Health and social care: winter preparedness plan 2024 to 2025

Learning from Last Winter

As in previous years, we undertook a comprehensive exercise to understand the lessons learned from last winter, which focused on the development, delivery, and governance of the published actions. This work has informed and shaped our planning this year.

We have met with valued partners from across the NHS, Local Authorities, Health and Social Care Partnerships (HSCPs), the third, independent and voluntary sectors to listen to their concerns and identify gaps in last year's winter plan. We have implemented many of the requested changes and will continue to work alongside those most affected by the plan, to make necessary improvements, so that our plan can best reflect the current context and support our system.

Local systems, and the individuals and organisations that work within it to deliver health and care to our most vulnerable individuals, worked hard to meet high levels of demand and ensure people received care when they needed it most. However, we know that complex challenges remain and there is still work to be done to ensure people can access the timely care they need in the appropriate setting.

Last winter and in previous winters, we have seen unacceptable waits for ambulances, assessments and care packages, long ambulance queues and delays in A&E departments, and hospitals more broadly. We have experienced high levels of hospital occupancy, delayed discharge and unmet need within our communities, as well as increased demand for GP appointments and for social care packages and assessment.

We know that all aspects of our health and social care system are interconnected. Increased pressure in one part of the system is not isolated but impacts more widely across the whole system. Increased occupancy within our hospitals for example can increase the individual's length of stay and impact on levels of delayed discharges. This also leads to poorer outcomes for individuals which in turn can have a knock on impact on the demand for social work assessment and, in particular if an individual has a prolonged hospital stay, the level of care they require when they do leave hospital. It is important to recognise the significant impact longer lengths of stay have on individuals, causing deterioration, reducing independence and in some cases resulting in life-changing decisions such as admission to institutional care.

We have also seen that these are not limited to the winter period with increased pressure on our health and social care system at all times of the year. This has, since the Covid-19 pandemic, regularly continued throughout the summer months and we have, this year, seen delayed discharges remain at peak levels long after they would normally begin to reduce. It is also important to note that Covid has not gone away, but simply added to the pressures experienced, at points this summer we have seen over 600 hospitalisations from Covid, Scotland wide. These pressures are only exacerbated by challenges with workforce availability, demographic and population issues, and budget constraints.

This all indicates that we will enter this winter with a health and social care system under more extreme pressure than ever before. This has provided the context for the development of this plan and the initiatives contained within.

Critically, the report highlighted that to be effective, planning for periods of surge should be a year-round and not limited to the winter months. That is why this year, we have a dedicated team responsible for working across the health and social care system to determine actions to be implemented and delivered throughout the year, to build resilience and capacity in our systems.