Health Secretary Angela Constance has pointed to a pattern of hospital beds being occupied by patients whose needs could be met in other settings, and called on every part of the NHS to take a more active role in reducing pressure on accident and emergency departments as winter approaches.
Constance called on wider parts of the NHS to take on a greater share of the workload, pointing to the volume of cases presenting to emergency medical staff each winter. Plans addressing the recurring seasonal pressure on Scotland's health service were set out by the cabinet secretary.
Among the measures outlined are an expansion of hospital-at-home provision, a care approach centred on returning patients to their own surroundings as a first option, a public-facing information drive to help people identify the most appropriate route to care, a push to raise flu vaccination uptake, and action to reduce the length of time patients spend in hospital beyond the point when they are clinically ready to leave.
Data gathered by the British Medical Association across several health indicators point to an approaching winter that may place greater strain on NHS services than those seen in recent years.
At a fringe event during the SNP conference, Constance drew attention to uneven outcomes across different areas of the country in reducing delayed discharge, noting that while some degree of variation was to be expected, the gaps were pronounced. She raised the question of why approaches such as discharge without delay or discharge to assess, where they had proven effective in certain areas, were not being extended more broadly.
Constance added that patients across Scotland's hospital wards who fall outside the delayed discharge category are also being discharged later than their clinical readiness warrants. She called for expanded hospital-at-home provision to proceed alongside the targeted measures already shown to reduce discharge delays.
Her remarks pointed to a dual concern — beyond the attention focused on delayed discharge, she noted that other areas within hospitals also warrant examination. The vast majority of patients leaving hospital — roughly 97 in every 100 — do so without any hold-up in their discharge.
Constance noted that those working in emergency medicine feel they bear the entirety of the clinical risk, and raised the question of whether patients across various hospital wards might be ready for discharge sooner than current practice allows. She described those workers as operating under sustained pressure, required to maintain both a demanding pace and an unrelenting level of intensity throughout their shifts.
Those involved in emergency medicine are calling on other parts of the system — both upstream of the point of first contact and within the hospital network — to take on a greater share of the workload, so that responsibility becomes more evenly distributed across the system as a whole.
Constance stated that every component of the system bears a responsibility to go beyond the minimum, and that placing the full burden on a single part of the service is not a viable path forward. She indicated that those involved are expected to contribute at a greater level than has been the case to date.
