NHS Winter Preparedness Plan: Health Secretary statement - 28 October 2020

Presiding Officer, the rise in positive tests for COVID-19 confirm that not only is the pandemic still with us, but that this virus will seize any opportunity to spread.  Today I will set out the decisive steps we are taking to prepare our NHS to respond to this and wider winter pressures.

Earlier this year I put our NHS on an emergency footing – that emergency remains.

The plan published today is directly linked to the social care plan I will publish next week – they are interconnected and interdependent and I will return to Parliament next week to set that out in more detail.

Scientific evidence indicates that prior to a vaccine further waves of infection are probable. Previously, the incredible commitment of our health and social care staff, as well as the unstinting support and perseverance of the people in Scotland, prevented the NHS from being overwhelmed.  Our over-riding priority is to make sure that continues to be the case. 

That is not only vital to saving lives and providing care to those with COVID-19, it is vital if we are to make sure  - as far as we can – that care can be provided safely for the other health needs of our nation.

We need to make every effort to prepare the NHS for the pressures it will face in the coming months as we do every winter. But we do that this year with the additional demands from a significant resurgence of COVID-19; and from the uncertainty of Brexit as the threat of no deal at the end of the transition period remains.

A few weeks ago I set out the key pressures on our NHS. 

• The critical public health measures to deal with COVID- 19 of Test and Protect and flu vaccination;
• the demands of dealing with rising COVID cases and holding capacity for any surge in these numbers;
• the need to re-start and maintain critical health care services in the community and in hospital to deal with those who have been waiting as a result of the earlier lockdown and do what we can to prevent that number significantly increasing;
• to do that, whilst putting place necessary COVID safe measures of increased PPE, physical distancing and enhanced cleaning all of which inevitably decrease the volume of patients that can be seen in any one clinical or theatre session.

All of those demands are there now – and facing a workforce who have had a very tough year already.

So it is inevitable that difficult decisions will have to be taken to prioritise NHS capacity and resilience to address these.

That’s why today I’m publishing our NHS Winter Preparedness Plan, to set out those very real challenges and capture the range of actions we’re taking, and the resources being made available, to support what has to be a multi-faceted response.

Last month I announced £1.1 billion for NHS Health Boards and Integration Authorities to meet the costs of responding to the pandemic.

Today I’m announcing an additional £37 million to ensure our health and care services are in the best position to respond to these unprecedented winter challenges.

These resources will support our key priorities for the next phase; our vaccination programmes; Test and Protect; and sustaining our essential services.

Our objectives on vaccinations are twofold - to vaccinate nearly 2.5 million people – an increase of 50% over last year for the flu, and to be ready to deliver a safe, effective vaccine against COVID-19 as soon as one is available.

The first of these is underway using a range of delivery routes, with Health Boards aiming to deliver vaccinations to all high risks groups by 31 December with many operating seven days a week to do that.

Alongside this our work is underway – learning the lessons from the flu programme – to see a national plan with local delivery for the COVID-19 vaccine – as soon as one becomes validated and available and with an initial focus on protecting the most vulnerable to harm. As that work crystallises I intend to return to the Chamber to provide more detail to members.

Our Test and Protect strategy is a key element in that battle to disrupt the spread of the virus.

We are increasing overall Scottish testing capacity from current position of around 27,000 to at least 65,000 tests per day by the winter, drawing upon both NHS Scotland and UK-wide Lighthouse lab capacities. Three new NHS Regional Testing Hubs will be fully operational by early December, contributing an additional 22,000 daily tests to that 65 thousand number.

And we’re working  through what additional capacity new processing technologies can offer and new test routes can bring to our plan to increase the cohorts of individuals offered regular asymptomatic testing – in line with the clinical review published on last Friday.

Our contact tracing record remains strong.  Over the 4 week period of 21 September to 18 October, weeks when case numbers were rising - 91% of positive cases successfully completed within 48 hours – 75% of that number within 24 hours.  This is a vital service – our second line of defence and so we continue to actively ensure health boards use the resources provided to make sure we have both the capacity and the back up resilience through the National Contact Tracing Centre.

Members will recall the planning we put in place to deal with hospital and ICU COVID cases in the early months and that need to repurpose approximately 3,000 acute beds nationwide for COVID-19 patients remains.

