The Scottish Government has released a strategy entitled ‘Health and social care: winter resilience overview 2022 to 2023’, setting out the support for the health and social care sector available during the winter period.
The strategy begins with a foreword from the Secretary for Health and Social Care, Humza Yousaf, in which he states, “There is no recovery without resilience, nor resilience without recovery.”
A set of priorities has been agreed with the Convention of Scottish Local Authorities (CoSLA); along with investment of £600 million, these priorities aim to “put people at the heart of what we do, and to guide and focus our collective efforts in preparing for winter.”
The government and CoSLA agreed on eight priorities that the strategy will address. Here, we will take a look at each priority, including a focus on the plans around integrated care which can be found in priority four.
Priority one: ensure patients are receiving care at home.
The strategy acknowledges how some patients access their health and social care: “we recognise that primary and community care is for many people, the front door to the health service, where their needs are first raised.” It explains that supporting primary care providers and community care can alleviate the pressure hospitals currently face. The strategy pledges increased funding for multi-disciplinary teams (MDTs), equalling £170 million. This amount “will be the minimum funding position for future years.”
The strategy moves on to explains quality healthcare information will be made more accessible to make sure that patients receive the most appropriate care and empower them to support themselves; to support the delivery of this, the government will work with NHS 24 to make self-help guides more readily available.
Digital tools are to be used to improve access further, with remote appointment tool Near Me used to increase use and access across a range of services including mental health and social care. There are plans to launch a learning programme to support wider adoption across a wider range of services, in addition to plans to increase the use of Connect Me, a remote monitoring service.
The strategy explains plans to invest a ‘pharmacy first’ approach, with pharmacies providing support and advice for minor ailments to reduce the pressure on hospital services and embed a more community-focused and home-focused approach to healthcare.
It also sets out plans to work with independent contractors to ensure that effective access to primary care is put in place, as well as active management for urgent and unscheduled care to make sure that patients are triaged correctly and placed on the correct pathways for their patient journeys.
Priority two: expand the workforce over the winter period, including recruitment and retention, with focus on staff wellbeing.
The strategy begins by praising its current staff saying, “our highly skilled and committed workforce is the cornerstone of our response every winter.” However, it acknowledges that in order to continue to meet the rising demands from service users, especially in the winter months, capacity has to continue to expand. Staff wellbeing must also be cared for.
A variety of different options are being explored to continually grow the workforce, including broadening recruitment plans and supporting more volunteers playing a part in the health and care services.
One option is to devolve powers to NHS boards. The strategy explains that it will “utilise local flexibilities within NHS pension arrangements, and offer ‘pension recycling’.” It will allow better support for NHS boards to assist with staff who have affected been by annual and lifetime pension allowance issues, which will support staff retention for the NHS.
Moving onto recruitment, the strategy explains that it has already welcomed over 200 new overseas nurses. £8 million of funding will be available to support boards in recruiting a further 750 nurses. Running alongside this, the strategy has also accelerated the national social care recruitment campaign using previous learnings from past campaigns in an effort to drive recruitment.
The trainee doctor workforce has been expanded by increasing the number of available medical training places, which has seen an additional 139 trainee doctor posts created in the autumn of 2022 alone, across a variety of specialities.
The strategy describes how the government continue to fund the National Volunteering Coordination Hub run by the British Red Cross. They also plan to implement a National Leadership Development programme, which will include targeted leadership development for health and social care to work proactively to manage culture change, and in turn “alleviate pressures on retention and recruitment.”
Priority three: support the delivery of care services that are safe and clinically sound throughout the autumn and winter months.
Here, the strategy acknowledges the challenges that the health services may face during the winter months, including waves of COVID-19 and flu.
It states: “Vaccination remains our best line of defence against flu and Covid-19, and we are working to ensure that more than two million eligible people in Scotland are offered and able to receive vaccines.”
To do so, the government will work with health boards and stakeholders to ensure that vulnerable individuals will have access to the winter vaccines. The Autumn/winter vaccination programme has already commenced.
The strategy also pledges to work with the boards to deliver a “safe, resilient and sustainable out-of-hours service”, to continuously ensure that patients have access to primary care 24/7.
There is a commitment to legislating for a Patient Safety Commissioner who will “champion the voice of the patient within the patient safety system.” In conjunction with this, the strategy also sets out a commitment to deliver the Scottish Patient Safety programme (SPSP), aiming to improve the quality of care being delivered and decrease harm.
