UK Covid-19 Inquiry Module 3 report: Scottish Government response

Recommendation 5 - Prepare to scale up urgent and emergency care capacity & Recommendation 6 - Prepare for and test the ability to scale up hospital capacity

Recommendations 5 and 6 are addressed collectively, as the actions required to implement them are closely aligned.

Chair’s recommendation (Recommendation 5):

The UK Government, Scottish Government, Welsh Government and Northern Ireland Executive, in conjunction with organisations responsible for delivering services, should plan for surge capacity in urgent and emergency care during a pandemic. Plans must ensure that there is sufficient workforce capacity and the ability to surge, including the number and type of staff required, recruitment and training provision. This should be completed as part of the whole-system civil emergency strategy recommended in the Inquiry’s Module 1 Report (Recommendation 4). Plans should be published and subject to review every three years.

Chair’s recommendation (Recommendation 6):

The UK Government, Scottish Government, Welsh Government and Northern Ireland Executive should work with trusts and health boards to ensure that pandemic plans include practical steps to rapidly scale up hospital capacity to treat acutely unwell patients. This should include critical care services that can deliver multiple levels and types of organ support. It should also cover necessary equipment, supplies, space and staff, including redeployment and training. All trusts and health boards must keep an easily accessible, up-to-date record of the information needed to implement these plans in the hospital sites they operate. This should include technical aspects of critical care expansion such as power, ventilation, oxygen and waste management systems. Plans for expanding capacity should be published, subject to review every three years and tested as part of the pandemic response exercises recommended in the Inquiry’s Module 1 Report (Recommendation 6).

Scottish Government response:

The Scottish Government accepts both recommendations 5 and 6 in principle, and recognises the central role of all NHS Boards in ensuring that robust, practical and regularly reviewed arrangements are in place to respond to future pandemics or public health emergencies.

The Scottish Government has already begun taking steps to address these two recommendations, including:

• The Scottish Government has commissioned all NHS Boards (this includes territorial health boards and special boards such as NHS 24 and Scottish Ambulance Service (SAS)), to review and assure their arrangements in terms of current capacity and the ability to scale up when required, while also contributing to the development of a consistent national approach to preparedness and resilience
• While capacity can fluctuate, work by the Scottish Intensive Care Society Audit Group has shown increases in critical care capacity in Scotland since the pandemic
• A review of critical care equipment has been undertaken. All NHS Boards are holding and maintaining on site ICU equipment to double capacity
• Work is underway to confirm the approach to maintaining this capacity (as equipment will require replacement in five years’ time)
• PSD Scotland is working in partnership with NHS Boards to deliver a national Medical Equipment Management System, to provide the Scottish Government with national oversight of Board medical equipment

Further initial steps proposed are as follows:

The Scottish Government has commissioned work to ensure there is a clear overview of health boards' capacity.

Health Boards have been asked to review existing plans and arrangements for managing significant increases in urgent and emergency care demand, including:

• Workforce arrangements
• Staffing models
• Training and competency
• Mutual aid
• Governance and escalation
• Risks and gaps

Health Boards are also undertaking a review of current plans for expanding hospital and critical care capacity. The Scottish Government has asked that this includes:

• Additional bed capacity
• Critical care expansion capability
• Availability of equipment, supplies and consumables
• Workforce
• Infrastructure requirements
• Command, control and decision-making arrangements

Actions and implementation timescale(s):

Returns from this exercise are expected by the end of September 2026 and will give the Scottish Government an overview of current arrangements, key risks, what actions Boards are planning to address, any gaps and what the resource and funding implications are. It will also offer government assurance that adequately robust arrangements are in place. The national review of the Board returns and identification of common themes is due for completion December 2026.

Where areas for improvement are identified, Health Boards will develop and implement actions to strengthen preparedness and resilience. From 2027 ongoing review and testing of the plans through resilience exercises will commence, with a formal review of plans being undertaken every three years thereafter, whilst also being updated regularly to ensure they remain effective and fit for purpose and in line with equalities considerations. The expectation is that this initial review and improvement work will be concluded by March 2027.

Recommendations 5 and 6 will be added to the agenda of a standing four nations meeting to ensure alignment and a co-ordinated approach across the four nations.

Scottish Government will then monitor these on an ongoing basis so that ministers and the public can be assured that that the lessons identified by the Inquiry are being addressed.

Accountable Officer:

The Director General for Health and Social Care, working with the Directorate for the Chief Operating Officer, NHS Scotland within the Scottish Government, will be accountable for the implementation of the Scottish elements of this recommendation.