To ask the Scottish Government what its response is to the reported view of the Royal College of Emergency Medicine that its winter planning is “not doing enough” to support accident and emergency departments as they approach their busiest time of year. (S6T-02142)

We know that there are challenges to come for our health and social care system this winter, and in particular for our accident and emergency departments. Our health and social care winter preparedness plan sets out how we will ensure that people in Scotland receive safe and timely access to health and social care services and support over the winter.

We have a number of specific actions that will help to reduce pressure on our busy accident and emergency departments, such as improving discharge planning, enhancing our hospital at home services and treating more people in the community, when it is clinically appropriate to do so.

In addition, we have recruited a record number of NHS 24 call handlers, who will be available this winter to direct people to the most appropriate care, thereby helping to reduce unnecessary accident and emergency attendances.

Public Health Scotland recently revealed that levels of delayed discharge from hospitals reached a record high in August, which is one of our warmest months. The Royal College of Physicians has said that that should be a cause for huge alarm. Does the cabinet secretary think that hospital staff will gain any confidence from the Government saying the same thing it says year after year?

I accept the fact that delayed discharge is too high and that variation in performance of local systems is too wide. That is why I have been meeting the Convention of Scottish Local Authorities and local chief officers weekly to monitor progress. If it had not been for the intervention, support and whole-system approach that we took over the summer, there would be an even worse picture of delayed discharge.

I hope that the work that has been put in at pace by local systems—in particular those that have had the most challenging positions to address—will bear fruit and we will see a reduction, going forward. However, we need to reduce much faster so that we give confidence to the staff who work in our acute sector to ensure that they feel prepared for winter.

According to the care homes census, one in five care homes has closed since 2014, which means that there are 18 per cent less care homes than there were a decade ago, while demand is going rapidly upwards. Many more are likely to close over the coming years. That is the root cause of hospital overcrowding: people have nowhere to go. Cabinet secretary, is it not the case that the Government has lost control of social care?

Always speak through the chair, please.

No, that is not the case. We continue to work with local government to look at areas such as the national care home contract and improving the advice and guidance that are available for treating and supporting adults without capacity, to ensure that we support the position in local areas. There have been challenges in relation to care home closures and the decisions that have been taken at the local level in that regard, but there is more cause for optimism in some of the more challenging areas, where local authorities are looking at innovative ways of bringing some of those care homes back into use. That will be important.

We must also recognise that residential care is not the right place for everybody, and that we need to support more people at home. Hospital at home is an important investment that we are making. It is now the eighth-largest hospital for geriatric services in Scotland, and we will continue to support the work on expanding that, both as a means to support people to stay at home for longer and as a means to avoid hospital in the first place.

I refer members to my entry in the register of members’ interests. I hold a bank nurse contract with NHS Greater Glasgow and Clyde. What additional support is the Scottish Government providing to health boards to implement its winter planning?

A record number of NHS 24 call handlers are available this winter to direct people to the most appropriate care. We have also strengthened arrangements to alternative services, including flow navigation centres and same-day emergency care, to support people to receive the right care in the right place and to help to reduce unnecessary A and E attendances.

Over the months ahead, we will continue to work with boards to enhance patient flow at our acute sites, to improve discharge planning and hospital at home services and to reduce conveyance of people from care homes where it is clinically appropriate. We have baselined the funding that is available for health boards to support all-year-round surge planning, rather than its just being a focus in winter, as we recognise that such pressure could be faced at any point in the year.

The Royal College of Emergency Medicine has said:

“We are seeing lots of discussion, but we haven’t seen any useful measures so far that will make it any better for people working in A&Es this winter”.

That sums up the situation perfectly. Cabinet secretary, you have been in post for eight months and you are wheeled out time and again to provide smokescreens—

Speak through the chair, please.

The cabinet secretary has not delivered any meaningful action. Why has the cabinet secretary failed to improve A and E times?

First, I fully respect the views of the Royal College of Emergency Medicine—I went to Forth Valley hospital with representatives of the royal college to see the work that is being done there to improve the flow through the accident and emergency department.

I recognise the pressures that exist in our accident and emergency services. That is partly due to the delayed discharge picture and the need to make more beds available in hospitals, but we also need social care packages in place to enable people to leave hospital and return home without delay. We are supporting local systems to try to achieve that, both by getting the processes right and exemplifying best practice and by supporting those who have further to travel in order to ensure that they are able to meet our expectations for a much better service for the people whom we are here to serve.

The cabinet secretary mentioned hospital at home a couple of times in his answers. Can he say any more about the steps that the Scottish Government is taking to further develop the programme, which, as we know, plays an important role in reducing pressure on hospitals and ambulance services?

I thank Joe FitzPatrick for raising an important issue. To continue to develop the hospital at home service, the Scottish Government has made available £3.6 million of funding for 2024-25, which takes the overall funding for hospital at home for older people to more than £15 million since 2020.

The Scottish Government’s continued investment demonstrates that it is committed to hospital at home and sees the programme as a national priority. By providing care in that way, we are enabling more people to receive treatment in the comfort of their own home, rather than in an acute ward; we are relieving the pressure on front-line services in traditional hospital settings; and, crucially, we are getting better outcomes for those patients, which means that they are re-enabled at home and are more likely to stay at home for longer, and will require a smaller social care package as a result. That is a win-win, which is why we are continuing to invest in the hospital at home scheme.

That concludes topical question time.