Health and social care: winter overview 2021 to 2022

Increasing capacity to meet demand and maintain high quality integrated health and social care services throughout autumn and winter

Urgent & Emergency Care

Demand on the urgent and emergency care has been, and continues to be very significant, mirroring levels only experienced during pre-Covid winter months. The continued access to urgent and emergency services will continue to be a priority in our health service.

Aims

• Reduced level of attendances ensuring faster access for those who require to attend.
• Reduced level of admissions increasing available bed capacity.
• Reduced level of admissions increasing available bed capacity.
• Reduced level of long delays in A&E ensuring high quality of patient care.
• Timely discharge from hospital preventing delay and building capacity by reducing inpatient length of stay.
• Continued compliance with the Six Essential Actions to improve unscheduled care.

How We Will Deliver This

• Continue to take forward the Redesign of Urgent Care into its second year, which is backed by £23 million, and will provide the fastest and most appropriate care for people when they really need it by refining access for public to clinical triage and assessment offering virtual consultations wherever possible and improve access for professional partners through Flow Navigation centres.
• Interface Care, backed by an additional £6 million in this financial year, will deliver high-quality care that safely provides an alternative to hospital admission, or will support early front door discharge, reducing length of stay and increasing bed capacity. The programme will optimise staff and patient experience and will be implemented by early winter.
• Discharge without Delay, backed by an additional £4 million in the current financial year, will improve pathways in, out and through hospital settings, building capacity by reducing inpatient length of stay. Working together with patients, families and/or carers, we can ensure patients are able to be treated in their home where this is appropriate and effective to do so.

Routine and Planned Care

The impact of addressing the COVID-19 pandemic meant many health and care services had to be suspended or reduced in scope and scale. As a result, there are many people who are waiting longer for the care they need. The effects of the pandemic on NHS capacity continue to be felt therefore maximising capacity over winter is a key priority and is the central aim of the NHS recovery plan.

• Clinical Prioritisation
• Diagnostic Services
• Maximized NHS Capacity
• Alternative Pathways

Aims

• Ongoing treatment of urgent cases, including cancer patients, is maintained.
• Maximised use of all available capacity to minimise the number of people having treatment postponed over winter.
• Reduction of long delays for treatment.
• Increased level of diagnostic procedures.
• Alternative pathways of care available to provide care closer to home.

How We Will Deliver This

• We will create additional dedicated capacity through the Independent Sector over winter.
• We will use national assets, such as the Golden Jubilee National Hospital, to provide additional procedures across key specialities areas.
• We will continue the redesign of care pathways to ensure best practice is embedded across the country to support increased capacity to accommodate new outpatient appointments in hospital clinics, including diagnostic capacity.
• We will increase ophthalmology activity through the National Eye Centre, which was the first of the National Treatment Centres to go live last winter.

Social Care

We continue to face significant demand across health and social care services, including demand in the community and in hospital. It is vital that we do all we can to maximise capacity over the winter period through investment in staffing, resources and facilities. Actions are therefore being taken in an integrated and co-ordinated way across the whole system as our Home First approach is not only better for patients, but supports our acute and primary care services too.

The Adult Social Care Winter Preparedness Plan sets out in more detail the range of actions we are taking to support this vital part of the system.

Aims

• Strengthened capacity of Multi-Disciplinary Teams (MDT’s).
• Scaled up and enhanced provision of tech-enabled care and home adaptations.
• Scaled up and enhanced provision of rehabilitation, re-ablement and innovative approaches.
• Enhanced Local Authorities’ Care at Home and community services capacity to keep people at home when it is safe to do so.

How We Will Deliver This

• We will strengthen multi-disciplinary working through MDT’s made up of staff from professional groups across health and social care. We have announced an additional £20 million for the remainder of this financial year and on a recurring basis to enable both the establishment of new multi-disciplinary teams and strengthening of existing teams.
• We will enhance Care at Home capacity in recognition that we also need to make wider provision to improve access to care at home support in the first place. We have announced an additional £62 million in funding this year and on a recurring basis to enhance care at home capacity. This funding will be dedicated to building capacity in care at home community-based services, by increasing staff hours alongside innovative approaches to care. This will help to address current unmet need, and deal with the current surge in demand and complexity of individual needs.
• We will provide Interim Care placement to ensure everyone gets the right care and treatment at the right time, in the right place, we need to make sure that people who no longer need to be in hospital can move to a more homely setting to complete their recovery and next stage of care. We have announced an additional £40 million for this financial year to fund interim care for patients to enable them to be discharged from hospital.

Primary Care

Aims

Full recovery of NHS dentistry services

Deliver the full recovery of NHS dentistry services and tackle routine dental care that has been deferred due to the pandemic.

