 Mae'r next item of business is a debate on motion 9191 in the name of Michael Matheson on hospital home programme in Scotland. I'd invite members wishing to participate in the debate to press the request speak buttons now or as soon as possible and I call on Michael Matheson to speak to and move the motion. Cabinet Secretary, around 11 minutes please. Thank you Deputy Presiding Officer and I'm pleased to open today's debate on hospital home programme. The health of every individual in our society is a priority for this government and with every shift and approach to how we provide healthcare to the people of Scotland comes a need for scrutiny and public debate. Projections for future bed demand suggest that by 2031 Scotland will need to increase hospital bed capacity by around 2,000 to 3,000 beds. This is equivalent of five large district general hospitals so it's essential that we look at alternative sustainable solutions for patients and for our healthcare system. Since 2020 the Scottish Government has invested some £7.6 million in the development of hospital at home and I was delighted to announce a few weeks ago a further £3.6 million for this financial year to support its further expansion across Scotland. This will increase our current capacity by some 50 per cent by the end of 2023-24, allowing more people to receive the care they would usually receive in hospital at home. Hospital at home services are consultant led with expert teams on hand to provide short term hospital level care. Patients have access to interventions such as oxygen and intravenous antibiotics and investigations such as ECG and scans at home or in a care home. Hospital at home has been in operation now in Scotland for over a decade. We now have services in nearly every board and partnerships across Scotland. I'd like to put on record my thanks for the excellent work done by the dedicated healthcare professionals delivering care across the country around the clock to make this possible. We are all aware of the fundamental issues facing our health service, increasing demand, increasing complexity and increasing acuity, which means that, when there is a surge in demand, our NHS and our wider health and social care system is at times under significant pressure. We are still dealing with the combined shock of the global pandemic and of course Brexit, which are making securing workforce very challenging. Over recent months, services have been working hard to recover, but pressure on acute hospital services has been increasing throughout the UK now for some time. The culmination of that is increased hospital occupancy levels, which are routinely at around 95 per cent, well above historic levels and beyond what is acceptable. We must, in the best interests of both patients and the people who work in the NHS and in the social care sector, use every lever available to us to address these combined pressures. Key to reducing demand on our hospitals is to provide care closer to home. Hospital at home is one of the levers that we are already using very successfully. In 2022-23, over 63,000 bed days were provided by hospital at home services for older people. In fact, data released by Healthcare Improvement Scotland this month showed that the number of older people admitted to hospital at home services in 2022-23 is almost the equivalent of a large city hospital like Aberdeen royal infirmary, making hospital at home the fifth biggest hospital for older people. Beyond considering the challenges on the system within health and social care, we must first and foremost consider what the people of Scotland want and need. 10 per cent of people over 65 in Scotland are living with frailty, and we know that that can have a considerable impact on a person's quality of life. We also know that older people in Scotland in particular are often those most significantly impacted by hospital stays. Evidence tells us that on average 10 days in a hospital bed is equivalent of 10 years of muscle wasting for an older person. Emission of a patient with frailty to an acute ward increases the likelihood of them losing muscle strength, agility and of course confidence. By taking people who may already be frail out of a hospital setting, we can reduce deconditioning and exposure to other avoidable harms, such as hospital-acquired infections, including delirium and falls. We are more than happy to give way. Alex Rowley, I am grateful for the cabinet secretary for giving way. As somebody in five who has watched hospital home develop over many years, I am a big supporter, but does he accept that these elderly frail people need, we have to as a Government, ensure that these people have the support that they need in the community and therefore social care needs to be able to respond? I agree with that point that has been made. Of course, Fife has been one of the leaders around the development of hospital home, but we need to make sure that social care provision is able to meet the demands that come alongside that as well, which is why we are taking forward considerable investment in social care but also around the development of a national care service. We also know that a hospital stay is, by its very nature, removed people from their home environment, away from their surroundings and their loved ones, which can lead to distress and anxiety. There are practical considerations for a patient's carers and families, such as transport, which can make a hospital stay a disruptive and sometimes expensive time for the family. We must ask the question, is hospital always the best place for every patient to receive the treatment that they need? Sometimes, of course, the answer will be yes, but that is not always the case. Recent evidence review identified several key findings on the benefits of hospital home. Firstly, hospital home can be delivered safely without increased rates of death or readmission to acute care. Hospital home may reduce the likelihood of patients living in