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

Defining a surge in demand for health and social care services

A surge in demand for health and social care services refers to a sudden and temporary increase in need, that exceeds standard or anticipated levels. These surges typically occur over a short-time period – of days, weeks, or a few months – and place considerable strain on service capacity, workforce, and resources, requiring a coordinated and timely response across local systems and communities.

Surges will usually have a triggering factor which causes the increased demand. The most predictable of these is winter, where increases in respiratory viruses and weather-related injuries tend to result in more people accessing services. However, triggers for surges can happen all year, such as through the emergence of novel strains of viruses such as covid and rhinovirus, heat-related illnesses, and exacerbation of pre-existing conditions during heat waves, and major local events.

Identifying and understanding the underlying cause of a surge in demand may help to identify how long the surge period is likely to last and any additional mitigating actions that might be able to be taken to help inform the implementation of local surge plans. It may also assist local areas in future strategic planning, should the surge in demand resurface.

Surges represent time limited increases in service demand. Longer term factors such as demographic change are contributing towards an overall sustained increase in the number of people accessing health and social care services. Addressing this requires fundamental, longer-term shifts in how services are designed and delivered, and how we will achieve this is set out in the SRF, PHF and OIP.

Additionally, there are exceptional circumstances where a major incident, such as cyber-attacks, major accidents, or extreme weather may place exceptional short-term pressure on services. The Scottish Government, the NHS, and Local Authorities all have comprehensive emergency resilience procedures in place which can be activated in those circumstances.

Ultimately, the assessment as to whether a system is experiencing a period of surge and how long it lasts will be a matter for local determination, using data and evidence of system pressures to inform decision making as to how and when to step up or down their surge response.