Recommendation COVID-M3.5: Scale Up Urgent and Emergency Care

5.1 The Welsh Government agrees with the Inquiry that urgent and emergency care services must be able to respond quickly and effectively to increased demand during a future public health emergency or pandemic. 5.2 The ability to scale up urgent and emergency care depends on many parts of the health and care system working well together. This includes primary and community care, NHS 111 Wales, ambulance services, emergency departments, hospital flow, and timely discharge from hospital. 5.3 Since the pandemic, considerable work has been undertaken to strengthen urgent and emergency care in Wales. A key part of this has been delivery of the Six Goals for Urgent and Emergency Care — policy and programme (2021‑2026). The six Goals were designed to shift the system from reactive, hospital‑centric care to a proactive, whole‑system model‑improving resilience by addressing demand, patient flow and outcomes across the entire pathway. The programme has focused on improving access, reducing avoidable hospital attendance, supporting rapid response in the community, access to hospital care when needed and enabling people to leave hospital safely and promptly when able. 5.4 NHS organisations in Wales are already required to develop annual plans to prepare for times when demand is expected to increase, such as winter and periods of extreme pressure. 5.5 For winter 2026/27, planning has begun. It will focus on making sure organisations are ready, responsibilities are clear, and plans are tested against different levels of demand. The NHS in Wales’s approach to winter planning, and urgent and emergency care surge planning, will be reviewed and strengthened each year. 5.6 Winter plans for 2026/27 will be based on two demand scenarios: the most likely level of demand and an extreme pressure scenario. This approach is intended to help organisations plan consistently across Wales and show what action they would take if pressure on services increases. Health boards are expected to work closely with local authorities through Regional Partnership Boards when developing their winter plans. 5.7 More broadly, NHS organisations in Wales will move from this traditional planning model focused on planning for winter pressures to, planning throughout the year. This reflects the changing pressures on health and social care services, including heatwaves, severe cold and wider environmental impacts rather than a single, predictable winter peak.

5.8 This approach will help organisations and services across the NHS in Wales to understand pressures in real‑time and respond more flexibly when demand increases or services are disrupted. This year‑round planning approach will take bed capacity and workforce availability into account and supports a more realistic understanding of system vulnerability, and places greater emphasis on prevention, and maintain safe care for patients throughout the year. 5.9 As planning for urgent and emergency care is closely linked to wider hospital capacity planning it is recommended that the response to this recommendation is read alongside the response to Recommendation 6.

The Scottish Government accepts both recommendations 5 and 6 in principle, and recognises the central role of all NHS Boards in ensuring that robust, practical and regularly reviewed arrangements are in place to respond to future pandemics or public health emergencies.

The Scottish Government has already begun taking steps to address these two recommendations, including:

The Scottish Government has commissioned all NHS Boards (this includes territorial health boards and special boards such as NHS 24 and Scottish Ambulance Service (SAS)), to review and assure their arrangements in terms of current capacity and the ability to scale up when required, while also contributing to the development of a consistent national approach to preparedness and resilience

While capacity can fluctuate, work by the Scottish Intensive Care Society Audit Group has shown increases in critical care capacity in Scotland since the pandemic

A review of critical care equipment has been undertaken. All NHS Boards are holding and maintaining on site ICU equipment to double capacity

Work is underway to confirm the approach to maintaining this capacity (as equipment will require replacement in five years’ time)

PSD Scotland is working in partnership with NHS Boards to deliver a national Medical Equipment Management System, to provide the Scottish Government with national oversight of Board medical equipment

Further initial steps proposed are as follows:

The Scottish Government has commissioned work to ensure there is a clear overview of health boards' capacity.

Health Boards have been asked to review existing plans and arrangements for managing significant increases in urgent and emergency care demand, including:

Workforce arrangements

Staffing models

Training and competency

Mutual aid

Governance and escalation

Risks and gaps

Health Boards are also undertaking a review of current plans for expanding hospital and critical care capacity. The Scottish Government has asked that this includes:

Additional bed capacity

Critical care expansion capability

Availability of equipment, supplies and consumables

Workforce

Infrastructure requirements

Command, control and decision-making arrangements

The government agrees with the Inquiry that it is important to continue to prepare to scale up urgent and emergency care capacity.