residential care following an acute episode, and patients express high levels of satisfaction with the services. Finally, the cost of hospital home is generally lower than for inpatient care. Crucially, patients value being in the comfort and the familiarity of their own home and appreciate the reduced disruption to their daily routines. I appreciate the cabinet secretary giving away. Many of us appreciate the importance of care at home. Areas such as Dumfries and Galloway, the severe lack of nurses and help to deliver that care at home, there is still a role for cottage hospitals. Cottage hospitals and the value for the community were recognised by the First Minister and his role as the health minister. Would you not agree that step-down facilities such as cottage hospitals still play a big role and can also voice my disappointment that you are not coming to collect a petition signed by 4,000 people to see Newton Stuart and Cacubrie cottage hospitals reopened? The issue about the design of healthcare services locally is best directed by the local health board and health and social care partnerships in the integrated joint boards. Knowing what is the best way in which to meet the needs of the local community, in my view, is the most appropriate approach. Hospital at home can play an important part in that. I know that Dumfries and Galloway are taking forward work in order to develop and expand their service. We also need to be honest about the challenges that we face in expanding hospital at home. Although NHS Scotland's staffing levels are at a historic high due to 10 years of consecutive growth, clearly recruitment and redeployment of staff is a limiting factor, particularly in more remote and rural areas. It is unquestionable that the loss of EU freedom of movement has put unnecessary barriers in place to recruit staff from Europe and, of course, the UK's post-Brexit immigration system is certainly not helping. The Scottish Government recognised the challenges that boards and front-line staff are facing, which is why we announced £8 million of funding to support boards to recruit an extra 750 nurses, mid-wise and AHPs from overseas by 31 March 2023, and they have made good progress in taking that forward. NHS Scotland has been expanding capacity across a series of clinical pathways to manage the on-going pressures of acute care to help to support recovery towards a sustainable future. Those new models of care have been developed at pace. We must also double the amount of virtual beds from 441 beds at the beginning of 2022 to 806 beds by the end of March this year. That is equivalent to adding an extra district general hospital in just 15 months. That is 806 patients every day receiving care at home who might otherwise have been in hospital. Since 2020, we have invested significantly in the development of hospital home, recognising its value as we seek to recover from the pandemic. Our ambition is to continue the expansion of hospital home across a range of specialities and to expand our capacity in preparation for winter to help to create responsive and resilient services for the future. The recovery of the NHS is dependent on implementing innovative models of care that put the individual's best interests at their heart. Hospital at home is a prime example of just that. A delivery model that benefits not only patients, their families and their carers but also goes a significant way to reducing pressure on acute hospitals and NHS staff in an effective and compassionate way. The challenges of the pandemic have compelled our public services to innovate and adapt. We must now build on this momentum to transform the way that we deliver care. The continued expansion of hospital home supports our ambition to ensure that people receive the right care for them in the right place at the right time. I move the motion in my name. Thank you, cabinet secretary. I now call on Sandra Skolhany to speak to and move amendment 9191.2 for around seven minutes. Dr Gohany. Thank you. I wish to declare an interest as a practicing NHS GP and move the amendment in my name. The hospital at home's programme's aims are laudable. It is indeed right, we're safe to do so, to provide elderly patients and those who need medical treatment and care in the comfort and familiarity of their own home. Treatment might include having an IV or oxygen supply, there's also scope to provide access to hospital tests and as a doctor I can see the good hospital at home can be and I've seen it in my own patients. Of course the more we can deliver safe care at home then the more we can free up capacity in our hospitals and we are crying out for solutions and that's because and this is an undisputed fact that successive SNP health secretaries have failed to tackle delayed discharge from our hospitals. In February 2015 today's deputy First Minister declared when she was health secretary that she would end delayed discharges in Scotland by the end of that year yet another tiresome SNP announcement. However the reality is that over the past eight years more than 3,000 patients who were medically fit to go home have died on the wards. In March 23 there were over 54,000 days spent in hospital by those whose discharge was delayed. So hospital at home can make a difference though we must be realistic when it comes to resourcing the programme and deploying teams of mobile specialists. Tapping into a seemingly endless number of beds available in patients own homes does not solve the problem of shortages of clinicians within the NHS. Since the programme first launched in 2011 it has rolled out to every health board except NHS Dumfries and Galloway and NHS Shetland. During the main Covid years between 2020 and 2022 the programme received £8.1 million in funding. I will yes. Emma Harper It's interesting what Dr Gullhane is saying about NHS Dumfries and Galloway and I thank him for taking that intervention because I know time is short. My understanding is that NHS Dumfries and Galloway have taken forward a home teams approach which is how they are delivering the equivalent of hospital at home. Sandy Gullhane, I can give you the time back. As I said at the start of my statement I would welcome anything that reduces delayed discharge. By May 2022 the Scottish Government said there are an estimated 275 virtual beds created through hospital at home and for comparison there are 333 staff beds at university hospital air. It was then announced that 275 bed number would double by the end of that year. That didn't happen. So we have another announcement. 