Health and social care: winter preparedness plan 2024 to 2025

Priority One

Priority One: Prioritise care for all people in our communities, enabling people to live well with the support they choose and utilise effective prevention to keep people well, avoiding them needing hospital care.

Social care and support services, social work and Unpaid Carers, alongside other community-based health and social care services, play a vital role in supporting people to live well at home. Ensuring safe, effective person-centred care through an integrated and co-ordinated approach is critical year-round but particularly over winter. Health and social care professionals operate in numerous community settings, operated by public bodies, independent providers and third sector organisations. These professionals work with thousands of people across Scotland, helping them to stay well, flourish and live independent lives year-round and particularly in the winter period, reducing the pressure on our health and social care system and ensuring that individuals continue to receive the best possible care in challenging circumstances.

Primary care is the first point of contact with the NHS. This includes contact with community-based services provided by GPs, community nurses, dentists, dental nurses, optometrists, dispensing opticians, community pharmacy and general practice-based pharmacists and pharmacy technicians. Each week in Scotland there are around 680,000 General Practice consultations, with 25,000 people attending our hospital Emergency Departments.

Likewise, the Council social work department and community based organisations are often an individual's first point of contact for care and support whether as someone seeking additional support for themselves or as an unpaid carer. It is vital that we recognise the key role our partners play in enabling people and communities to live well through preventative, holistic, and place based support.

How we will jointly deliver this priority:

• Proactively support people at highest risk in our communities to keep well and prevent the need for hospital care, supporting the community services which deliver this critical work. This includes:
  • Supporting the health and social care professionals working in every care home and care at home service, who maintain the health and wellbeing of thousands of people across Scotland by taking forward activity under the Joint Social Services Taskforce (JSST) which has the most valuable impact on the social care and social work workforce in partnership with Scottish Care, NES, the Scottish Social Services Council (SSSC), Social Work Scotland, Coalition of Care and Support Providers in Scotland (CCPS) and unions.
  • Enabling the delivery of high quality, effective and personalised care in care homes across Scotland, with dedicated health and social care professionals providing a safe and nurturing environment. We ensure that the best care is provided through a range of improvement activity, and the Healthcare Framework. The Health and Social Care Standards set out what should be expected when using health, social care or social work services in Scotland and these underpin the Care Inspectorates inspection frameworks^[4][5][6]. Providing excellent care for individuals in their own homes through dedicated care at home services, which provide care tailored to the needs of almost 90,000 people across Scotland^[7], enabling people to live as independently as possible in their own homes.
  • Ensure there is clear communication at a national level that a care package may be - home care, either long term or to support reablement, or it could be a mix of home care; digital technology and aids and adaptations or in some situations, just digital or aids and adaptations.
  • Supporting individuals to live their lives in ways that are meaningful to them, maintaining their own and their carers' health and wellbeing through self-directed support and support for unpaid carers COSLA and Scottish Government recently published the Self Directed Support (SDS) Improvement Plan to support progress of implementation of SDS so that people consistently experience choice and control over their care.
  • The provision of free personal and nursing care payments to over 10,000 adults across Scotland^[8].
  • Critical to this is the strong partnership working between Integration Authorities and local providers and third sector interface.
• Writing to all local areas in advance of winter to reassure them of the flexibility available in the statutory guidance, when considering the employment of a family member as personal assistant under SDS option 1. This will support local decision making and development of processes which will mitigate, manage or reduce risks when it is in the best interests of the supported person to employ a family member with Power of Attorney (POA) / guardianship as a personal assistant.
• Ensure that existing programmes of work being progressed by Digital Health and Care (DHAC) and COSLA are utilised fully to support system pressures, including
  • Maximising the benefits of the shared Alarm Receiving Centre (ARC) - the shared ARC is now live with several HSCPs and 7 more to be onboarded over the next few months. The shared ARC is a cloud-based common platform for ARCs across Scotland supports the required shift towards more proactive and preventative approaches to supporting citizens, including the integration of Telecare data to support assessment, anticipating need, and supporting early interventions. With standardised data, telecare providers can anticipate citizen needs and tailor interventions, accordingly, ensuring timely and targeted support.
  • Use data more effectively to support early intervention using the Telecare Information Framework (TIF). Through the adoption of this data set, telecare service providers will gain access to valuable insights that support early intervention and preventive measures. By leveraging data analytics, providers can proactively identify individuals at risk and intervene promptly, ultimately improving outcomes and enhancing citizen wellbeing.
• Through the Mental Health and Wellbeing Strategy we will ensure we have the right activity in place to meet changing need this winter and in coming years, with a strong focus on prevention and early intervention, to allow people to access care in the most appropriate setting or pathway.
• Through the Mental Health and Wellbeing Delivery Plan, continue to build on work underway to improve unplanned and urgent mental health care, including for those in mental distress, by utilising a multi-agency response and alignment with the national rollout of the Distress Brief Intervention (DBI) programme and;
  • Continuing to invest in NHS 24's Mental Health Hub.
  • Support Boards providing access to a mental health clinician 24 hours a day, seven days a week.
  • Embed the Time, Space, Compassion principles.
  • Increase access to existing and developing services by developing a mental health unscheduled care resource pack by Autumn 2024.
  • Continue to increase awareness of available pathways into support and care through developing tailored messaging for specific population and equalities groups in 2024.
  • Continue to invest in the Enhanced Mental Health Pathway and promote partnership working to increase Police Scotland and Scottish Ambulance Service (SAS) access to local clinical support.
  • Take an evidenced based approach to improvement work to better understand how people are accessing and receiving unplanned mental health care, ensuring that improvements to unplanned and urgent care are underpinned by robust data, including person demographic data.
• Respond to recommendations by Her Majesty's Inspectorate of Constabulary in Scotland's (HMICS) thematic review of Policing and Mental Health published in Autumn 2023, and the subsequent Police Scotland actions on mental health.
  • Through the multi-agency Partnership Delivery Group (PDG) on mental health and policing established to drive forward activity aimed at improving outcomes for people in mental health need, as well as those experiencing distress or crisis, publish a Framework for Collaboration supporting partnership working at a local level for police, health, social work, social care services and across public and third sectors, in the Autumn, as well as a cross-sector Action Plan before the end of 2024, which will detail how long-term ambitions are to be achieved.
  • A national review of Psychiatric Emergency Plans by the Mental Health Unscheduled Care Network by November 2024, followed by the development of national guidance in 2025 to ensure reasonable consistency across 14 Health Boards.
• Maintain consistent engagement with Boards, sponsored bodies and key groups such as Primary Care leads, National Out of Hours (OOH) oversight group, SAS and NHS 24 to continually monitor the performance of the Primary Care system through regular performance reporting on:
  • GP capacity and resilience
  • OOH availability
  • SAS and NHS 24 performance