Priority four: maximise capacity meeting demands, and maintain integration.
The strategy recognises “that actions and improvements would be best and most sustainably delivered in an integrated and coordinated way across the whole system.”
The government is supporting health boards, health and care partnerships and local authorities to increase the provisions of intermediate care that will “impact positively on patients and services over the winter; also, to work towards building sustainability for the future.”
It plans to do this by continuing to implement the Home First, Discharge without Delay, Discharge to Assess and effective End of Life pathways to reduce waiting times and backlogs.
In addition, in-community capacity will be increased, enabling more patients to be discharged to their own home settings as a default ambition. The strategy explains that “this increase in capacity will be context specific according to need and be a mixed model of an increase in health and care community services.” The government intends to mobilise the use of the local voluntary and third sector to enable more patients to be discharged and avoid any future readmission to the hospital.
The strategy commits to working toward the transformation of mental health service integration and explains that national guidance has been developed to help support this more integrated approach. Pathways for mental health presentations are being enhanced, for example, “referral routes from NHS 24 to local services for urgent care during the out of hours period and increased availability of mental health clinicians providing professional support to Police Scotland and the Scottish Ambulance Service.”
The strategy breaks down how an additional £528 million in funding will be used, such as £124 million to enhance care at home, £20 million supporting interim care arrangements, and £40 million to enhance multi-disciplinary teams within the healthcare system.
Priority five: continue focus on reducing long waiting lists, by protecting planned care.
This section begins by explaining: “Boards have had to take the difficult decision over the last two winters to step down planned care in order to treat patients requiring emergency treatment” and goes on further to acknowledge the impact this has had on waiting lists and on patients.
The strategy now commits to protecting planned care throughout the winter months for 2022/23.
To work towards delivering this, the strategy shares how a joined-up NHS Scotland approach is being utilised including cross boundary working and maximising use of national boards.
Through the Centre of Sustainable Delivery, they are developing “once for Scotland” pathways to deliver additional capacity, which will make use of digital opportunities and new options to access and deliver patient care.
Alongside this, a “waiting will” framework is being developed to offer more support to people as they wait for treatments and appointments, and four new treatment centres will be opened in an effort to reduce waiting times.
Commitment has also been laid out for supporting different care types, including cancer care and CAMHS (child and adolescent mental health).
Priority six: prioritise care for vulnerable patients in the communities.
The guide reinforces how it aims to mitigate the impact challenges of winter, colder weather and COVID-19 for those who are classed as at-risk, including older patients, children, disabled patients, or those who live with a lifelong condition.
The strategy explains how the government are putting in measures to help people stay well this winter, including allocating £3 billion in funds to assist with the cost-of-living crisis.
More advice and guidance will also be provided for health boards, health and social care partnerships and local authorities to ensure that more care and accommodation packages are in place for patients who are moving from inpatient treatment to community patients, with plans to tailor the advice and support for individual patient circumstances.
Priority seven: support and recognise the value of unpaid care in alleviating pressure on the health and social care sector
The strategy explains the key benefits of a national care service (NCS) and highlights how the social care and social work workforce need to be valued and receive the recognition they deserve.
To help this aim, the government has now allocated £124 million that will assist with partnerships between health and social care services to expand the capacity for care at home. This aims to “support people to maintain or even reduce their current levels of need and help to ease the pressure on unpaid carers.”
There are plans to build on efforts made during the pandemic by extending the partnership between the Scottish Health Service and the British Red Cross to host the aforementioned National Volunteer Hub.
Alongside this, the strategy commits to encouraging local authorities to use the full range of self-directed support options and to better enable friends and family members to act as personal assistants which will “allow recipients to use self-directed support in the flexible way intended by the Social Care (Self-Directed Support) Scotland Act 2013.”
Priority eight: work in partnerships across the health and social care sector and with other partners to deliver this strategy.
Here, the strategy explains how the government will work to deliver these priorities across Scotland and ensure that it has put a system of governance in place with oversight across sectors, in order to recognise and mitigate any potential risks. Through this, it seeks to enable an effective response to “whole-system winter pressures”.
The Chief Operating Officer for NHS Scotland will be supported by Health and Social Care Directors, and will report to ministers on the overall progress in the delivery of the response options. This reporting system is set to “enable us to actively monitor and evaluate strategic risks to allow timely national-level decision making.”
You can read the full strategy here.