NHS Scotland pandemic pressures: Cabinet Secretary's statement

Presiding Officer,

This week the number of people in hospital with COVID-19 has reached the highest level since the start of the pandemic, which is having a significant impact on our health and social care services, especially in A&E.

Our Health Board colleagues, those working on the front line, all tell us, that the last two weeks have been the toughest in the pandemic so far and the latest data shows some of the lowest performance against the four hour A&E target we have ever seen. 

This level of pressure impacts on patients and staff and I want to start, firstly by thanking our NHS and social care staff who we owe a huge debt of gratitude to and who are continuing to provide vital treatment and optimal patient care during some of the most challenging times.  And also to patients, and those who have in any way been either inconvenienced or who are suffering because of the current pressures. I have no hesitation in apologising for that suffering and for that inconvenience and I appreciate the patience that every person is showing at this extremely challenging time.

There are of course a number of contributing factors impacting on A&E services, including:

• A record number of people in hospital with covid
• Infection, prevention and control measures
• Workforce pressures exacerbated by record levels of community transmission
• Increased attendances to A&E services
• High levels of delayed discharges
• Longer length of stay in hospital

Today there are 2322 COVID patients in our hospitals, that number has more than doubled since February and is now past the previous peak of last winter when 2,053 patients were in hospital with Covid in January 2021. Using the latest published COVID-19 modelling we anticipate this may well continue to increase over the next few weeks.

The increase in cases and hospitalisations is largely due to the dominance of the more transmissible Omicron BA.2 variant, which accounts for around 90% of all reported cases.

The latest ONS survey data shows that over 7% of people in Scotland in the community  tested positive for Covid in the week to 12 March. This is the highest estimate Scotland has seen since the survey began in Autumn 2020.

Thanks to the excellent progress that has been made on vaccinations the recent rise in cases and hospitalisations has not thankfully translated into increased cases of severe illness requiring intensive care.

However, this level of continued pressure is challenging in the context of a health service that has been dealing with sustained and relentless demand and pressure for nearly two years, unlike in wave one of the pandemic when services were stood down, we are of course remobilising our NHS.

In addition, infection, prevention and control guidance remains in place and is important for maintaining safety within our hospitals. However, this create additional complexities and inefficiencies when it comes to moving people through the system. For example, patients cannot wait in the discharge lounge, or ‘sit out’ to wait for discharge drugs.  This means they must wait in the bed space longer than required, which then requires to be deep cleaned prior to a new admission.  Also, patients cannot access normal transport and must travel either on their own or with other patients with Covid.

I am able to advise though that each of the four UK nations are looking towards developing an exit strategy from the existing UK winter IPC guidance and considering what a return to business as usual looks like going forward. These next steps include a range of changes which, if implemented, would help to relieve some of the pressures the system is experiencing. 

But ultimately if we can control community transmission of Covid, we will help alleviate the current pressure we are under.

The level of NHS staff absences attributed to those testing positive for Covid has increased by almost 100%, it has doubled over the last four weeks to almost 4,700.  This increase in staff absence puts an incredible strain on the delivery of health services. 

Asymptomatic healthcare workers are asked to continue to test twice weekly. This includes all NHS staff and patient facing primary care independent contractor staff. However we are reviewing this regularly as part of the testing transition plan.

In the latest week ending 22 March an average of 6,000 NHS staff, or around 3.4% of the NHS workforce, were reported absent each day for a range of reasons related to COVID-19. We have worked hard throughout the pandemic to maintain record staffing levels across our NHS. NHS Scotland’s staffing levels are up by over 28,000 whole time equivalent under this Government to a record high level. 

We've invested in growing our workforce by just under 10% in the last two years to enhance our services’ capacity to deal with the new pressures they've faced.

We recognise the scale of the improvements required and are working closely with partners to accelerate domestic and international recruitment to Scotland.

