Looking relaxed and content at Vale of Leven Hospital dialysis unit.

By Jeane Freeman, Health Minister, Scottish Government

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

Earlier this year, I put our NHS on an emergency footing, and that emergency remains. The plan published today is directly linked to the social care plan that I will publish next week. They are interconnected and interdependent. I will return to Parliament 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 Scottish people, prevented the NHS from being overwhelmed.? Our overriding priority at this time is to ensure that that continues to be the case.? Not only is that vital to saving lives and providing care to those with Covid-19, it is vital if we are to ensure, 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 that it will face in the coming months, as we do every winter. However, we do that this year with additional demands because of a significant resurgence of Covid-19 and the uncertainty of Brexit, given that the threat of there being no deal at the end of the transition period remains.

A few weeks ago, I set out the key pressures that are on our NHS. Those are: the critical public health measures of test and protect and flu vaccination, to deal with Covid-19; the demands of dealing with rising Covid cases and holding capacity for any surge in case numbers; and the need to restart and maintain critical healthcare services in the community and in hospital to deal with those who have been waiting as a result of the earlier lockdown and to do what we can to prevent that number from significantly increasing.

That all needs to be done while putting in place the necessary Covid-safe measures of increased personal protective equipment, 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 those demands are here now, and are faced by a workforce who have already had a very tough year. Therefore, it is inevitable that difficult decisions will have to be taken to prioritise NHS capacity and resilience to address those demands. That is why I am publishing our NHS winter preparedness plan today. I am doing so to set out those challenges and to capture the range of actions that we are taking and the resources that are being made available to support what has to be a multifaceted response.

Last month, I announced £1.1 billion of funding for NHS health boards and integration authorities to meet the costs of responding to the pandemic. Today, I am announcing an additional £37 million to ensure that our health and care services are in the best position to respond to those unprecedented winter challenges. Those 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 for flu—an increase of 50 per cent over last year—and to be ready to deliver a safe and effective vaccine against Covid-19 as soon as one is available. The first of those is under way using a range of delivery routes, with health boards aiming to deliver vaccinations to all high-risk groups by 31 December. Many are operating seven days a week to do that.

Alongside that, work is under way on a national plan with local delivery for the Covid-19 vaccine, learning the lessons from the flu programme. As soon as a Covid-19 vaccine becomes validated and available, our initial focus will be on protecting the most vulnerable from 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 vital element in the battle to disrupt the spread of the virus. We are increasing overall Scottish testing capacity from the current position of around 27,000 tests per day to at least 65,000 by the winter, drawing on NHS Scotland and UK-wide Lighthouse laboratory capacities. Three new NHS regional testing hubs will be fully operational by early December, contributing an additional 22,000 daily tests to the 65,000 number.

We are also working through what additional capacity new processing technologies can offer and what new test routes can bring to our plan to increase the cohorts of individuals who are offered regular asymptomatic testing. That is in line with the clinical review that was published last Friday.

Our contact tracing record remains strong. Over the four-week period of 21 September to 18 October—weeks when case numbers were rising—91 per cent of positive cases were successfully completed within 48 hours, and 75 per cent of that number were completed within 24 hours. It is a vital service—our second line of defence—so we continue to actively ensure that health boards use the resources that are provided so that we have the necessary capacity, as well as back-up resilience through the national contact tracing centre.

Members will recall the planning that we put in place to deal with hospital and intensive care unit Covid cases in the early months. The need to re-purpose 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. Today, in some of our acute settings, we can see the importance of retaining that capacity as hospital and ICU cases rise.

Work goes on at the Golden Jubilee Hospital where non Covid patients continue to be treated.

Those beds need staff—trained, skilled staff—so an increase in Covid cases will inevitably limit capacity for other services. We need to be ready for that and plan for the possibility that resumed non-Covid services might have to be limited or paused so that we can direct capacity to accommodate Covid or winter pressures.

Those pressures will impact differently across the country—we can see that today. However, although 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, strive to maintain as much non-Covid healthcare as possible.

We are putting in place a national framework to ensure a 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 in which 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 that people receive the right care in the right place, make the work that is under way to redesign urgent care all the more important. That redesign work, which is being undertaken with the full involvement of clinical colleagues and boards and is overseen by the mobilisation recovery group, which I chair, aims to help patients know where to go for urgent care when they need it.

It is a significant programme of work, and it will not be completed in six months or even a year. It will be undertaken carefully and in stages. In order to test it and make sure that it works and is safe and accessible, the first phase of the redesign programme will be implemented at a pathfinder site over November, from which we will learn lessons, from patients as well as from the service. We then aim for a national roll-out in December, which will be supported by £20 million of investment and a major information campaign to ensure that people know how to access the right care in the right place.

Although 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 done throughout the pandemic, we will continue to provide treatment for cancer and other life-threatening conditions. Recently, health boards have begun to safely restart a number of diagnostic and screening services and elective procedures. Last month, we wrote to health boards and their integration authority partners to confirm the provision of more than £78 million to ensure that NHS boards continue to restore as much of their elective activity as circumstances allow. That funding will support additional activity, with more than 70,000 out-patient appointments, more than 13,800 elective procedures and more than 98,000 diagnostic tests.

The NHS Golden Jubilee hospital 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. It is operating as a Covid-light site.

Since July, more than 4,000 out-patients have been seen in the NHS Louisa Jordan hospital, with numbers continuing to grow. The 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 services for patients in the early stage of the pandemic has meant that many people who need care are waiting longer than any of us would want them to. I am truly grateful to them for bearing with us as far as they have, and I assure them that we are doing all that we can to get the care to them as quickly as possible. The place to start is with clinical judgment so that we prioritise planned and unplanned care based on clinical need and those with the greatest need are treated first. That should be done in a consistent way across the country.

I said at the outset that addressing all those demands raises perhaps the most significant demand of all: the demand on NHS staff, who have already had such a tough year. We have asked much of them, and we are asking that again. There are not words to express how truly grateful I am to them. However, more than words, we need to ensure that they have the support that they need. I intend that all the practical on-the-ground support that we saw in the early phase remains and that the significant additional support for mental health and well-being stays in place, and I intend to ensure that staff hubs and rest areas are maintained and to establish a mental health network, backed initially by £5 million of funding.

We know that, like the year so far, the next few months will not be easy. They will once again require difficult judgments and difficult choices to be made. I am all too aware of the sacrifices that our response will entail, from the amazing but weary front-line workers to people 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 those challenges. We have learned a great deal from the first wave of the pandemic, and we are better prepared.

Our “Winter Preparedness Plan for NHS Scotland—2020/21”, which was published today, sets out the range of actions that we are taking to support our incredible healthcare services and to work with them to manage the next phase. That is nothing more than they and the people of Scotland deserve.

Top picture: Jeane Freeman plants a tree at Vale of Leven Hospital. She is joined by campaigners who are anxious to secure the future of the local District General Hospital. Picture by Bill Heaney

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