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

Introduction

The number of people needing to access health and social care services varies naturally over time and our systems are flexible and often are able to meet these normal fluctuations in need. In recent years there has been sustained and growing demand for health and care services which has meant those with greater need have been prioritised. However, there are periods where this demand increases beyond the standard level that health and social care services plan to deliver and there is a surge in the number of people requiring care and treatment. Whilst the most common and predictable of these are the additional pressures that arise during winter periods, these surges can occur locally or nationally because of other triggers and at varying times of the year.

The scope of this document is focussed on setting out the national planning priorities and principles to support local health and social care services to develop their own operational surge and winter preparedness plans. Local systems are best placed to develop robust operational plans, shaped by their organisational needs and the needs of their communities; however, it is also important that these are aligned with nationally agreed planning priorities and principles.

This document is intended to complement and operationalise the strategic direction set out in Scotland’s key health and social care frameworks, the Health and Social Care Service Renewal Framework (SRF)^[1], Population Health Framework 2025–2035 (PHF)^[2], and the 2025-26 Operational Improvement Plan (OIP)^[3]. Together, these frameworks emphasise the importance of prevention, person-centred care, system resilience, and collaborative leadership. Embedding surge planning as a core sustainability tool ensures that local systems are not only prepared for periods of increased demand but are also consistently contributing to the long-term transformation and sustainability of health and social care services across Scotland.

The core priority when delivering health and care services during periods of pressure is to ensure that people remain central in the approach. It is critical to ensure that human rights are supported to the highest attainable standard of mental and physical health, and the right to live independently as part of a community are upheld and that every person in Scotland can continue to expect high quality care, regardless of any increased pressures on services. We have further strengthened and embedded a person-centred and person-led approach in the development of these national priorities and principles, building on the values set out in previous health and social care winter preparedness plans.

Local systems should embed these priorities and principles when developing their local winter and surge plans and implement them in a way that is most appropriate for their specific needs. Key to this is planning in a collaborative and whole system way; the delivery of services during periods of sustained pressure requires close partnership working across multiple agencies and organisations. Planning for the safe management of demand and capacity across health and social care services should align with existing local resilience structures.

Whilst these national priorities and principles are intended to support surge planning in all contexts and health and social care systems should develop their local plans on that basis, it is recognised that the most common driver for increased demands on health and social care services is winter.

Whilst the core of winter preparedness lies with local systems planning in line with these national priorities and principle, there will also be additional national actions undertaken each year to help support Scotland wide preparedness which may vary from year to year depending on circumstances, and these will be set out separately ahead of each winter as necessary via a letter to system leaders.

It is also recognised that systems are operating within an extremely challenging fiscal climate, with increasing demand for services. NHS, Integration Authorities, and Local Authorities are responsible for planning and delivering services in line with available resources, ensuring those most at risk are able to access care when they need it.