Pressures facing the NHS: First Minister's speech - 9 January 2023

Good morning – thank you for attending and let me wish all of you a Happy New Year.

We have called this briefing today to talk in some detail about the pressures the NHS is currently facing and the actions being taken to mitigate and address these pressures – and of course to answer all of your questions.

I’m joined as you can see by the Health Secretary and Deputy Chief Medical Officer. The DCMO will be able to give a clinician’s perspective on the current issues.

I want to acknowledge first of all that while this is almost certainly, in fact I think without any doubt, the most difficult winter ever for the National Health Service, those who work in it are doing a magnificent job. Whether that is in hospitals, the ambulance service, NHS 24, across social care, in GP surgeries and other settings, health and care workers are making extraordinary efforts during exceptionally challenging times. I do know, however, the toll that is taking on them, given the nature and scale of current pressures. So I want to say how enormously grateful I and the entire government is to all of them.

I also want to acknowledge, because I think it is important that we do so, the NHS was under pressure before Covid struck us.

Changing demographics and ever increasing expectations of what healthcare advances can deliver – which of course in themselves are positive developments – were posing challenges for the NHS and necessitating reforms to care pathways.  

That said, Covid, and I think we all know and understand this, represented a significant shock to the system– and its ongoing impact, together with associated backlogs, coupled with extraordinary levels of other illnesses this winter, is creating pressure that is truly unprecedented.

And I want to just give some more detail to illustrate all of that.

First, on Covid. In the final week of 2022, the ONS estimated that one in every 25 people in Scotland had Covid.

Now, vaccines and treatments, thankfully, have significantly reduced the health harm of Covid.

But even so, more than 400 people with that virus were admitted to hospital just last week.

In total there are, right now, more than 1200 patients with Covid in our hospitals, and for context  that is double the number 4 weeks ago.

Now, even if this is absolultey the case, not all of them are in hospital directly or solely because of Covid, never-the-less the fact they have COVID means that enhanced infection control proceeds have to be in place and that  has an impact on hospital capacity.

In addition to the ongoing impact of Covid, the NHS is of course dealing with backlogs of treatment built up in earlier stages of the pandemic.

Now, it is important to say  that progress is being made here – for example, over the autumn, more than 90% of operations were performed as planned and the number of operations was a third higher than 12 months previously – so that is good progress, but the impact of backlogs remains significant.

In addition to Covid, the country has been experiencing extraordinary levels of winter flu.

More than 1,000 patients were admitted to hospital with flu during each of the last two weeks.

And finally, there has also been a rising number of cases of Strep A and other respiratory viruses, resulting in a significant demand for services.

So the impact of this combination of Covid, flu and Strep A is clear in the statistics measuring demand for health services.

 If we look at the two four-day Christmas and New Year holiday periods, NHS24 answered almost 100,000 calls – that’s the highest number in more than a decade.

In the final week of last year, compared to the week before, calls to NHS24 increased by around 50%.

The impact on the Ambulance Service has also been significant compounded by longer turnaround times which I will come back to later. But the ambulance service responded to more than 16,000 emergency incidents in the past week which is 11% higher than the average  over the last four week period.

 

I want to stress at this point though the massive contribution that both NHS24 and the Ambulance Service – through new and innovative ways of working - are making to preventing pressure on hospitals being even greater than it already is.

Additional NHS 24 staff were recruited in the run up to Christmas, and while call wait times were often longer than usual over the festive period because of the scale of demand, the overwhelming majority of calls received by NHS24 were dealt with through that initial contact without the need for any further intervention such as a visit to hospital.

Also, more than half of all patients seen by the Ambulance Service over the festive period were treated and discharged without needing to go to hospital at all.

Now to put that into context – before the pandemic, more than 60% of those who called the Ambulance Service would then be taken to hospital.

The approach being implemented by the Ambulance Service - called “See and Treat”  - is literally preventing hundreds of people every week having to go to hospital.

Now that is better for patients but it also helps reduce pressure on hospitals and of course it is also testament to the expertise of the clinicians working in the  Ambulance Service.

Now the impact of these initiatives shouldn’t be underestimated. But, despite them the reality is hospitals right now are currently almost completely full.

Last Wednesday, hospital bed occupancy across Scotland exceeded 95% . Now for context, at the same stage in 2020 - before the pandemic struck – occupancy was around 87%.

Now that reflects three factors.

First, the sheer scale of demand as a result of all the things I have already mentioned.

Second – partly in fact as result of initiatives like as ‘See and Treat’ – those who do require further care tend to be sicker with more complex needs.

And third, delays in the discharge of patients who no longer need to be in hospital.

Now, it is important to stress that the vast majority of people – somewhere around 96% - do leave hospital when they should.

And while we have seen a slight reduction in delayed discharges in the most recent weeks, there are, however, more than 1,700 people currently in hospital who don’t need to be there – and whose interests are not best served by being there - because care packages that would allow them to be discharged home or to a care home are not in place.

That obviously makes it harder to find beds for new patients who need to be admitted – and this creates pressure at the front end of the patient journey.

And that pressure causes the longer waits in A&E that we have been seeing over recent times and longer turnaround times for ambulances which, in turn, can mean longer ambulance response times.  

So in summary – while NHS staff continue to deliver excellent care, truly excellent care, for thousands of patients each and every single day - in some key areas, the system is not currently providing patients with the speed of treatment that we want to see.

Significant action to address this is already underway in addition to important reforms such as ‘See and Treat’ and ‘Hospital at Home’.

