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

Section 6: Expectations on Local Systems

Purpose

Responsibility for preparedness, resilience, surge and winter planning sits primarily at a local level. This Framework provides a consistent national approach to support NHS Health Boards, Integration Authorities, Local Authorities and partners to develop planning arrangements that reflect population needs, local risks, and the national principles and priorities set out within it. Preparedness should be embedded within routine planning, governance and service delivery, rather than viewed as a seasonal exercise. Local systems should maintain a year-round focus on prevention, resilience, flow, workforce sustainability and organisational readiness to support safe, effective and person-centred care during periods of normal operation and increased demand.

The expectations in this Framework are grouped into seven domains that support preparedness, resilience, surge and winter planning across Scotland's health and social care system. Together, they provide a practical framework for implementation, assurance and continuous improvement, recognising that resilience depends on coordinated action across the whole system. The seven domains are:

1. Governance, Leadership and Planning

Clear leadership, accountability and governance arrangements support effective planning, decision-making and coordinated action.

2. Intelligence, Monitoring and Escalation

Timely intelligence, monitoring and escalation support early identification of risks and pressures and enable proactive responses.

3. Prevention, Integration and Community Resilience

Prevention, integrated working and community capacity help reduce avoidable demand, support independence and strengthen resilience.

4. Workforce Resilience and Sustainability

A resilient, skilled and supported workforce is essential to maintaining safe, effective and sustainable services.

5. Emergency and Service Resilience

Preparedness arrangements should support effective responses to exceptional demand, disruption and civil emergencies while maintaining essential services.

6. Person-Centred Care and Carers

People, families and carers should remain at the centre of planning, decision-making and service delivery regardless of wider system pressures.

7. Continuous Improvement and Assurance

Continuous learning, testing, exercising and assurance help strengthen preparedness and resilience over time.

Together, these seven domains describe the key actions local systems should take to strengthen preparedness, improve resilience and support safe, effective and person-centred care during periods of both normal operation and increased pressure. The following expectations set out the practical actions that support delivery within each domain.

6.1 Governance, Leadership and Planning

Effective governance and leadership create the conditions for timely decision-making, coordinated action and system resilience.

Local systems should:

• Demonstrate clear leadership, accountability and oversight for preparedness, resilience and surge planning.
• Embed preparedness and resilience within strategic planning, governance and routine decision-making arrangements.
• Maintain current, tested plans that support an effective response to periods of increased pressure.
• Foster collaboration, shared responsibility and continuous improvement across partner organisations.

6.2 Intelligence, Monitoring and Escalation

Timely intelligence and effective risk management enable systems to anticipate pressures, mitigate risks and take early action.

Local systems should:

• Identify emerging risks, capacity challenges and service pressures at the earliest opportunity.
• Use data, intelligence, forecasting and local insight to support proactive decision-making.
• Maintain shared situational awareness across health, social care and community services.
• Escalate significant risks and pressures through agreed local, regional and national arrangements where required.

6.3 Prevention, Integration and Community Resilience

Prevention, integration and community capacity reduce avoidable demand, support independence and strengthen whole-system resilience.

Local systems should:

• Deliver integrated planning across urgent and unscheduled care, primary care, community services, mental health services, social care, housing and wider partners.
• Strengthen prevention, future care planning and Home First approaches to reduce avoidable deterioration and admission.
• Support timely discharge and effective care transitions through collaborative, person-centred planning.
• Reduce delays associated with complex discharge pathways, including Adults with Incapacity processes.
• Recognise and maximise the contribution of communities, independent providers, volunteers, the third sector and social care providers to resilience and wellbeing.

6.4 Workforce Resilience and Sustainability

A resilient, skilled and supported workforce is essential to maintaining safe, effective and sustainable services.

Local systems should:

• Maintain workforce resilience, mobilisation and surge capacity arrangements.
• Support workforce wellbeing, health and safety, and sustainable working practices.
• Promote recruitment, retention, training and workforce development.
• Ensure staff have the skills, competencies and support required to adapt services during periods of pressure.
• Consider workforce fatigue, human factors and longer-term sustainability when planning responses.

6.5 Emergency and Service Resilience

Preparedness arrangements should support a coordinated response to exceptional demand, disruption and civil emergencies while maintaining essential services.

Local systems should:

• Maintain readiness to respond to pandemics, major incidents and other civil emergencies.
• Ensure preparedness arrangements support Emergency Preparedness, Resilience and Response (EPRR) guidance and relevant duties under the Civil Contingencies Act 2004.
• Maintain plans to scale services and capacity rapidly during periods of exceptional demand.
• Maintain arrangements for hospital and critical care expansion, including workforce, infrastructure and supply resilience.
• Use digital technologies, operational intelligence and interoperable systems to support effective decision-making and service delivery.
• Protect planned care, cancer services and other time-critical pathways wherever possible.

6.6 Person-Centred Care and Carers

People, families and carers should remain at the centre of planning, decision-making and service delivery, regardless of wider system pressures.

Local systems should:

• Ensure preparedness arrangements reflect GIRFE principles and support person-led, value-based care.
• Promote equitable access to care and support for all communities.
• Recognise unpaid carers as essential partners in care, preparedness and resilience.
• Ensure carers have access to appropriate information, advice, support and respite where required.
• Engage people, carers and community partners in the development, implementation and review of preparedness arrangements.

6.7 Continuous Improvement and Assurance

Continuous learning, testing and assurance help ensure preparedness arrangements remain effective, proportionate and responsive to changing risks.

Local systems should:

• Regularly review, test and assure preparedness, resilience and surge arrangements.
• Participate in exercises, simulations and learning activities where appropriate.
• Capture learning from periods of pressure, incidents and emergencies.
• Implement lessons identified and use evidence to strengthen future preparedness.
• Share learning and good practice across organisations and systems to support continuous improvement.