Response to exceptional winter pressures: minister's speech

Presiding Officer, the staff of the NHS are the beating heart of the service. They have been nothing short of exemplary in the care they have provided in the face of exceptional winter pressures.

They have gone more than the extra mile, they have worked across and beyond boundaries, and above all they have continued to deliver safe and effective patient care in the most challenging of circumstances.

I'm sure I speak for all of us when I give a heartfelt thank you to our NHS and community health and social care staff for their continuing dedication. That thanks is shared by patients and their families, many of who have contacted me to praise efforts of staff.

Equally, I want to apologise to patients whose treatment has been delayed. I want to take this opportunity to thank them, and their families, for their patience and understanding during this extremely busy time.

Winter pressures

Each year we try and prepare for the additional pressure winter can bring. This include working with the service, and other partners, since the summer to prioritise and invest an extra £22.4 million to meet A&E and winter pressures.

However, our NHS is facing a number of sustained challenges this winter:

• emergency departments seeing the highest level of attendances over the festive period in a number of years – during the two week festive period attendances were up 10% compared to the same time the previous year; in the week leading up to Christmas alone this level rose to 20%
• we saw a huge surge in falls and fractures before Christmas, which has undoubtedly impacted on the number of admissions and length of stay in hospitals - some hospitals reported the level of demand in one day being the equivalent to average demand for a week
• flu rates in Scotland doubled in December, with the most recent figures from Health Protection Scotland showing around 46 Scots in every 100,000 were suffering from the virus, comparing to 22 in every 100,000 for the same week in 2016
• over the festive period – there were over 73,000 calls to the Scottish Ambulance Service between the 15th of December and 2nd January. Indeed, overnight on Hogmanay the ambulance service saw its control centres take almost 40% more calls compared to the same time last year
• the NHS 24 received more than 45,000 calls in the four days over Christmas, almost double the number of calls of the same period last year, with thousands more calls being taken over the New Year period. Christmas Day in particular was the busiest for NHS 24 since it began in 2002

In short, the demand for emergency care services has been unprecedented over the festive period.

Our NHS has sought to manage the impact of this is a number of ways. For example, where necessary for infection control, hospitals have on some occasions closed wards – which means these beds can be closed for a number of days.

NHS Boards are taking decisions to manage the exceptional demand based on their local plans, which may include some deferral of non-urgent elective surgery. Boards are reporting that over the festive period, the level of cancellations were consistent with that of previous years.

It is important to say that, unlike in England, there is no blanket cancellation of non-urgent elective procedures planned. In England, it was reported that an estimated 55,000 non-urgent operations could be deferred as a result of their deferral of all non-urgent inpatient elective care to 31 January.

Flu outbreak

I'd like now to take some time to set out the impact of flu on our health service, and on our population, and what action has been taken.

I've already outlined the increase in flu rates this year, which is at the highest in the last six years and double that of last year.

It is right that we take flu seriously, and note that and that Scotland was hit by flu earlier than anywhere else in the UK.

As we do every year, we put in place preparations ahead of the flu season commencing. We've worked to ensure flu vaccines are available to those who need them, and that people are aware and encouraged to be vaccinated.

Each year, the World Health Organisation reviews evidence from previous years and determines the most likely flu viruses that should be covered by the vaccine programmes in the northern and southern hemispheres for the next influenza season. These are the only vaccines that are available on the global market.

The data tells us that the most commonly found flu types in Scotland so far are well-matched to this year's vaccine and it is ill-informed and alarmist to suggest otherwise.

Sustained exceptional levels of demand or regular peaks in demand – such as during increased flu levels - require different clinical processes from the usual systems in place in hospitals.

Vaccination uptake rates

Of course the vaccine is only useful if we can make sure as many people as possible receive it. I note that the Conservatives claimed over the weekend that uptake rates in Scotland have dropped.

The fact is that our uptake rates are broadly in line with the uptake in previous years. Overall, to the end of the second last week of 2017, over 1.4 million people had been vaccinated by the NHS in Scotland. That is 26% of the whole population. To the same point in the previous year, 26% of the population had been vaccinated. So we are in line with where we were last year. And in fact, in some eligible groups we've increased uptake, for example pregnant woman with risks has increased to 57.5%, higher than England.

In Scotland all primary school children have been offered the vaccine since 2014/15, providing improved immunity to the wider population. This year 71% of that primary school population has been vaccinated. But in England, this year, only children in the first four years of primary school are offered the vaccine – and uptake in that group is 50% or less for each of those four year groups.

Healthcare worker vaccinations

And I want to say a word about health care staff vaccination. It is lower than we would want it to be. I am absolutely grateful to the NHS staff for all the hard work they do, but in this particular area I think we can go further.

We estimate that so far over 40% of health-care staff have been vaccinated – that includes both patient-facing and non patient-facing staff, whereas the English figure only includes frontline health care workers. I would caveat this by saying the figure may be an under-estimate as it will not reflect the proportion of staff who may have been vaccinated through the national programme, because of clinical eligibility.

And we've made clear to the NHS that free seasonal influenza immunisation should be offered by NHS organisations, including primary care employers, to all employees directly involved in delivering care.

I know that NHS Boards across Scotland have worked hard to promote uptake through innovative approaches and in providing leadership through senior clinicians and managers.

We've supported them with national resources, including developing a toolkit that helps those charged with promoting and delivering planning of their local flu campaign and providing campaign posters and leaflets to every health board in Scotland.

This year our public campaign, which launched in October, included adverts for the Childhood Flu and Seasonal Flu programme for adults ran on television, radio, digital and social media platforms.

We've also worked with a wide range of partners to distribute promotional materials, including the British Heart Foundation; British Red Cross; and Scottish businesses that are Healthy Working Lives registered. In total this work resulted in 106 organisations supporting the seasonal flu campaign, and 93 organisations supporting the childhood flu campaign.

Campaign materials for the general public from GP surgeries, nurseries, libraries, community centres and antenatal clinics, have also been distributed. While, ultimately, the decision about whether or not to be vaccinated is down to individuals, I'm sure we would all want to take this opportunity to urge all those eligible to get the flu vaccine as soon as possible.

Mortality rates

Finally, there has been some rather alarmist commentary on flu mortality rate which has been reported which needs to be corrected.

Four people have passed away in hospital who were admitted with flu related symptoms. Each one of these deaths is a personal and family tragedy.

However, all-cause mortality is not the same thing as flu-related deaths. This data reflects deaths due to any cause – accidents, other diseases, old-age. This is not just about flu.

And on this point, timing is important. This three week period at the end of 2017 reflects a period before we really started to see flu infections presenting in our hospitals so it is too simplistic to say that this excess is explained by flu. Work is underway by public health experts to investigate this urgently so we can use facts rather than speculation.

As I've said there are a number of factors contributing towards the current pressures, which hasn't just been about flu, but clearly it will be a key factor over the coming weeks. Usually the winter flu season has an eight to ten week duration, so it is too early to say what the end season picture will be, but we must view the current and emerging data in the right context.

We must also allow space for our health service to continue to treat our sick patients with flu like illnesses, or other conditions, and to allow them to recover from what has been, and still is, a very challenging time.

NHS and care staff have worked incredibly hard over the last few weeks and have pulled together to cope with winter pressures and I want to pay tribute to them again. They deserve the collective support of this parliament in their endeavours and I hope that they will get today.