Our Health Boards retain the ability to double ICU capacity within one week, treble it in two weeks and quadruple it to over 700 should circumstances demand.

And today, in some of our acute settings we can right now see the importance of retaining that capacity as hospital and ICU cases rise.  

But these beds need staff – trained, skilled staff.  So an increase in COVID cases inevitably limits capacity for other services. We need to be ready for this and plan for the possibility that resumed non COVID services may have to be limited or paused so we can direct capacity to accommodate COVID or winter pressures.

Those pressures will impact differently across the country.  We can see that today.  But whilst that is the case we need to have an approach that strives for as much equity of access for patients as we can and – unlike in the early response – strives to maintain as much non COVID health care as possible.

So we are putting in place a national framework to ensure that consistent approach to prioritisation for planned and unplanned care across the country, alongside actions to mitigate the impact in local areas if we face the situation where services need to be suspended for any length of time.

The pressure on acute capacity and the patient centred approach of our NHS which works to make sure people receive the right care in the right place, makes the work underway to redesign urgent care all the more important.   

That redesign work – undertaken with the full involvement of clinical colleagues, boards and overseen by the Mobilisation Recovery Group, aims to help patients know where to go for urgent care when they need it. 

This is a significant programme of work and it won’t be completed in 6 months, or even a year.  It will be undertaken carefully and in stages.  And to test out the first part – make sure it works and is safe and accessible, the first phase of that redesign programme will be implemented at a pathfinder site over November.  With the lessons and the learning from that - from patients as well as from the service, we then aim for a national rollout in December - supported by £20 million of investment and a major information campaign to ensure people know how to access the right care in the right place.

Whilst our response to COVID-19 is fundamentally important, so too is our ability to continue to provide care and treatment for other health needs, both urgent and routine. 

As we have throughout the pandemic, we will continue to provide treatment for cancer and other life threatening conditions. More recently, Health Boards have begun to safely restart a number of diagnostic and screening services and elective procedures.

We wrote to Health Boards and their Integration Authority partners last month to confirm the provision of over £78 million to ensure that NHS Boards continue to restore as much of their elective activity as circumstances allow. This funding will support additional activity with over 70,000 outpatient appointments, over 13,800 elective procedures and over 98,000 diagnostic tests.

NHS Golden Jubilee continues to play an important role with an additional 1,600 urgent and cancer patients seen between March and September and a plan to treat a further 13,000 across all relevant surgical specialties before the end of March next year, operating as a COVID-light site.

Over 4,000 outpatients have been seen in NHS Louisa Jordan since July, with numbers continuing to grow. That facility offers us crucial additional capacity in orthopaedics, dermatology, oral medicine and imaging as well as remaining ready to stand up to care for  COVID patients if we need it to.

The curtailment of many service for patients in the early stage of the pandemic meant that many people who need care are waiting longer than any of us would want.  I am truly grateful to them for bearing with us and as far as I can I do want to assure those patient that we are doing all we can to get the care to them as quickly as possible. The place to start is with clinical judgement so we prioritise planned and unplanned care based on clinical need so that those with the greatest need are treated first and that we do that in a consistent way across the country.

I said at the outset that addressing all of these demands raises perhaps the most significant demand of all – the demand on NHS staff who already have had such a tough year.  We have asked so much of them – and we’re asking it again.

There aren’t the words to express how truly grateful I am to them.  But more than words – we need to make sure they have the support they need.  I intend that all of the practical, on the ground, support we saw in the early phase remains and the significant additional support for mental health and wellbeing stays in place - ensuring staff ‘hubs’ and rest areas are maintained and establishing a Mental Health Network, backed initially by £5 million of funding.

We know the next few months – like the year so far -  are not going to be easy. They will once again require difficult judgements and difficult choices to be made.  I am all too aware of the sacrifices our response will entail – from the amazing but weary front line workers to those across our communities who may need to wait longer for treatment than I would want.

I am absolutely determined that we will do everything in our power to be ready for these challenges. We have learnt a great deal from the first wave of the pandemic and we are better prepared. Our NHS Winter Preparedness Plan sets out the range of actions we are taking to support our incredible healthcare services and to work with them to manage this next phase.

That is nothing more than they – and the people of Scotland – deserve.