Keeping Care Close to Home debate: speech by Social Care Minister Kevin Stewart

Presiding Officer, the parliament will be well aware of the scale of challenge across our public services and the level of uncertainty that we have faced over the last two years. In this context, it gives me particular pride to reflect on the ways in which our frontline NHS and social care workforce, and all those working to support them, have stepped up and adapted to new ways of working during the most challenging of times.

I would like to take a few moments to set out some reflections on the health and social care response to Covid-19 and some of the lessons learned which are supporting us to future proof our NHS and Social Care services to provide sustainable reform and better care for the people of Scotland.  

We know that demand for health and care services is increasing and the COVID-19 pandemic has accelerated the need to make optimal use of the resources we have. Innovation and transformation are critical to enabling our NHS to achieve reforms in the delivery of care.

The impact of addressing the Covid-19 pandemic meant many health and care services had to be suspended or reduced in scope and scale. This affected almost all aspects of NHS care. As a result, demand for our healthcare services has increased which is impacting on the efficiency of our services.  For example –

• Attendances to our A&E services have increased and are now above 95% of pre-Covid average levels
• Average length of stay in hospital is up around 1 day compared to recent seasonal average
• Planned care waiting times have significantly increased
• Acute capacity is regularly above 95%

These issues are compounded by other challenges such as –

• Infection, prevention and control measures
• Workforce pressures
• Delayed Discharge

The challenge of COVID-19 compelled our public sector to empower services to be flexible and adaptable and provide alternative pathways for people accessing healthcare. Teams blurred organisational boundaries with unprecedented levels of collaborative working between sectors. We must all now build on this momentum to transform the way we deliver care and how our systems work together.

With NHS 24 as the key point of contact, through our Redesign of Urgent Care Programme, we have provided wide-scale triage of people away from hospital services towards virtual hubs, staffed by an A&E team, established to prevent unnecessary exposure to a hospital setting and ensuring the right care, at the right time. Where hospital attendance is required this can now be scheduled. We are now seeing between a 15 – 20% reduction in people self-presenting.

NHS 24 has focussed on ensuring that patients receive the correct advice immediately without a requirement to be placed in a queue. Although this means patients may sometimes have to wait longer for their call to be answered, over 95% of calls are closed first time with patients getting appropriate support and advice without any requirement to be placed in a queue for a call back.

The Scottish Ambulance Service continues to increase ‘see and treat’ outcomes to ensure patients receive the most appropriate care first time, reducing demand on operational ambulances.  As a result of this, 41% of patients were managed in their local homes or community settings last year. Through the Advanced Practitioner role, SAS has also provided vital virtual pre assessment care, which positively impacts on reducing avoidable A&E attendances and safeguarding patients within the community.

We’ve significantly increased the options for people to access health and care services. This includes increases in availability of digital mental health support and therapies, being able to monitor a condition from home or the ability to have a video consultation with a health or care professional.

One of the key areas for keeping people at home is through telecare which currently supports 180,000 people in Scotland. Local Government Digital Office are currently leading on its transition to digital which will support a more joined up, resilient service across our country.

During the pandemic, the use of Near Me video consultations in Scotland rose from around 1,000 consultation per month to a peak of 90,000 per month.  Our aim going forward is to continue to provide safe, person-centered and sustainable care through video consulting with public choice as a key priority.

Just after Christmas the Health Secretary announced a series of actions to increase virtual capacity.  This is key to reducing demand on our hospitals and ensuring there is enough capacity within the community to provide care closer to home. To manage ongoing pressures on acute care as a result of the pandemic, and support recovery towards a sustainable future we have been focused on building virtual capacity since early in the new year.

This work focuses on four priority pathways which I will come on to discuss in a moment. Combined, these services have avoided or saved around 655 bed days per day. This is the equivalent to adding a large district general hospital the size of acute care capacity to our existing bricks and mortar hospitals.

