Impact of the Pandemic
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, there are many people who are waiting longer for the care they need. Addressing this backlog of care, while continuing to meet the ongoing urgent health and care needs of the country, is the central aim of this recovery plan.
Before the pandemic, waiting times for elective care were improving by virtue of the Waiting Times Improvement Plan - for example, in the 18 months to March 2020, the number of new outpatients waiting over 12 weeks had reduced by over 30%. However, the pandemic resulted in a 41% reduction in new outpatient activity in 2020/21 - equating to around 586,000 appointments. Inpatient and day case activity reduced by more than 50% - around 138,500 procedures.
The easing of Covid-19 restrictions is now enabling a return to greater normality for services. While this will allow activity levels to start to increase again, it will also see deferred demand from those who have not been able to access services normally over the past year and a half. As a result, as services return to normal and backlogs in care to be tackled, the number of people awaiting treatment will continue to rise unless action is taken to increase healthcare capacity. Delays in care will also mean a deterioration in condition that will mean that more people will require hospital treatment than would otherwise have been the case. We know that it will take time - and a series of targeted actions to build capacity and redesign patient pathways - to bring waiting times back within targets.
We must also recognise that, alongside the impact on patients, the pandemic has had a significant impact on the wellbeing and resilience of NHS staff whose continued dedication and efforts will be critical to the successful remobilisation and recovery of services. That is why this Recovery Plan includes additional support for staff, to ensure that they can recover and recuperate.
This Recovery Plan sets out how we will take forward or aim of increasing NHS capacity by at least 10% as quickly as is possibly in order to address the backlog in care and meet ongoing healthcare needs for people across the country. As well as outlining the principles our NHS recovery is shaped by, it also sets out the over £1 billion of targeted investment need to deliver improvements in the short term, throughout this 5 year term of the Scottish Parliament, and sustainably for the future.
The backlog of care in acute service doesn't just affect the acute aspects of the NHS, ultimately it also puts additional pressure on primary care as patients seek support and relief while they wait for the elective care they have been diagnosed as requiring. That is why our Recovery Plan details the focussed action we intend on taking to recover all the integral parts of our National Health Service.
Prior to the pandemic Scotland's NHS carried out approximately 270,000 inpatient/day cases per year, and approximately 1.4 million outpatient appointments. The effects of the pandemic on NHS capacity continue to be felt in 2021/22, but in the coming years we will be increasing our NHS capacity substantially beyond pre-pandemic levels of activity. The measures that we have identified will result in an increase of 55,500 procedures per year by the end of this plan - a 20% increase over pre-Covid levels. A summary of how we will deliver this is set out in the table below:
|Additional Inpatient and Day case Activity||2022/23||2023/24||2024/25||2025/26|
|National Treatment Centres||12,000||19,000||25,000||40,000|
|Additional activity at NHS board level||15,500||15,500||15,500||15,500|
One aspect that cannot yet be fully quantified is the true backlog in care that will emerge following the pandemic, as we know there will be a number of people who will not yet have presented with conditions requiring treatment. As a result we will continue to work to identify ways of adding additional activity, through new facilities or through improvements to existing ways of working. We will include the results of this work in the annual updates to this plan.
For outpatients we will increase capacity for outpatients by 10% compared to pre-pandemic activity levels of around 1.4 million appointments and procedures a year.
The vast majority of this increase will be delivered through the redesign of care pathways that learn from the latest and best practice from across Scotland, and beyond. The new Centre for Sustainable Delivery (CfSD) will work with health boards to help best practice to be embedded across the country and help release consultant's time to accommodate new outpatient appointments in hospital clinics.
|Increases in hospital outpatient capacity||8,000||12,000||16,000||20,000|
|Releasing activity through redesign of care pathways||50,000||70,000||90,000||120,000|
Our specialist diagnostic services are split between imaging services (MRI scans, CT scans) and endoscopy services. We are investing £29 million this year, to provide an increase of 78,000 diagnostic procedures and have identified means to increase these procedures by 90,000 by the end of this plan.
|Additional Diagnostic Procedures||2022/23||2023/24||2024/25||2025/26|
|Additional CT pods||29,000||29,000||29,000||29,000|
|Mobile MRI Units||24,000||24,000||24,000||24,000|
|Innovation in diagnostics||5,000||7,000||9,500||12,000|
These goals are ambitious but achievable. Key to that achievement will be working in partnership with stakeholders across health and care settings to ensure a whole system approach. This will include working with unions and staff side organisations, local partners and communities, third sector organisations and, of course, the wider public. Good communication will be essential to keeping people informed of progress, nationally and locally - as part of this, we will publish annual updates against this plan. The volume of increased activity in particular specialisms will be driven by a range of factors, not least existing demand and projected demand from demographic change. As a result the shape of increased capacity will vary by specialism and treatment.