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

Section 3: National Principles

Purpose

The National Principles establish the values and behaviours that should underpin preparedness, resilience, surge and winter planning across Scotland's health and social care system. They describe how decisions should be made, providing a common foundation for local planning, service delivery and operational response during periods of usual pressure and surge pressure.

The principles are intended to support a person-centred, preventative and sustainable approach to preparedness that recognises the interdependence of services across health, social care and communities. They should inform governance, planning, prioritisation and decision-making at all levels of the system.

Principle 1: Person-Centred and Person-Led Care

People should be at the centre of decisions affecting their health, care and wellbeing and have timely assessment, effective navigation and access to the most appropriate service or pathway based on individual need. Preparedness arrangements should support people to access safe, effective, high-quality and person-centred care regardless of wider system pressures. Services should promote dignity, independence, recovery and wellbeing, while respecting individual preferences, rights and outcomes.

Planning and delivery should reflect the principles of Getting it Right for Everyone (GIRFE), supporting coordinated and personalised approaches to care. Consideration should be given to those most at risk of deterioration, avoidable admission, delayed discharge or poorer outcomes, ensuring that services remain responsive to local population needs and inequalities.

During periods of increased demand, decisions should continue to be informed by what matters most to people and should seek to minimise adverse impacts on experience, outcomes and access to care.

Key Considerations

Local systems should:

• Place people, families and carers at the centre of planning and decision-making.
• Promote personalised and coordinated approaches to care.
• Support dignity, independence and wellbeing.
• Consider the needs of those most at risk of poor outcomes.
• Ensure equitable access to care and support.

Principle 2: Leadership, Partnership Working and Shared Accountability

Strong leadership and effective partnership working are essential to maintaining resilience and delivering coordinated responses during periods of increased demand. Preparedness and surge planning should be developed and delivered through collaboration across health, social care, local government and wider partners, recognising that pressures experienced in one part of the system can rapidly affect capacity and performance elsewhere.

Organisations should work collectively to support population wellbeing, improve flow, manage risk and maintain resilience. This includes effective collaboration with social care providers, primary care, housing, independent providers, third-sector organisations and unpaid carers.

Partners should work together to improve outcomes and maintain system resilience, supported by clear governance, escalation and decision-making arrangements that enable timely action and coordinated responses when pressures emerge.

Key Considerations

Local systems should:

• Promote collaborative whole-system planning and delivery.
• Maintain clear governance, leadership and accountability arrangements.
• Support coordinated decision-making and escalation processes.
• Recognise the contribution of all partners to resilience and preparedness.
• Foster a culture of shared responsibility for outcomes and performance.

Principle 3: Continuous Improvement, Preparedness and Organisational Learning

Preparedness should be informed by evidence, data, operational experience and learning. Partners should use information, evaluation and insight to continuously improve services, strengthen resilience and enhance their ability to respond to changing demand and emerging risks.

Learning from challenges, successful practice, exercises and operational experience should be systematically reviewed and incorporated into future planning. Preparedness arrangements should remain dynamic and responsive, reflecting changes in demand, population needs and operational experience.

Organisations should maintain arrangements to regularly review, test and exercise preparedness plans. Testing and exercising provide assurance that plans remain practical, effective and capable of supporting coordinated responses during periods of exceptional demand, pandemics, major incidents and other civil emergencies

Key Considerations

Local systems should:

• Use evidence, data and operational intelligence to support planning and decision-making.
• Learn from previous periods of pressure, incidents and emergencies.
• Review and update preparedness arrangements regularly.
• Test and exercise plans to support readiness and assurance.
• Promote continuous improvement and organisational learning.

Principle 4: Value-Based Health and Care

Preparedness planning should focus on improving outcomes that matter most to people while ensuring resources are used effectively, sustainably and equitably. Decision-making should seek to maximise value across the health and social care system by balancing quality, outcomes, experience and stewardship of resources.

A value-based approach supports prevention, early intervention, reduction of inequalities and delivery of high-quality person-centred care. It recognises the need to make informed decisions that support both immediate resilience and the longer-term sustainability of services.

During periods of increased pressure, organisations may need to adapt service delivery arrangements. Decisions should continue to be guided by outcomes, equity, safety and sustainability, ensuring that actions taken to address immediate pressures also contribute to longer-term improvement wherever possible.

Key Considerations

Local systems should:

• Focus on outcomes that matter most to people.
• Support effective, equitable and sustainable use of resources.
• Prioritise prevention and early intervention.
• Consider the impact of decisions on inequalities and future sustainability.
• Balance short-term operational pressures with long-term improvement objectives.