Hansard

Presiding Officer, I hope that you will appreciate that it was never my intention to cause you or the Parliament any issues when I spoke to the media ahead of my statement. If issues were caused, I offer an apology to you and to the chamber, and I give an assurance that we will take the necessary steps to ensure that it does not happen again.

The past 18 months has been a time of unprecedented pressure in the national health service, as it has faced the biggest challenge of 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 Scotland, 24 hours a day and seven days a week.

I again take the opportunity—as, I am sure, other members will do—to thank all our hard-working Ambulance Service staff for the work that they are doing in such difficult circumstances. I understand that those who call an ambulance are often in considerable distress, but I hope that we all agree that our ambulance colleagues deserve to be treated with the utmost respect.

It is important to remember that, despite the significant pressures that our service is under, staff continue to deliver a highly effective response to our high-acuity patients—30-day survival rates for such patients are at their highest ever recorded levels.

That said, I recognise that some people are not receiving the standard of service that they should be getting or the standard of service that the Ambulance Service and the Scottish Government want to be delivered. I completely accept that some of the cases that we have heard about—in the chamber last week and in the media—are unacceptable. I have no hesitation in apologising to families who have been let down.

It is in that context that the Ambulance Service is currently operating at level 4 of its escalation plan, which is the highest level. That decision has not been taken lightly. In practice, it means 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 co-ordination cells and support teams are all working extended hours.

The situation in Scotland is not unique. The global pandemic has created the most challenging crisis in almost every sphere of our lives—including our national health service—in the history of peacetime Britain and certainly in our lifetimes. Ambulance services across the UK, as well as the wider NHS, are experiencing unprecedented demand. That is largely because of Covid, but it is 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 immediately life-threatening incidents, which was 20.7 per cent of all incidents that were attended that month. Compared with the figures for August 2018, when there were 5,788 immediately life-threatening incidents, which was 10.6 per cent of incidents attended, that clearly shows the significant increase in acuity of presentations to the service.

The vast majority of patients in those immediately life-threatening incidents require to go to hospital. With acute occupancy for most boards already between 87 and 96 per cent, and most mainland boards in excess of 100 per cent for intensive care unit occupancy, we can clearly see the pressures that our services are under.

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

It is, however, important that I once again make it categorically clear that we are still firmly in the midst of a global pandemic. Today, I will outline to members the measures that we are putting in place to ensure that 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 the autumn and winter.

Our immediate actions will be backed by additional investment of up to £20 million, on top of the additional £20 million that has already been invested this year to recruit an additional 296 ambulance staff. That equates to additional in-year investment in the service of more than £44 million, which is an uplift of nearly 16 per cent on last year’s resource budget.

Many of the actions that we are taking are aligned with suggestions that have been made by the unions that are attached to our Ambulance Service, which have set out a number of suggestions for support. Those actions focus on immediate assistance from partners, continued workforce enhancements and improvements to the flow of cases into emergency departments.

In terms of the immediate, there are short-term pressures on the Ambulance Service that will be relieved only through the wider public and voluntary sector standing up to support the service at this incredibly challenging time. I can confirm that a request for military assistance was made immediately after First Minister’s question time last Thursday. Since then, officials have been working to finalise the package of support that the military will provide.

The assistance will consist mainly of the provision of 88 drivers to free up our paramedics and technicians to focus solely on providing patients with the best clinical care. Fifteen support staff are also being requested, which means that there will be support in the form of 103 military personnel. There are still authorisation processes to go through, but we do not envisage any challenges with gaining the required approval. All going well, some of those military personnel will be ready to be deployed and driving ambulances this weekend. As always, my thanks go to the Army for its responsiveness.

I have also reached out to the Scottish Fire and Rescue Service, and I am glad to say that, in typical fashion, it has risen to our call. It will scale up the Ambulance Service’s access to volunteer firefighters for driving, and that will now also include full-time firefighters. Again, that is with a view to providing more valuable paramedic and technician time on the front line.

The immediate assistance is not being sought only from the wider public sector. We have also brought in support from the British Red Cross, 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. I make it absolutely clear that, if someone is in critical or life-threatening need, they will be taken to hospital in an ambulance, if one is requested. Alternative transport arrangements are for patients with low acuity. Patient safety will, of course, remain our number 1 priority.

