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I know that Stephen Kerr will be aware of international evidence about the efficacy of drug consumption facilities in reducing wider harms. There is evidence of a reduction in the infections, such as HIV and hepatitis, that come from sharing needles and that type of behaviour. Those are some of the areas of harm reduction that I am talking about.

I would also want to be able to point to increasing engagement with some of the statutory and community services in Glasgow by people we have been unable to engage with previously. The evidence from the first day, yesterday, is that some of the people who were coming through the door were accessing those services for the first time. Those people were able to have conversations on taking a different path, and on starting a road to recovery, for the first time.

I understand that there is some vagueness to that, because the service is a preventative measure that it is hard to measure aside from through hard-nosed drug deaths statistics. However, I hope to point to the safer consumption facility making a difference in those areas.

I thank the Presiding Officer for this opportunity to update the Scottish Parliament on how our health and social care system is responding to the pressures of winter.

It is clear that our health and social care services and the people that they serve are experiencing the impact of peak winter demand. It is traditionally a challenging period of the year, and this year has been no different. In particular, the national health service continues to see significant numbers of cases of influenza A, which have been, and remain, very high. This extraordinary flu surge of course adds to the normal respiratory issues that we might expect at this time of year. In the face of that particular issue, and the wider winter pressures, I would first like to express how enormously grateful I am—and, I am sure, everyone in the chamber is—to all those working in our health and social care settings for their immense efforts over the busy festive period. The resilience and determination shown by staff in the face of pressures across the health and care sector are inspiring.

There is so much to thank them for. Every part of our health service has gone above and beyond to serve the country during the hardest months of the year. I thank the staff of the Scottish Ambulance Service staff for their sacrifice and devotion to their task in staying at work beyond the end of their shift as they wait to turn around at hospitals. I thank the social care staff who are doing extra shifts to make up for staff being off sick with flu. I thank the general practitioners who are working at the weekends to offer appointments and bolster the resilience of the entire system. I thank hospital staff, such as the porter I met at St John’s hospital in Livingston on Christmas eve who was working extremely hard to turn around beds as quickly as possible. We, in this chamber, often talk about service, but that is the reality of public service: the hard, relentless, skilled, devoted and dedicated work to serve the people who need it most. We owe all of them a debt of gratitude.

In recent days and weeks, I, with the First Minister, have been meeting health boards, representatives from the Scottish Ambulance Service, health and social care partnerships, Public Health Scotland and NHS 24. We have discussed the latest system updates, the high cases of influenza and how the health service is responding to increased demand. I am very encouraged to hear about the collaborative working right across the system, with strong leadership and staff supporting one another. In practice, that co-operation has seen boards working closely with the Scottish Ambulance Service to manage the flow of patients through emergency departments across Scotland.

The Scottish Ambulance Service and board senior clinical managers have been present on hospital sites, assessing risk and prioritising patients who are most in need of urgent treatment. GPs from out-of-hours services have been working in minor injuries departments and helping to treat and discharge patients, where clinically appropriate. The Scottish Ambulance Service’s integrated clinical hub, which receives calls transferred from NHS 24, has calls reviewed by GPs in the call centre. They help to advise self-care, prescribe medication, or refer to out-of-hours services when it is clinically appropriate to do so. That helps more patients to be treated at home or in the community, and prevents unnecessary ambulance conveyance to hospital. That kind of co-ordination has played an important role in protecting resources for those who are most urgently in need.

I express my regret that anyone seeking care has to wait longer than necessary to receive it—as, no doubt, will have happened during this difficult period—but, at this point, thanks to our robust preparation and the dedication and hard work of staff across the health service and the social care sector, our services continue to hold up well in the face of the additional pressures. That has been important, because there is no doubt that Scotland has been hit hard by flu this winter. Although we planned for increases in flu over the winter, the very high levels that we are experiencing inevitably put additional strain on the system.