Without these services patients would have been admitted to hospital and / or experienced a longer length of stay adding to the already significant pressures and providing a poorer outcome for the patient.

Through this work. we have enhanced ‘hospital at home’ services across Scotland over the last few months. This work is critical as we move into the recovery phase and we are already seeing a significant impact. 

The level of care we are able to provide at home continues to evolve and grow, and we are now seeing the spread of services such as hospital at home.  I visited a hospital at home service in Edinburgh and The Cabinet Secretary visited the Forth Valley service, on their first birthday, recently and was extremely impressed with the care they provide. 

At that visit we announced a further £3.6 million was being made available this year to support further development.  This takes our total investment in hospital at home to over £8 million. 

These services enable people to receive treatments that would otherwise require admission to hospital, such as an intravenous drip or oxygen supply. It also provides access to hospital tests under the care of a consultant in their own home.

Evidence shows that those benefitting from the service are more likely to avoid hospital or care home stays for up to six months after a period of acute illness. For older patients, it means being able to stay at home longer without losing their independence and this has contributed to overall improvements in patient satisfaction.

Local management information collected by Healthcare Improvement Scotland shows that between September 2021 and February of this year 4,500 people were treated by Hospital at Home services, who would otherwise been admitted to hospital. This equates to approximately 26,700 bed days.

Acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) are the most common cause of admission to hospital in Scotland. This condition affects 120,000 people in Scotland and is predicted to increase by 33% in the next 20 years.

Ambulatory Respiratory Services support patients with COPD in the community. Once in place, services can be expanded to manage other chronic lung conditions.

We have increased capacity for Respiratory Rapid Response services and they are reducing the number of occupied bed days, length of stay and readmission rates. Since mid-January 2022, 21,000 bed days have been avoided, this averages at approximately 176 beds per day.

We continue to work with Boards to upscale this service, and reduce variability in relation to what respiratory services are in place. The impact will grow as Boards further develop their pathways, particularly in the community.

We have also enhanced Outpatient Parenteral Antimicrobial Therapy (OPAT) capacity, which is a multidisciplinary service that provides an alternative for hospital admission or supports early discharge for a variety of patients with infection usually requiring IV therapy. To date 22,000 bed days have been avoided or the equivalent of up to 197 beds daily. 

To ensure we can respond to future waves of the pandemic and potential resurges of the virus, we have been working with partners to roll out national a Covid Remote Health Monitoring Pathway.

Over 6,400 COVID remote monitoring patient packs have been provided to 10 territorial boards and the Scottish Ambulance Service and another 6,000 packs will be distributed this month. We are also embedding the remote monitoring approach across other specialties such as respiratory and maternity.

Planning continues with a view to expanding virtual capacity and aiming to double the overall provision of acute care that is currently provided in the patient’s own home creating greater onsite hospital capacity and resulting in better patient outcomes at lower cost.

We have a range of other actions we are progressing to support flow through the hospital and minimise delays for patients, either being admitted or discharged including the Discharge without Delay Programme. 

To support our ambition of providing more care in the community we are committed to expanding our District Nursing service as set out in the National Workforce Plan published in 2019 and providing the necessary funding to support this. We are investing £47 million from 2020-2025 to increase the workforce by 12%. This will introduce a minimum of an additional 375 nurses within the district nursing service.

The service supports people to stay in their homes, avoids the need to be admitted to hospital or a care home, and can support early discharge from hospital. 

Our Health and Social Care services continue to face unprecedented pressures. We have a lot of work to do to help the system to recover, deliver our ambitions, ensure the people of Scotland receive the highest standard of care that they deserve, reduce waiting times and increase our workforce across the system.

There is absolutely no doubt that we have a long way to go to address full scale of challenge in health and social care but, by working collaboratively and with the continued commitment and dedication of NHS staff, and those in the social care sector, I am optimistic that we will not only recover but also innovate and redesign to deliver lasting improvements for the future. 

I will of course continue to update this Chamber on progress.