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

Expectation on NHS Health Boards and Integration Authorities

Responsibility for the delivery of effective surge and winter planning and preparedness sits firmly at a local level. NHS Health Boards and Integration Authorities and Local Government are expected to work together in the coordination, planning and implementation of surge response across their systems. This includes ensuring robust, integrated responses to periods of increased demand, grounded in local intelligence, collaboration, and alignment with the national priorities and principles and other key frameworks. Clear local leadership, accountability, and cross-sector coordination are essential to ensuring safe, person-centred care throughout the winter period and beyond.

Early planning for winter should also be recognised as a priority across the whole system. Learning from previous winters is most effective when captured through timely and structured debriefs, as immediate reflection adds significant value to future planning. It is also important to establish unified escalation processes so that all parts of the system are aware when pressures arise. A shared understanding of system pressures enables proactive support to be implemented quickly, helping to mitigate risks and maintain safe, effective services.

To ensure alignment with the national planning priorities and principles, local systems should:

• Review and update existing winter and surge plans to ensure alignment with the national planning priorities and principles
• Ensure strong local governance and accountability for delivery, with clear leadership across NHS Health Boards, Integration Authorities, Local Government
• Include surge planning and response as a core part of ongoing service planning and delivery, and regularly monitor its efficacy
• Use local data and insights to model expected demand and guide proactive planning, including early identification of risks
• Ensure collaboration and integration across systems, including planned, unscheduled, primary, community, mental health and social care services
• Maintain clear escalation and decision-making pathways, enabling timely response to rising system pressures
• Prioritise workforce wellbeing and capacity planning, effective workforce planning in line with the requirements of the Health and Care (Staffing) (Scotland) Act 2019, supported by best practice in risk assessment and escalation, rota management, staff redeployment processes, access to wellbeing support, and workforce vaccination offers
• Ensure that care remains person-led and value based, including actively involving communities and implementing the GIRFE principles
• Implement measures to support flow and reduce delayed discharges, including coordination with local authorities, third sector and community partners
• Use the whole system dashboard to support monitoring, reporting, and performance discussions during winter and periods of surge
• Participate in national assurance processes, including regular engagement with governance forums
• Capture and share learning throughout the winter and periods of surge to support continuous improvement and system-wide resilience, including through existing governance groups