Data from Public Health Scotland shows that the incidence of influenza in the community in Scotland has continued to increase in the latest week for which figures are available, although the rate of increase has slowed. We have seen the impact of flu in our hospitals, where there have been more than 1,500 influenza-related admissions in the latest week, surpassing the peak of around 1,400 in the winter of 2022-23.

Every year, the demands of winter challenge our health systems. That is why, in preparation, we published our winter plan a month ahead of the equivalent date last year, and earlier than ever before, to allow more time for whole-system preparedness. Published on 24 September, the winter plan was developed with input from the whole health and social care system, in partnership with the Convention of Scottish Local Authorities, bringing together best practice and improvement work to ensure that the most appropriate care is received in the right place and at the right time.?

Our investment in the hospital at home service has paid dividends, as it has enabled patients to spend Christmas in their own homes, with their families, where that is clinically appropriate. That vital service reduces hospital occupancy while still providing high-quality care.

As part of the winter plan, we committed to providing additional staffing for NHS 24 to support demand over the winter period. That recruitment programme has been a success, with call handlers now fully established and additional clinical staff in post.

Health boards have ensured the provision of NHS pharmaceutical services, so that people continue to have access to prescribed medicines and to services such as NHS pharmacy first Scotland. That service is available in all community pharmacies, to anyone registered with a GP practice in Scotland. It allows members of the public access to expert healthcare professionals without the need for an appointment.

In making those winter planning efforts, we have learned from previous intense winter pressures and we have built our approach to out-of-hours services, escalation and board delivery support on the basis of our experience. Out-of-hours services have remained resilient and responsive thanks to that approach and to our continued investment in the service and rigorous planning of staff cover for winter.

The flu vaccination programme runs until the end of March and the Covid vaccination programme until the end of January. As of 15 December 2024, we had administered more than 1.2 million adult flu vaccinations. The Scottish Ambulance Service has been instrumental in collaborating with boards during the winter vaccination programme. Its mobile vaccination outreach service has provided accessible vaccination facilities to remote, rural and island communities.

Vaccination offers the best protection against serious illness from flu, so I urge all those who are eligible for vaccinations this winter to come forward as soon as possible, to protect themselves and to support our health and social care services. Beyond vaccination, everyone can reduce the chance of catching flu or spreading it to others by practising good hand hygiene, taking other precautions and staying at home if they have respiratory symptoms.

I have thanked our health and social care workforces and will continue to do so. However, I also take this opportunity to thank the Scottish public for taking heed of our messages about accessing the right care in the right place and for taking steps to slow the spread of infections. As I have stated throughout recent weeks, it is important for everyone to be familiar with the different resources that are available, including NHS Inform’s online tools that can help them to get appropriate health advice as quickly as possible. People should always call 999 in a life-threatening emergency, but if that is not the case they should first visit the nhsinform.scot website or call NHS 24 on 111.

I must thank those who are looking after, or even just looking out for, other people—those who have checked in on elderly relations or friends, helped with getting their messages and provided other support over this, the hardest time of the year. I would also like to recognise the role of unpaid carers the length and breadth of Scotland, who, year round, work to support their loved ones. They are often the overlooked heroes of our health and social care system, and I thank them.

I reiterate the Government’s commitment to supporting general practice during this critical time. On 29 November, I announced an additional £13.6 million investment in general practice for this financial year. That funding is aimed at addressing financial pressures, supporting staff costs and enabling practices to recruit and retain staff. It is a practical response to the challenges that GPs face, especially during this period of high demand.

Our dedicated social care and social work workforce have worked tirelessly throughout the festive period, supporting people to remain well and live independently in their communities. That proactive support reinforces our health service by preventing the need for hospital admissions at a difficult time, while ensuring that individuals are cared for in the most appropriate setting.

Care homes have, of course, been affected by flu and, in some cases, have been required to close, in line with infection control procedures. We have engaged with local systems to make sure that they have the latest guidance and support on infection control, and I know that they are working collaboratively to manage that pressure.