Report on-going performance to Ministers and highlight any issues through CRAG, escalating and taking any action as appropriate.

• Provide ongoing support through the Scottish Dental Access Initiative (SDAI) to facilitate the opening of new or expansion of existing General Dental Services (GDS) dental practices to register new NHS patients for care, by engaging with boards to understand local issues and facilitate local solutions, such as Public Dental Service (PDS) providing alternative care to patients who cannot access GDS.
• Ensure the Primary Care system is as resilient as possible heading into winter and that people are able to access the care they need, in their community, where appropriate. One such example is the SAS Integrated Clinical hub, which helps to direct patients to the most appropriate point of care, without automatically directing them to A&E.
• Build resilience in social care through the invaluable work of our Local Authority and Health and Social Care Partnership resilience leads and existing Resilience Partnerships to facilitate effective business continuity planning, emergency preparedness and development of our resilience infrastructure.
• Ensure that Community Pharmacy are able to deliver core services, including NHS Pharmacy First Scotland, both in and OOH.
  • Health Boards ensure that there is adequate provision of NHS Pharmaceutical Care services and support to local health care needs, including winter.
  • Health Boards and local contractor committees continuing to work collaboratively to address any pressures across local community pharmacy networks such as cluster working.
  • Community pharmacies continue to provide appointment free access to pharmacists and the wider pharmacy support team for advice and treatment for minor ailments and every day common clinical conditions.
  • Ensuring that patients continue to have access to the prescribed medicines and services such as NHS Pharmacy First and a range of Public Health Services.
• Work to embed the Getting It Right For Everyone (GIRFE) principles through our 'Team around the person' toolkit, which has been co-designed with partners and people with lived experience. This will support Health and Social Care professionals to provide holistic support to people, alongside the My Health, My Care, My Home healthcare framework for adults living in care homes^[9].
• DHPs are made by local authorities to eligible individuals where they need help with their rent or housing costs. Eligible individuals can find out how to apply by visiting mygov.scot or contacting their local authority.^[10]

Protecting people through the delivery of vaccination programmes that reduce serious illness, hospitalisation and mortality.

Protecting people who may be most impacted by severe illness, hospitalisation or death from RSV, Covid-19 and flu, through vaccination, is a key means of reducing demand on our health and social care systems.

The new RSV programme, launched in August 2024, demonstrates the value of vaccination. This programme will be offered to pregnant women to protect babies and to older adults aged 75-80 RSV is the leading cause of emergency respiratory admissions to hospital in Scotland in infants, with 1,516 children aged under one hospitalised with the virus last year. There were also over 1,000 cases of RSV recorded in adults aged 75 and over in Scotland between October 2022 and September 2023, with more than half (535) having to spend time in hospital as a result. It is therefore anticipated that a successful programme will help to reduce these numbers.

We also want to see as many eligible people as possible protected from Covid-19 and flu this winter. Our eligible cohorts continue to be guided by independent advice from the Joint Committee on Vaccination and Immunisation (JCVI) who assess who is most at-risk from these viruses, and therefore would benefit from vaccination.

