care transitions.
• Community health and social care capacity, including care home and community service availability.
• Workforce resilience, including staffing availability, absence and wellbeing.
• Population health risks, including infectious disease activity and emerging public health concerns.
• System performance and operational intelligence, including forecast demand, service disruption and infrastructure risks.

No single indicator should determine escalation decisions in isolation. Local systems should consider trends over time, the interaction between pressures across the system and the potential impact on safety, quality, access and outcomes when determining appropriate action. Preparedness arrangements should include clear processes for reviewing indicators, sharing intelligence and initiating timely interventions where pressures are emerging

Local Escalation and Decision-Making

Responsibility for determining whether a local system is experiencing a period of surge, and the nature of the response required, remains a matter for local decision-making. Decisions should be informed by available evidence, operational intelligence, workforce considerations and the impact of pressures on access, flow, outcomes and service resilience.

Preparedness arrangements should include clear governance, escalation and decision-making processes that support timely action, effective communication and coordinated responses across partner organisations. Early intervention should be prioritised wherever possible, with planning informed by anticipation of demand rather than response to deteriorating performance alone.

Local escalation arrangements should also support timely communication with regional and national partners where pressures are likely to have a significant impact on service delivery, patient safety, system resilience or mutual aid requirements. This should support shared situational awareness and enable coordinated action across local, regional and national levels where appropriate.

Surge is a whole-system challenge requiring coordinated planning, early intervention and shared action across health, social care and community services.