We should bear it in mind that, in August this year, around 27 per cent of calls to the Ambulance Service did not require an ambulance response and only 21 per cent of calls involved life-threatening situations, although that percentage has risen considerably recently.

The decisions that I have outlined are not ones that we have taken lightly, but, given the urgency of the situation, the Government needs to respond with decisive, if unconventional, action to save lives, as it has done throughout the course of the pandemic. I make it clear that the full range of measures that I am announcing today have been assessed as clinically safe.

Of course, it is important that we are not only freeing up paramedic and technician capacity, but creating additional emergency capacity in the wider Ambulance Service. That is why we are also aiming to bring on board 100 second-year paramedic students to work across the service, including to assist our ambulance control centres 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. That will provide senior specialist clinical decision support to patients, thereby optimising the service’s response to people in need, and utilising additional clinical pathways where it is appropriate to do so.

Bolstering capacity at both 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 that have offered their support. However, I am mindful that it 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 will deliver almost 300 additional Ambulance Service staff by April 2022. Last year, 148 new staff were recruited, and the service plans to recruit another 443 this year, 148 of whom will be new staff, with the remainder covering planned staff turnover; 172 have already been recruited this year, with 186 due to be in post by the end of November, and the remainder by April 2022. The service is taking forward recruitment plans at pace.

The breakdown of new recruits is that there will be 69 staff in the north of Scotland, 139 in the west and 88 in the east. The additional new staff are a mixture of paramedics, newly qualified paramedics 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 result in the on-call requirement being reduced in Campbeltown and removed entirely in Fort William, Kirkwall and Broadford.

We know that our emergency departments are also under significant pressure. That is why we need to ensure that we are not just creating further problems for A and E departments that are already struggling. Therefore, we are also further investing in additional hospital ambulance liaison officers. We are almost doubling the number of HALOs from the 11 who are currently in place, with the result that there will be 20 posts throughout the country.

Those liaison officers are important in supporting flow through emergency departments and 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 well as possible. The HALOs will be concentrated at our busiest sites.

Most of us have seen pictures from Scotland and across the UK of ambulances queued up outside emergency departments. Getting people the care that 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 that the difficult winter ahead will bring. Our forthcoming winter plan will set out the measures that we and our partners will take to ensure that we can deliver high-quality, safe care in a sustainable way in the coming months. That will create capacity in our community health and care services and in our hospitals, and it will ensure that there are alternative pathways that people can access, where it is safe to do so, in order to avoid their admission to hospital, as well as ensuring that they can be discharged from hospital as soon as it is clinically safe.

I know that some members have suggested having pop-up facilities outside our A and E departments. The issue has been explored, and, although we will keep it under review, our clinicians and the likes of the Royal College of Emergency Medicine have expressed patient safety concerns in relation to that option. However, with immediate effect, we are repurposing some spaces to maximise capacity at the front door of hospitals across the country to ensure that patients can be safely transferred to clinical teams as quickly as possible. Where necessary, that might include expanding the footprint of our hospitals, even on a temporary basis, and we are working with NHS boards on that.

This will undoubtedly be the most difficult and challenging autumn and winter period that our health and social care services have ever faced. As in other parts of the UK, Scotland’s health boards have faced unprecedented demand over recent weeks, whether in emergency departments, in elective activity or in local general practitioner practices. The next months will 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, the fire service, the third sector, volunteers and the private sector, as well as from Ambulance Service staff themselves.

The wellbeing of our Ambulance Service and of health and social care workers more widely is of paramount importance. Throughout this period, our staff need to know that we are doing everything that we possibly can to provide them with the support that they need.

The situation that I have described has inevitably resulted in additional pressure for ambulance staff with regard to rest break compliance and shift overruns. This year, we are providing £500,000 of funding for additional support to Ambulance Service staff wellbeing. That includes additional welfare for crews and a range of wellbeing initiatives, such as personal resilience packages and techniques that are supported by a dedicated wellbeing team. I am still very supportive of SAS discussions with its trade union partners about having a rest break action plan in place as quickly as possible.

I have outlined an immediate plan of action, which is backed by up to £20 million of additional investment. Our Ambulance Service and NHS have 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.