Our adult Flu and Covid-19 vaccination programme will launch for winter, with all those over the age of 65, residents in care homes for older adults and all those in a clinical risk group, eligible for both vaccines. Both vaccines will be offered at the same appointment for efficiency.

This winter, the JCVI does not advise an offer of Covid-19 vaccination for frontline health and social care workers, staff working in care homes for older adults, unpaid carers and household contacts of people with immunosuppression. However, they do say that Health and social care service providers may wish to consider whether vaccination provided as an occupational health programme is appropriate, and ahead of such considerations, health departments may choose to continue to extend an offer of Covid-19 vaccination to frontline health and social care workers and staff working in care homes for older adults in winter 2024. Under this flexibility, Scottish Government has decided to offer frontline health and social care workers, including all staff working in care homes for older adults, Covid-19 vaccination this winter. It's important that we do everything we can to ensure those who are eligible for the vaccine, including frontline staff, take it up if they wish. We will work with partners including Public Health Scotland to promote and encourage uptake.

Unpaid carers and household contacts of the immunosuppressed will remain eligible for flu vaccination this winter, but will not be offered Covid-19.

The primary aim of the national Covid-19 vaccination programme remains the prevention of severe illness (hospitalisations and deaths) arising from Covid-19. As currently available Covid-19 vaccines provide limited protection against mild and asymptomatic disease, the focus of the programme is on offering vaccination to those most likely to directly benefit from vaccination, particularly those with underlying health conditions that increase their risk of hospitalisation following infection.

This year's flu programme aims to protect those most at risk of severe illness, reduce transmission of the infection and support the resilience of the health and care system, particularly during the winter months. Alongside this, it will be important for us to continue to closely monitor rates of respiratory viruses including Covid-19 and provide infection prevention and control advice and guidance as required.

In addition to vaccination and infection prevention, social connections, exercise and meaningful activity are vital for the wellbeing and quality of life of everyone, but in particular those living in a care home. It therefore remains fundamentally important that people living in care homes remain connected to their loved ones even in infectious outbreak situations in line with PHS Covid-19 Guidance.

How we will jointly deliver this programme:

• Work with Boards to introduce the new year-round maternal RSV vaccination programme from 12 August 2024 to protect infants.
• Offer the flu vaccination to all school age children in Scotland, including secondary school pupils as part of the seasonal child flu programme.
• Promote child flu vaccination uptake, especially in children aged 2-5 years, to ensure they receive the earliest protection to help stop the virus spreading. To have maximum impact, early completion of vaccination amongst this group is essential.
• Work with Boards to vaccinate all cohorts as advised by JCVI as part of the seasonal flu and Covid-19 vaccination programme.
• Frontline health and social care workers will be eligible for both Covid-19 and flu vaccination, but we will work with PHS and Boards to assess a return to peer-to-peer flu vaccination delivery models in clinical settings.
• Boards will continue to offer frontline Health and Social Care Workers the opportunity to drop into any community clinic, without the need to book, but workers can also book via the online portal and the national vaccination helpline if they would prefer.
• Although frontline Health and Social Care Workers are eligible for both Covid-19 and flu this winter, they will be more active promotion of flu vaccination uptake in that group, as well as non-frontline NHS worker groups, to help build resilience within the health and social care system. Continuing to encourage high vaccination uptake for both Covid-19 and flu, within care homes and care at home providers specifically is vital.
• Focus on key messaging to encourage uptake of the winter vaccination programme, with a focus on the individual properties and benefits of each vaccine, to target vaccine hesitancy and inclusion:
  • There will be no national Flu Vaccine Covid Vaccine (FVCV) marketing campaign in winter 2024 and no paid for media or marketing activity
  • Instead, PHS Comms will develop an inhouse creative for a predominantly digital campaign for all eligible groups.
  • There will be specific focussed assets designed to reach those who support vaccination but are hesitant or are not prioritising getting vaccinated^[11].
  • PHS will develop more clinical flu and Covid-19 messaging for the frontline Health and Social Care Worker group.
  • All PHS FVCV assets and toolkits will be distributed via established stakeholder networks.
  • There will be a PHS led seasonal child flu programme updated national marketing campaign - 'A Wee Skoosh'.
• Replenishing covid test stocks at regular intervals to meet projected demand. As a positive test is required to access Covid-19 treatments for those eligible, additional orders of new tests can be placed in line with demand.
• Continue to work with partners such as PHS, to ensure the delivery of a robust respiratory surveillance programme that quickly identifies signals or trends that are of concern and provide infection prevention and control advice and guidance as required.
• Continue to work with Executive Board Nurse Directors, and other professional leads, such as Chief Social Work Officers, Chief Officers and Care Homes to collaborate on the delivery of person-centred safe care and support to Improve the health and wellbeing of people living in care homes in line with the Healthcare framework for adults living in care homes.^[12]
• Continue to work with local partners to support people living in care settings to remain connected to their loved ones.