Seòmar agus comataidhean

I absolutely agree with the premise of Christine Grahame’s question. She is absolutely right that slips, trips and falls are a significant reason why we have increased admissions to hospital over winter. I can assure her that part of the reason why the plan is jointly published with the Convention of Scottish Local Authorities is that we recognise that many of the drivers of poor health and admissions to our health system involve issues beyond the health service, including, as she points out, gritting pavements and ensuring that walkways are cleared. I am more than happy to continue my discussions with COSLA colleagues, to ensure that they are taking those responsibilities seriously.

I pay tribute to the work that has been done by Mr Sweeney’s constituent and many others, not just in Glasgow royal infirmary but elsewhere in NHS Greater Glasgow and Clyde and across the health service in Scotland.

As Mr Sweeney knows, corridor care is not a phenomenon solely in Scotland but is a challenge that all hospitals face—I have family members in the north of England who see a very serious situation in that regard at present. That is not to say that I do not accept the challenge that is before us—of course I do. I see it when I go out, and I hear it from staff. I do not accept that the situation is either an inevitability or a norm. It is one that we must tackle, which is why I will work with our staff and health boards to ensure that improvements are made.

I thank Fulton MacGregor for giving me the opportunity to put on the record the importance of vaccination as part of our preparedness for winter. Experts in Public Health Scotland and the Scottish Government are closely monitoring the flu situation, but vaccination remains the best protection against flu. That is not just my message—the message of experts is clear that everyone who is eligible should come forward for vaccination.

We are working with health boards to make access easy and convenient, supported by a national campaign and engagement with trusted community voices to highlight the seriousness of flu. In concert with the chief medical officer, I have written to all NHS chief executives and social care providers in Scotland to ask them to set out how they are supporting health and social care workers to get vaccinated. Digital reminders have been introduced, and health and social care staff are receiving prompts to get vaccinated. Boards are also offering drop-in clinics and appointments that can be booked in any health board area, making it simpler for people with busy lives.

Earlier this year, we published our operational improvement plan, service renewal framework and population health framework, which together set out the short, medium and long-term actions that we will take over the next 10 years. Fundamental to our approach is giving greater control to those who best understand our national health service and social care system: the committed workforce that runs those services every day.

Our focus on winter this year is very much in line with that. It involves supporting services to plan for winter pressures in a way that best suits their local circumstances while ensuring consistency across the country through nationally agreed priorities and principles. However, today does not represent the start of our winter planning. On the contrary, we have been working since last winter to learn lessons and support NHS boards and social care partners to plan their own preparedness and response.

We have worked with partners in both the NHS and the Convention of Scottish Local Authorities to agree local plans that are underpinned by our national principles, and I am pleased to share those more widely today through the publication of our document “Surge and Winter Preparedness in Health and Social Care Services—National Planning Priorities and Principles”. That planning document builds on experience of previous years and sets out what matters most: prioritising care for those who need it most; taking preventative measures to keep people well; ensuring that people receive the right care, in the right place at the right time; supporting the mental health and wellbeing of the workforce; and maximising capacity by improving patient flow and access, reducing delayed discharges and tackling long waits.

Those principles will ensure that people continue to receive high-quality care even when demand increases and not only in winter but year round, including during periods of surge demand due to respiratory viruses, heat-related illness or major local events. Every year, when the temperature drops and winter arrives, viruses such as the flu are a concern. As this year’s winter vaccine marketing campaign reminds us,

“For some, flu hits harder”,

and it can be extremely serious. Although it is too early to predict what the dominant flu virus strain will be this season or how the season will evolve, I am paying close attention to the data.

With cases starting to rise and emerging evidence suggesting that this may be another particularly difficult flu season, I urge all those who are eligible for vaccination to come forward and make it a priority to get protected. No matter what, vaccination remains our best defence and one of our most important preventative public health interventions. Almost everyone who is eligible to receive a winter vaccination should now have been contacted with an appointment or a prompt to book one. I encourage anyone who is eligible but who has not yet heard to check the NHS Inform winter vaccines page for more information.

Members will remember that, at the peak of the season last year, we saw emergency hospitalisations increase significantly, with more than 6,500 adults being admitted to hospital as a result of flu. This year, given the early rise in cases among children and teenagers, I specifically encourage parents and carers to support children to have the vaccine when it is offered to them at school. That is also vital in helping to prevent transmission of the virus to older or more vulnerable family members and friends. Contrary to what we have heard in some quarters, vaccines are safe and effective and save lives, and I ask for the support of colleagues from across the chamber to reinforce that message.