• Our record £300 million of new investment to help services deal with system pressures over winter introduced a range of direct workforce investments and new measures to support Boards’ capacity for both domestic and international recruitment.
• We are investing £11 million over the next five years in new national and international recruitment campaigns and have established a national Centre for Workforce Supply to provide labour market intelligence.
• We are also recruiting at least 200 registered nurses from overseas with funding of £4.5million available to health boards to take this forward.
• We have asked boards to recruit 1,000 Agenda for Change staff to provide additional capacity across a variety of health and care services, with funding of up to £15 million.
• We are working with boards to develop nationally co-ordinated recruitment campaigns to actively recruit nursing and medical staff within the UK. A Band 5 nurse campaign launched on 18 February.
• Scotland has the best paid NHS staff in the UK and we have made £12 million available this year to support the wellbeing of our staff.
• We have also continued our long term investment in healthcare education by funding a record number of medical and nursing student places this year.

Demand is clearly putting pressure on our acute sites and right across the health and social care system. In the latest week, attendances at A&E departments increased to 26,000, the highest in six months. The last time Covid inpatients were above 2,000, in January 2021, attendance to A&E departments were at 16,000 for the week, an increase of nearly 40%, putting even more pressure on our NHS and impacting on delays in our A&E departments.

At the same time we are hearing from our healthcare colleagues that people who are admitted to hospital are sicker and as a result require more time in hospital with average length of stay up around one day (16%) on historic levels meaning a greater bed requirement.  

These issues are not unique to Scotland and our A&E departments continue to be the best performing in the UK, for over six years. Latest comparable data for January shows that Scotland’s A&E performance was 11.4 percentage points better than England and 14.1 percentage points better than Wales.

Our colleagues in the community are also experiencing challenges.  The current spread of Covid in the community is creating significant problems for our workforce. This is felt in social care but our health and social care partnerships are working incredibly hard to support people, both in the community and those coming out of hospital. All partnerships are now involved in our “discharge without delay” programme to improve discharge planning arrangements and reduce lengths of stay in hospital. 

For planned care, our NHS colleagues are working exceptionally hard to restart elective activity. Covid, workforce, and bed capacity pressures do, however, continue to create challenges and we are now receiving reports that some restarted electives are being postponed again to deal with the increasing pressure that out health boards are facing at this immediate time.

Extended waits for elective treatment increases the risk of deteriorating health and social care outcomes and the additional impact that has on unscheduled care. We are working closely with health boards and partners to support planning and delivery of the high level commitments in the NHS Recovery Plan, published last summer. 

We are also investing in our Hospital at Home programme. We have enhanced Hospital at Home services across Scotland over the last few weeks with further capacity expected to come on stream by the end of this month. This work is critical as we move into the recovery phase and we are already beginning to see some of the fruits of that input.  During the six month period, September 2021 to February 2022, 4,500 patients received care from a Hospital at Home service –  that is 4,500 people who without these services would have experienced an acute hospital stay. This resulted in 26,700 occupied bed days for Hospital at Home services - so an avoidance of 26,700 acute hospital occupied bed days.

The Redesign of Urgent Care programme is incredibly important too. We have supported it with  £23 million this year - it's another example of the positive work we are undertaking. Through this work we are strengthening alternative services so that those who think they need to go to A&E but their illness is not life threatening, can be seen or treated at home or in the community.

We are of course increasing funding to NHS 24 so people can get good advice and quickly as well because i know  some waiting times in NHS 24 have also been too long.

I have been upfront and honest about the scale of the challenge in terms of our NHS recovery. It will take time. The recovery will not be a matter of weeks or months, it will take years and we are working closely with boards to look forward together to deliver a package of measures to support sustainable recovery and, in the potential event of future Covid-19 waves, how can we insulate the recovery from those waves. That is the work we are undertaking.

We will continue to fund our National Treatment Centres and are putting £400m into the National Treatment Centre programme, which will again help us, particularly around elective care.

Funding for the NHS in 2022-23 is of course at the record level of £18 billion

To conclude, our health and social care services continue to face  unprecedented pressures and I hope i have managed to set the context of why they are under such severe pressure and I will work day and night, as I have done since being appointed to this role, to ensure that we support the men and women who are working so hard in our health and social care system. I will end where i started by thanking them for their incredible efforts over the course of this pandemic.