As in previous years, there has been significant work to reduce the level of delayed discharge across the system in advance of Christmas. Health and social care partnerships have been working hard to make sure that as many people as possible who are clinically ready to leave hospital can do that, whether they are returning home or to a care home. That includes maximising the use of discharge to assess, hospital at home and other initiatives that help to make sure that people can get the right care in the right place.

Winter tests every one of us. It tests individual people, families and our healthcare systems. However, this year, thanks to the incredible efforts of NHS staff and sure-handed planning, we are facing winter with resilience and resolve. I am sure that the whole chamber will join me in supporting and once again thanking the staff of our NHS and social care services, who provide so much to this nation in these difficult and challenging times.

I thank Paul Sweeney for raising the case of his 80-year-old constituent, and I apologise for the situation that he faced. In my statement, I recognised the fact that too many people will have waited too long over the festive period. As I referenced, prioritisation and escalation, through the winter plan, have allowed the system to hold up well in the face of what I believe to be unprecedented levels of flu in the system, compared with recent years.

However, I recognise that too many people will have waited too long. I would be more than happy to receive more information about the situation that Mr Sweeney’s constituent faced and to ask for more information from NHS Greater Glasgow and Clyde so that he can have full information about what happened in that situation.

I thank Fulton MacGregor for his engagement with general practice in his constituency, and I am heartened to hear that that engagement is happening.

I also reiterate the Government’s commitment to supporting general practice during this critical time. In answer to Sandesh Gulhane, I referenced the areas where I have seen incredible work by general practitioners over the festive period, for which I am very grateful.

In addition, on 29 November, at the British Medical Association’s Scottish local medical committee conference, I announced an additional £13.6 million investment in general practice for this financial year. That funding is aimed at addressing financial pressures, supporting staff costs and enabling practices to recruit and retain key staff. It is a practical response to the challenges that GPs face.

I frequently meet the BMA, and my officials have regular meetings with the Scottish GP committee. Those meetings provide opportunities for GPs not only to raise their concerns but to discuss the opportunities for reform and improvement, and to shift the balance of care from secondary into primary care.

I thank Stuart McMillan for raising that point. As part of the winter plan, we committed to providing NHS 24 with additional staff to support demand over the winter period. That recruitment has been successful, with call handler numbers now at full establishment and additional clinical staff being in post. This winter, a record number of NHS 24 call handlers have been available to direct people to the most appropriate care, and that has helped to reduce the number of unnecessary accident and emergency department attendances. As of September 2024, NHS 24 had in post a total of 1,492.3 whole-time equivalent staff, and the number of staff in post in NHS 24 has increased by 54.5 per cent over the past 10 years.

During my most recent visit to NHS 24, before Christmas, in addition to the direct service that NHS 24 provides, I heard about the work that the breathing space team provides in supporting people who find the festive period to be incredibly challenging from a mental health perspective. I am grateful to all those who have been working across NHS 24 for the work that they have done under the considerable pressure that has resulted from demand across the system.

I am grateful to Audrey Nicoll for raising that point. The First Minister has chaired meetings with all the representatives whom I mentioned my statement in order to co-ordinate and ensure that there is confidence in the resilience of the system to avoid situation such as the one in NHS Grampian that Audrey Nicoll outlined.

In practice, there has been incredibly strong co-operation among national and regional boards, which have been working closely with the Scottish Ambulance Service to manage the flow of patients through emergency departments across Scotland.

GPs from out-of-hours services have been working in minor injuries departments to help to treat and discharge patients, and the Scottish Ambulance Service’s integrated clinical hub, which receives calls that are transferred from NHS 24, has been having its calls reviewed by GPs in the call centre, so that they can advise about self-care, prescribe medication or refer patients to out-of-hours services.

With regard to critical incidents, health boards operate their own escalation policies for management of in-patient capacity. That includes well-established processes, with locally agreed trigger points, for maintaining a safe service and ensuring patient safety. Actions are widely communicated with staff to ensure that they know the appropriate course of action to take to respond to pressures, and boards can, of course, ask the Government for advice as and when it is required.