The readiness of our services to respond to winter is closely tied to the progress that we are making to strengthen our NHS. Waits, particularly by those who have been waiting for more than a year, are coming down for the fourth month in a row. I know that some in the chamber seek to suggest that we are not making progress, but that does a disservice to the incredibly hard-working staff whose efforts mean that our NHS is turning a corner and delivering tangible improvements.

We are also treating more people, with more than 31,000 more appointments and procedures between April and September this year than in the same period in 2024. Diagnostic backlogs are being tackled by increasing capacity through enhancing radiology services and mobile scanning units so that, by March 2026, 95 per cent of those who are referred will be seen within six weeks. We are expanding the number of hospital at home beds to 2,000, making that Scotland’s largest hospital.

We have increased access to front-door frailty services in accident and emergency departments, improving patient flow and outcomes. I saw that at first hand on my recent visit to Dumfries and Galloway Royal infirmary’s acute frailty unit. The average hospital stay for those who are admitted to that unit is now 3.4 days compared with a typical 17.5-day average hospital stay for frail older patients.

We are rolling out a theatre scheduling tool that is increasing operating theatre productivity by up to 20 per cent for some specialties.

We are also seeing progress on urgent and unscheduled care. We are working closely with both NHS 24 and the Scottish Ambulance Service to ensure that they are as resilient as possible ahead of winter. Following a £5 million investment, NHS 24 has implemented new call centre and clinical support systems that are bringing benefits and efficiencies for patients and staff. Over 90 per cent of eligible ambulance requests are now transferred digitally by NHS 24, eliminating manual transcription, reducing errors and significantly speeding up the process for patients.

I am pleased to confirm that the Scottish Ambulance Service will recruit more than 290 new front-line staff this year, including newly qualified paramedics and ambulance care assistants, some of whom I had the great pleasure of meeting when I visited the Queensferry contact centre earlier this week.

To ensure a resilient system that can adapt to the challenges that we face requires a collective effort. That is why I am pleased to confirm today that I am also directing boards to take a new subnational planning approach to some key priorities. On digital care, business systems, emergency access standards and orthopaedic elective services, I expect boards to work together to achieve a significant and measurable impact for patients and communities. That will see us optimise the capacity in our system. In doing that, I want to ensure there are no barriers to boards working collaboratively to deliver high-quality, safe and effective care to patients and communities across Scotland.

Although boards’ geographical boundaries and current accountabilities will remain, there will be new expectations about structured subnational planning and delivery. To deliver that, NHS boards are putting in place two subnational planning structures—one focused on the east of Scotland and one focused on the west of Scotland—building on the good joint working that is already in place. That is about ensuring that the same high-quality care is provided no matter where people live and, in particular, how we ensure that the unique needs of our Highland, rural and island communities are being met.

There will also be a vital role for our special health bodies in engaging with and supporting that new planning approach, and I have been clear that I expect trade unions to be engaged as that work develops. Indeed, our workforce will be pivotal in ensuring that this approach to service planning brings improvements for staff and patients, and I look forward to engaging with staff-side colleagues on the effective implementation of the approach when I meet them next week.

I turn to social care. I recognise that our response to winter must be a whole-system response and that our social care sector has an incredibly important role to play. I acknowledge the real challenges that the sector is facing at the moment—not least the United Kingdom Government’s increase to employer national insurance contributions, which is costing social care providers £84 million, and its increasingly harsh and restrictive approach to international social care workers.

I also acknowledge the historical and systemic issues that the sector is facing when it comes to funding and structure. Although investment has reached record highs, Scotland’s adult social care sector faces strain. There is much more work to do in the longer term, and I reiterated that when I met COSLA’s spokesperson for health and social care, Councillor Paul Kelly, yesterday. I do not shy away from that and neither does he. However, we know that the sustained pressure on the system exacerbates over the winter months, and I am determined to ensure that that pressure is relieved as much as possible.

That is why I confirm today that we have identified up to £20 million to bolster social care capacity and support front-door resilience in the areas where need is most evident. That funding will be delivered through health boards to build on the examples of success that we have seen in NHS Lothian and NHS Forth Valley, where the sharing of resource across the health boards and health and social care partnerships has delivered significant improvement. Investing in social care is the right thing to do, but it will also help to reduce hospital admissions and, ultimately, relieve pressure on our NHS acute services.

The measures that I have outlined today represent only a small slice of the vast amount of work that is already under way. Although I have outlined some of the real progress that we have made so far, I am committed to providing a more comprehensive report for the end of the current session of Parliament. That will include reporting on progress against our operational improvement plan, service renewal framework and population health framework, as well as a final report against our NHS recovery plan for 2021 to 2026.