For example, in October, an additional £600 million was provided specifically to augment health and social care capacity over the winter.

This included funding to recruit up to 750 extra nurses, midwives and allied health professionals from overseas - as well as 250 support staff across acute, primary care and mental health. Some of those staff are already in place and recruitment is ongoing.

In addition, looking slightly further ahead, our draft budget for next year – and the tax proposals in it – mean that we will increase the health revenue budget by more than £1 billion in the next financial year.

And of course we do hope that the prevalence of winter illnesses will abate in the weeks to come, reducing some of the pressure currently being experienced.

However, all of that said more needs to be done now - and the reason I have spent a bit of time today talking about both the scale and nature of the current pressure is that it tells us where further action will have greatest impact.

In short, to reduce the pressure in hospitals and the knock on impacts at the front door, we need to do more to, firstly, avoid unnecessary attendances at hospital and, second, to speed up the discharge of patients from hospital.

That is where our immediate focus is. The Health Secretary will provide detail to Parliament in a statement tomorrow but let me highlight in summary form some areas of activity now.

Firstly, in relation to avoiding unnecessary hospital attendances.

I mentioned earlier that additional call handlers and clinicians were recruited to NHS24 before the festive period.

I can confirm that NHS24 staffing will increase further in the coming weeks to further enhance its capacity to offer advice and care – and so reduce the need for intervention by other parts of the NHS, including hospitals.

NHS24 will also be accelerating other strands of work planned for later this year – such as a new app and an extended range of self-help guides.

Primary care is of course already working under intense pressure – however, we are working to support health boards to maximise primary care capacity including, for example, through the kind of initiative set out by NHS Lanarkshire last week to open GP practices on Saturdays.

 We will also take further, immediate steps to speed up discharge from hospitals.

 Again I Health Secretary will say more tomorrow, but I can confirm that we will be providing immediate extra funding to health and social care partnerships to support the booking of additional care home beds for patients to be discharged to whilst their care packages are being finalised. 

That will benefit patients, I think it is important to note that first and foremost, but it will also free up much-needed capacity in hospitals.

Let me know just as I come to a conclusion, say a word about escalation contingencies, should these prove necessary over the remainder of the winter.

 Ministers do, of course, have emergency powers and the ability to direct health boards – that are set out in the NHS (Scotland) Act 1978 and we, of course, continue to keep the use of these under regular review.

However, two points, I think, are important.

First, any action we take must have tangible impact, which I why I have spent time today talking about the nature of the pressures and the targeted actions we believe will have the biggest impact. What I think we should always avoid is simply putting different labels on the problem, such as ‘critical incident’, without being clear about the practical effect and impact of that.

Second, while the NHS faces exceptional pressures across the whole country, it is important that NHS Boards retain the ability to respond flexibly to local circumstances and deploy local solutions. 

So at this stage, our priority is to empower and support NHS Boards.

Again the Health Secretary will say more tomorrow but a letter of guidance will issue to Boards this week making clear they can and should take steps to prioritise and protect critical and life-saving care if that is deemed necessary – accessing advice from government as required.

These steps could include, for example, delivering a different model of care for a short period to prioritise critical and life-saving care; opening or procuring additional capacity; and relocating staff to areas of greatest pressure.

Now the final points I want to make before opening to your questions are really for the wider public.

Firstly, I want to stress today that despite the pressures, that I have been talking about today that people are experiencing, the NHS is there for those who need it.

But it is also important to say that for many people, the best advice and support might be available on the NHS Inform website or the NHS 24 App, or by calling NHS 24.

So I would encourage people to make use of these services as many are already doing.

Second, while it is without a shadow of doubt that it is the job of government to support the NHS to deliver care for all who need it, we learned during the COVID experience that all of us can play a part to help reduce pressure on the health service.

I have already mentioned that Covid and flu are contributing significantly to current pressures.

We can all help ourselves – and also the NHS – by taking reasonable precautions to reduce the risk of getting and spreading these viruses.

Vaccination continues to be absolutely vital.

So if you are eligible for a Covid or flu vaccine and haven’t had it already, please do get vaccinated – and remember if you are the parent or carer of a child who is eligible, please make sure they get vaccinated too.

It is also worth remembering that many of the basic protections we stressed during the pandemic are still relevant now – good hand hygiene, good ventilation, for example.

And anyone with symptoms of a respiratory infection –a cold, flu or Covid – should try to stay at home if at all possible, and avoid contact with others.  And if you do need to leave home, wear a face covering which fits well.

More generally, we continue to advise those over the age of 12 should wear face coverings when on public transport or in public indoor spaces. That includes hospitals, GP surgeries and other healthcare facilities.

By protecting our own health in these ways we also do help to protect the NHS.

Now we anticipated and planned for this winter to be difficult – but, even so, current pressures are exceptional and severe. So once again, my thanks go to the entire health and care workforce.

And I can assure everyone that government is resolutely focussed on supporting the NHS through these challenges.

I chaired a meeting of our cross government resilience committee on Friday. I will do so will again this Friday and weekly for the foreseeable future.  

There are no easy solutions – given the nature and scale of the challenges faced right now. But by enabling more people to get support and treatment out of hospital, by ensuring that care is in place for people able to leave hospital, we can make an impact in relieving some of the pressures our hospitals are facing.

And we can ensure that - as we move through winter and into spring – the NHS can continue its recovery from the pandemic and provide patients with the support and treatment they need.

With those comments we will now open up to questions.