I am very grateful to Jackie Baillie for referencing, in addition to those staff whom we have already spoken about, the community and voluntary sector staff who contribute so much to our health and social care services by providing access to and reaching those people whom statutory services cannot reach. I recognise that work, and I thank Jackie Baillie for recognising their contribution.

The hospital at home service is operating now, and it has been increased in the current financial year. It is an innovation that is right for patients, as it allows people to remain in their homes, and for our health and social care services.

Should the Scottish Government’s budget be passed, it will mean that, by the end of the next financial year, the number of hospital at home beds will be expanded to provide the largest hospital in Scotland. We are expanding hospital at home because it is an innovation that works.

The delayed discharge figures will be published tomorrow; Jackie Baillie will understand why I cannot pre-empt what is to be in them.

With regard to the Scottish Ambulance Service, Jackie Baillie is absolutely right that it has faced unprecedented demands on its services. However, in order for her argument to hold water, she has to pretend that ambulance services elsewhere in the United Kingdom have not also faced unprecedented challenges. The critical incidents that were announced in Wales and in various hospital trusts in England point to those pressures being a shared challenge that has been faced this year because of flu.

I was incredibly heartened by the conversation that I was able to have with Wes Streeting and other health ministers across the four nations just before Christmas about what we need to do on reform and improvement, because I believe that there are shared areas in which we are looking to invest. Those include shifting the balance of care; reducing hospital occupancy; reducing the length of stay in hospitals; and reducing delayed discharge, because that is what is causing our systems to choke, which has meant that our ambulance service staff—to whom, again, I am very grateful—have been struggling to be able to convey patients into hospitals.

I am not absolving myself of responsibility for the situation that is being faced; I am simply trying to point out to Ms Baillie the context, of which I know that she and others across the country will be aware.

I thank Gillian Mackay for raising that point. I reiterate the point that I made in my statement about ensuring that people access the right care in the right place and that they utilise the services that are available through NHS Inform and NHS 24. I hear the point that she has made about minor injuries units. Such a decision would be for NHS Forth Valley to take, and I would be more than happy to facilitate a discussion between it and Gillian Mackay on that potential option.

I recognise the challenge that exists in the system. As I said in response to Jackie Baillie, Sandesh Gulhane and others, we need to make the investment that is in the proposed budget, which would allow for greater capacity in social care and primary care and thereby avoid people being admitted to hospital in the first place. That would also provide the capacity that would enable our accident and emergency departments to deal with patients and our Scottish Ambulance Service to convey patients.

It is about dealing with hospital occupancy, length of stay and delayed discharge. We have prioritised spending in the budget to enable that to happen. I look forward to members of the Scottish Parliament from all parties supporting the budget so that we can provide for improvement of our services.

I agree with Alex Cole-Hamilton: the situation with regard to our four-hour standard is not good enough. It is not one that I accept and we need to see improvement. That will happen by creating capacity, and that will come through the investment that is set out in the budget.

I thank Clare Haughey for highlighting a critical area. Again, I encourage anyone who is eligible for a flu vaccination, or who is part of any of the vaccination programmes this winter, to take up the opportunity to be vaccinated.

As of 15 December 2024, we had administered more than 1.2 million adult flu vaccinations and more than 517,000 child flu vaccinations. Uptake in the highest-risk groups, such as people who are living in care homes and those aged 75 and over, remains strong—although it is slightly lower than we achieved in the winter of 2023—with 82 per cent of care home residents and 78 per cent of those aged 75 and over having been vaccinated against flu this winter.

Health boards have been heavily advertising their drop-in clinics, with many citizens accessing vaccination over Christmas and new year. Therefore, we expect the figures to have increased when Public Health Scotland publishes the next round of data later this week.

A range of tailored resources and promotional materials have been prepared by PHS and disseminated through partners, including local NHS boards and the community and voluntary sectors, as well as the Government, to encourage uptake by all who are eligible.