Scottish Ambulance Service: statement by Health Secretary Humza Yousaf

Scottish Ambulance Service Statement

Introduction

Presiding Officer

The last 18 months have been a time of unprecedented pressure in the NH. It has faced the biggest challenge in its 73 year history.

The Scottish Ambulance Service is the heartbeat of our NHS. It has a unique role in engaging with all parts of the Health and Social care system across the whole of Scotland - 24  seven days a week.  

I would like take the opportunity once again, as I am sure other Members will, to thank our all our hard working Ambulance Service staff for the work that they are doing in such difficult circumstances. And while I understand those calling an ambulance are often in considerable distress, I hope we can all agree that our ambulance colleagues deserve to be treated with respect.

It is important to remember that, despite the significant pressures our Service is under, they continue to deliver a highly effective response to our high acuity patients with 30 day survival rates for these patients at their highest levels ever recorded.

That said, I recognise that some people are not receiving the standard of service that they should be getting, or indeed the standard of service that the Ambulance Service or indeed Scottish Government wants to deliver.

And I completely accept that some of the cases we heard both in the chamber last week and the media are unacceptable.  I have no hesitation in apologising to the families who have been let down.

It’s in that context that the Ambulance Service is currently operating at level 4 of its escalation plan -  that’s the very highest level. This is a decision that has not been taken lightly. It means in practice that all clinically trained staff in support departments have been redeployed to the front line.

The Service has stood up its National Command and Control Centre and management teams, regional coordination cells, and support teams are all working to extended hours.

But of course, we are not unique here, the Global Pandemic has created the most challenging crisis in almost every sphere of our lives, including our NHS, in the history of peacetime Britain, certainly in our lifetimes.

Ambulance services across the UK, as well as the wider NHS, are experiencing unprecedented demand – largely because of Covid but also due to a combination of increasingly complex cases, delayed demand and exceptionally busy emergency departments.

Last month our ambulance crews responded to 10,733 immediate life threatening incidents which was 20.7% of incidents attended that month. In comparison to a figure of 5788 and 10.6% of incidents attended in August 2018 it clearly shows us the significant increase of acuity in presentations to the Service.

It also means that the vast majority of these patients require to go to hospital and with acute occupancy for most Boards already between 87% and 96% and most mainland Boards in excess of 100% for ICU occupancy, we can clearly see the pressure our services are under.

That is why we have already taken significant action both prior to and since the onset of the pandemic. This includes additional funding to recruit more Ambulance staff, enhanced air transfer capacity through a contract with Loganair and a strategic working group set up to implement actions to improve turnaround times for ambulances.

However, it is important that once again, I make it categorically clear that we are still firmly in the midst of a global pandemic.

Today I will outline to members the measures we are putting in place to ensure our Ambulance service has the full range of support from our wider public services at its disposal as we enter what will inevitably be the most challenging part of the year in Autumn and Winter.

Our immediate actions will be backed by additional investment of up to £20m, this is on top of the additional £20m already invested this year to recruit an additional 296  ambulance staff.

This equates to additional in-year investment of over £44m in the Service that’s an uplift of nearly 16% on last year’s resource budget.

Many of the actions we are taking are aligned to suggestions made by unions attached to our ambulance service who have set out a number of different suggestions of support and focus on immediate assistance from partners, continued workforce enhancement and improvements to flows of cases into Emergency Departments.

Partnership working

In terms of the immediate, there are short-term pressures on the Ambulance Service that will only be relieved through the wider public and voluntary sector standing up and supporting the Service at this incredibly challenging time.

I can confirm the request for Military Assistance was made immediately after First Ministers Questions last Thursday. Officials have been working since then to finalise the package of support that the military will provide.

This assistance will mainly consist of providing 88  drivers to free up our paramedics and technicians to focus solely on providing patients with the best clinical care. 15 support staff are also being requested meaning support in the form of 103 military personnel.

There is still authorisation processes to go through, but we do not envisage any challenges with gaining the required approvals. All going well, some of those Military Personnel will be ready to be deployed and driving Ambulances this weekend. My thanks to the Army, as always, for their responsiveness.

I have also reached out to the Scottish Fire and Rescue Service and I am glad to say, and in typical fashion, they have risen to our call. They will scale up the Ambulance Service’s access to volunteer firefighters and now also full time firefighters for driving, again with the view to providing more valuable paramedic and technician time on the front line.

Immediate assistance however is not just being sought from the wider public sector. We have also brought support both from the British Red Cross and as well as private contractors, such as taxi companies, to help with some of the Ambulance Service’s work where no emergency Ambulance is required. Let me make myself clear, if you are in critical or life-threatening need you will be taken to hospital in an Ambulance, if one is requested. Alternative transport arrangements are for those patients with low acuity and patient safety, of course, will remain the number one priority.

Bear in mind that around 27% of calls to the Ambulance Service in August 2021 did not require an ambulance response and only 21% of calls were life-threatening situations, though this percentage has risen considerably recently.

These are not decisions we have taken lightly at all, but given the urgency of this situation, this Government needs to respond with these decisive, if unconventional, measures to save lives, as it has done throughout this pandemic. Let me be clear though that the full range of measures I am announcing today have been assessed as clinically safe.