Taken together, all that will demonstrate how we have progressed recovery from the huge impact of the pandemic and how we are modernising our NHS and social care services for the years ahead. I thank our dedicated NHS staff, who I know will continue to work tirelessly in the coming weeks and months. I will continue to ensure that we are prepared not only for this coming winter but all year round.

Clare Haughey puts on the record important context relating to the challenge that is being faced in all parts of the United Kingdom, despite what Labour colleagues here might say.

As I set out in my statement, we are increasing investment to strengthen the Scottish Ambulance Service and NHS 24 ahead of winter. More staff will help to address capacity challenges, improve care for those who need urgent treatment and ease pressure on accident and emergency departments. Additional roles in the Ambulance Service’s integrated clinical hub mean that more patients can be treated without unnecessary hospital visits, freeing up crews to deal with life-threatening emergencies.

Likewise, the recruitment of new NHS 24 staff will reduce call handling times, manage rising demand and enhance clinical supervision, ensuring faster and safer triage for patients. We have also significantly increased the number of paramedics in recent years, and those changes will deliver tangible benefits for people across Scotland during the busiest months. I pay tribute to our Scottish Ambulance Service staff and thank them for the work that they do.

I accept the premise of Alex Cole-Hamilton’s question, as I did at the RCN conference this morning. Later this morning, I set out to the Royal College of Midwives my gratitude to staff for the work that they are doing. I want to address the challenges that staff raised and celebrate the remarkable contribution that they deliver. Too often, their contributions and individual innovation and service delivery go unnoticed, to the detriment of their work, in favour of people outlining only the challenges in the system.

The best way that we can address moral harm and injury is by improving access to our health service and reducing waiting times. We are turning a corner in that regard, thanks to the investment in the budget that Mr Cole-Hamilton supported, as well as the incredible endeavours of our staff. I agree with him on the situation regarding delayed discharge and social care. That is why, as I said in my statement, I have allocated additional resources for social care.

I recognise the potential prevalence of H3N2. I received a briefing on that from the chief medical officer, alongside the First Minister, earlier this week. It is too early to say whether that will be the dominant strain of flu this year, but I recognise Jackie Baillie’s points about the impact that it has had elsewhere in the world. That is also why my statement points to the need to ensure that we are asking people to take up their vaccination appointments, which I hope the member will reiterate in her communications.

I expect that everyone who is eligible for a vaccination has now received an appointment. If they have not, they should contact NHS Inform and seek the advice that they need. I encourage everyone to take up the vaccine and parents to enable their children to take up the vaccine. We know that H3N2 has initially been most prevalent in children and teenagers. In order to prevent the spread from becoming more critical for adults, which happened last year, we need to ensure that immunity is provided, and that is exactly what we are investing in across Scotland.

Social care providers face real financial pressures from the UK Government’s increase to employer national insurance contributions, as Stuart McMillan highlighted, which is expected to cost the sector an additional £84 million. That is coupled with workforce shortages across the care sector that have been exacerbated by a significant decline in the number of health and care visas that are being granted by the Home Office—there was a 77 per cent drop in the year to June 2025.

We are working closely with partners to understand the impact of those issues, to identify further mitigating actions and, at the same time, to improve hospital flow and reduce delayed discharge. That is critical.

The money that we are announcing today will be targeted at the local systems that are most in need in order to deliver faster discharge and better integration with social care. Alongside that, record funding of £15 billion for local authorities in 2025-26 will help to strengthen resilience.

Rona Mackay is absolutely right: we have made strong progress to ensure that every health board has frailty services in its A and E departments. Implementation is at different stages, and all boards continue to develop their services. The service will particularly help older patients, with the average length of hospital stay reduced by around 14 days and no increase in readmissions. We have been speaking about the preventative approach that we need to shift to, and that is exactly the type of preventative approach that is proven to work. We are also on track to deliver 2,000 hospital at home beds by December next year. We are shifting the balance of care from acute hospital-based settings into the community and into people’s homes whenever possible, ensuring that people get the right care in the right place and at the right time. That is underpinned by £200 million of record funding going into the health service.

I met Ambulance Service staff last month, when I visited the ARI, and I heard directly from them the concerns that they have and about the incredible work that has been done by the hospital ambulance liaison officer—HALO—staff at the front door of our hospitals. I pay tribute to them for that work. I am also impressed by the work that is being done by Ambulance Service colleagues and by our unscheduled care leadership in NHS Grampian to come forward with an improvement plan for the health board. That is being overseen by the oversight board and the assurance board, which is relevant to NHS Grampian’s escalation status. We have committed additional funding to NHS Grampian for its unscheduled care pathway work.