Further supporting financial sustainability

Further supporting the financial sustainability of General Practice and our other contractor groups to ensure they remain a viable community healthcare service for years to come.

Increased appointment flexibility

Provide increased flexibility around the type of appointment that is offered in the Community to ensure greatest choice for patients and practitioners.

Supporting patients in remote and rural areas

Patients are supported in remote and rural areas with appropriate access to NHS community eye care services that have been impacted by the COVID-19 pandemic.

Roll out of primary care multi-disciplinary teams (MDT)

Make it easier and quicker for patients to be seen by the right professional in the community, by accelerating the roll out of primary care multi-disciplinary teams (MDT) to support General Practices.

Safe, resilient and sustainable out of hours service

Deliver a safe, resilient and sustainable out of hours service across Scotland to ensure patients have access to urgent primary care 24/7.

How We Will Deliver This

• We will invest additional funding for enhanced dental examinations for children and adults, ensuring that patients receive a thorough preventative catch-up session with their NHS dental team.
• We will target oral health inequalities and child dental services by enhancing the Childsmile Programme in practice and the wider community, as well as other vulnerable groups of patients, including domiciliary care, and unregistered patients.
• We will make additional funding available this financial year to support general practice sustainability, further recruiting pharmacists, nurses, physiotherapists and mental health workers to support general practices and increase the number of appointments with these professionals, supporting effective triage.
• We will invest in the primary care estate, working jointly with RCGP and SGPC to support GPs to make more effective use of social distancing relaxations through updated guidance on access to allow, where appropriate, more face-to-face appointments to take place. This funding will also be used to improve GP telephone systems to allow additional telephone lines and improved triage.
• We will incentivise out of hours working for Final Year General Practitioner Training (GPST3s) to increase staffing over holiday and festive periods.
• We will invest in Out of Hours (OOH’s) senior leadership capacity to support service organisation, facilitate pathway development and interface working across the system to release dedicated clinical resource to focus on patient care.
• We will provide additional resources for education within the OOH’s workforce to enable the development of the MDT in OOHs, ensuring appropriate ANP/AHP training programmes and support for all OOH’s clinicians via small group reflective practice learning.
• We will develop and enhance the OOH’s administration support to ensure timely management of non-clinical tasks associated with patient care.
• We will support patients in remote and rural areas having appropriate access to NHS community eye care services that have been impacted by the COVID-19 pandemic.

NHS24 and Scottish Ambulance Service (SAS)

Aims

• Reduced call wait times at NHS24, and improved patient outcomes. Deliver on-demand care throughout winter by connecting people to health and care advice, information and support 24/7.
• Provide the highest level of care to patients, through improved Scottish Ambulance Service (SAS) response times, supported by reduced clinical handover times at A&E. Ensure care is delivered in the right place: be that at home or by transferring to the appropriate medical setting, to preserve life and promote recovery.

How We Will Deliver This

• We have recently announced a package of around £40 million to support the Scottish Ambulance Service, and are also providing support to NHS24, totalling £19 million, around their estates and recruitment plans.
  • We will facilitate the provision of partner organisation support for the Scottish Ambulance Service. This includes, where clinically appropriate, deployment of the Red Cross as well as the use of the fire service and the armed forces to drive ambulances under appropriate conditions. Private taxi companies will also be used where needed.
  • We will provide additional support in ambulance control rooms: the deployment of around 100 healthcare students as well as additional senior clinical support. This will assist and speed-up decision-making on best care for callers and this support will be available in control rooms in time for the festive period.
  • We will almost double the number of Hospital Ambulance Liaison Officers (HALOs) at our busiest A&E sites to help work with the hospitals to reduce ambulance turnaround times and get ambulances back out on the road as quickly as possible. These should all be in post by the end of November. For every 1 minute we can reduce daily average hospital turnaround times, we could increase our available resource hours by 21 hours per day, or 147 hours per week.
  • We will deliver additional SAS staff in Highland to reduce on-call requirements in Campbeltown and remove it entirely in Fort William, Kirkwall and Broadford.
  • We will invest an additional £500k in SAS staff-wellbeing initiatives given the pressure the service remains under.
  • We will deliver a new NHS24 call centre opening in Dundee in November, with the second phase operational in advance of the festive season. NHS24 are aiming to reach 677 WTE call handlers and 195 WTE Nurse Practitioners, many of whom will be based in the new centre in Dundee with recruitment for these posts currently underway.
  • We will recruit additional staff for the NHS24 Covid pathway (Target 150 WTE), to ensure adequate resource to meet demand and key performance standards.