Of course, it is important that we are not just freeing up paramedic and technician capacity but creating additional emergency capacity within the wider Ambulance Service.

That is why we are also aiming to bring on board 100 2nd year paramedic students to work across the service including assisting our Ambulance Control Centres to help with Call Handling and Dispatching over the winter period. On specific clinical issues, we are also bringing in temporary clinical input to decision making on mental health, addictions, falls, breathing difficulties, high intensity users, and trauma. This will provide senior specialist clinical decision support to patients, optimising the response to people in need by the Service, and utilising additional clinical pathways, where that is appropriate to do so.

Bolstering capacity both at the front and back ends of the Ambulance Service will be fundamental to saving lives and I am thankful to all those individuals and organisations who have offered their support.

Workforce enhancement 

I am, however, mindful this has been, and will be, a long pandemic and we cannot solely rely on immediate, short-term measures to build a sustainable future for the Ambulance Service.

That is why, as part of our Recovery Plan, we are delivering almost 300 additional Ambulance Service staff by April 2022. 148 new staff were recruited last year and the service plans to recruit another 443 this year, 148 of whom will be new staff and the remainder to cover planned staff turnover. 172 have already been recruited this year with 186 due in post by the end of  November and the remaining by April 2022. The Service is taking forward recruitment plans at pace.

The specific breakdown of new recruits sees 69 staff in the North of Scotland, 139 in West and 88 in the East. The additional new staff are a mixture of paramedics, newly qualified paramedics (NQPs) and technicians. We are also funding additional fleet for the Service which will see the introduction of a number of extra ambulances over the coming months.

As part of our on-going commitment with the Service to reduce and remove the requirement for staff to work on call in some of our more remote and rural areas, we are providing funding for 14 additional staff which will see on-call requirement reduced in Campeltown and removed entirely in Fort William, Kirkwall and Broadford.

Presiding Officer, we know that our Emergency Departments are also under significant pressure. That is why we need to ensure we are not just creating further problems for our A&E Departments that are already struggling.

That is why we are also further investing in additional Hospital Ambulance Liaison Officers, almost doubling numbers from the 11 currently in place to 20 posts throughout the country. These liaison officers are important in supporting flow through emergency departments and supporting improvement in ambulance turnaround times. HALOs will take part in the daily huddle and work across the hospital site in order to maximise flow as best as possible.

The HALOs will be concentrated in our busiest sites.

Improved Flow

Most of us have also seen pictures from across the UK, and of course, here in Scotland of Ambulances queued up outside of emergency departments. Getting people the care they need, in the most appropriate setting is crucial and is another key element in freeing up our Ambulance crews to respond to other patients’ needs.

We need a concerted effort across the whole public sector to ensure that all parts of the system can respond to the demand this difficult winter ahead will bring, and our forthcoming Winter Plan will set out the measures we, and our partners, will take to ensure we can deliver high quality, safe care in the coming months, and in a sustainable way.

This will create capacity in our community health and care services and in our hospitals and will ensure that, where it is safe to do so,  there are alternative pathways that people can access to avoid their admission to hospital and to ensure that they can be discharged from hospital as soon as it is clinically safe to do so.

I know some members have suggested pop-up facilities outside our A&E Departments. This issue has been explored, and while we will keep it under review our clinicians, and the likes of the RCEM have expressed concerns in relation to patient safety with this option.

However, with immediate effect, we are repurposing some of our spaces in our hospitals  to maximise capacity  in  the front door of our hospitals across the country  to ensure patients can be safely transferred to clinical teams as quickly as possible.

Where necessary this may need to include expanding the footprint of our hospitals even if this is on a temporary basis and we are working with NHS Boards on this issue.

Closing

To conclude Presiding Officer, this will no doubt be the most difficult and challenging Autumn and Winter that our health and social care services have ever faced. As with other parts of the UK, Scotland’s Health Boards have faced unprecedented demand over recent weeks, whether that be in Emergency Departments, Elective Activity or local GP Practices.

The following months are going to require us all to come together to support one another, as we are seeing through the brilliant response to the call for help from the military, fire service, third sector,  volunteers, private sector as well as ambulance service staff themselves.

On that point, let me close this statement by saying that the wellbeing of our ambulance service, and wider Health and Social Care workers, is of paramount importance throughout this period. Our staff need to know we are doing everything we possibly can to provide them with all the support that they need.

The situation I have described has inevitably resulted in additional pressure for ambulance staff with regards to rest break compliance and shift overruns.

This is why we are going to provide £500k of funding for additional  support to ambulance service staff wellbeing this year which includes additional welfare for crews, and a range of wellbeing initiatives including personal resilience packages and techniques supported by a dedicated wellbeing team. In addition, I am still very supportive of SAS discussions with their trade union partners about having a rest break action plan in place as quickly as possible.

Presiding Officer, I have outlined an immediate plan of action, backed by up to £20m of additional investment. Our Ambulance Service and NHS has been there for us in our hour of need, this Government will, in turn, be there to support our public services during their hour of need.

I look forward to taking Members’ questions.