3.6 million to the hospital at home programme for the financial year to create 156 additional virtual beds. The Scottish Conservatives support any measures to alleviate the pressures on our NHS such as the SNP's delayed discharge crisis. You may recall that we published a raft of proposals in our winter recovery plan and these included expanding the reach team, the initiative which helps patients to rehabilitate following a hospital stay and make adaptations to their home. The Royal College of Physicians in Edinburgh has said that while it welcomes increased investment in efforts to get patients out of hospital earlier and reduce admissions such initiatives require extra staffing. Hospital at home services must be developed and resourced in addition to existing services, not at the expense of those existing services. This isn't my view, it is the view of the Royal College of Physicians of Edinburgh. It requires adequate numbers of well-trained staff across MDT teams, including medical nursing, rehabilitation therapy and care staff. Professor Andrew Elder of the Royal College of Physicians in Edinburgh reported that we do not have sufficient numbers of such staff at present either in hospital or in the community and we will need to see more recruited as our population continues to age and their care rise. If the hospital at home programme is going to be expanded, the health secretary should fully assess the impact on informal carers. Hospital at home services should not pile unsustainable pressures on unpaid carers. It is important to get this right. The last thing we need is another announcement with no credible plan and failed delivery. We know that elderly people who receive care at home have less risk of delirium at the one-month follow-up. We also heard from the health secretary about how it improves muscle mass. Staying in your own home for longer without losing independence results in better wellbeing and satisfaction. In health, however, we cannot consider solutions in isolation. Silo thinking won't work. To make care at home work, we must improve performance along the whole elderly care pathway. More cash for hospital at home should go hand-in-hand with marked improvements in A&E waiting times. We must remember that our over-75s attend A&E at higher rates than any other age group—in fact, double that of the 65-74-year-olds. In the week ending May 2023, only 64.1% of patients were seen within four hours, 11% waited eight and 4.4 over 12. Bob Dorff. The hospital at home initiative is also partly about anticipatory care and referrals can come from GPs before or at A&E instead of a hospital admission. That chimes very much, I think, with the point that you are making, Mr Gohani. Through the chair, please, for interventions, as well as other comments. Dr Gohani, I'll give you the time back. Yes, I have made a referral myself to hospital at home. More people are waiting longer in A&E at the end of the First Minister's tenure as health secretary than when he started the job. The A&E waiting times must improve so that our elderly are seen sooner and with better outcomes when they return home. The SNP Green Government still seems to be pursuing the establishment of a national care service to centralise, rather than empower local decision making. Despite criticism from national care service plans from SNP members, Unison, COSLA, the Scottish Ambulance Service, here's a flavour. The NCS bill does not represent any value for money whatsoever, it's a blank check from the public purse. It seems like a sledgehammer to crack a nut. If this proposal goes through, staff are going to feel concerned about their jobs and their wages and pensions and, as a result, look for jobs elsewhere. It risks the overall NHS Scotland ambition to shift the balance of care. For hospital at home to work, we need a strong primary care. With closures like the GP practice in Invergarry just today, the SNP Government is failing the people of Scotland. After 16 years in government, the SNP Greens seem out of ideas when it comes to fixing our NHS. While the principle of hospital at home is good, the Government is tinkering. It is devoured of strategy and we can't see joined up thinking, no vision. Scotland needs a fresh approach that incorporates a modern, efficient and local solution into healthcare, where the Scottish Conservatives will increase primary care funding envelope to 11 per cent. I now call Paul Sweeney to speak to and move amendment 9191.1 up to six minutes, so around six minutes, Mrs Sweeney. Thank you, Deputy Presiding Officer, and I move the amendment in my name. Hospital at home is an initiative that we in Labour support. We have heard already the benefits of delivering healthcare external to hospital or acute care setting, all which are entirely valid and commendable. For a long time, we have been advocating for an approach to healthcare that is based on prevention rather than reaction. For a long time, we have been arguing that reducing the pressure on acute hospitals and acute care settings is essential and will deliver better outcomes. Everyone in this chamber is well aware of the benefits of early intervention and equally we are all aware of the consequences for hospitals and acute care settings when services that facilitate early intervention and prevention fail. We support the principle of the hospital at home programme and we will work with the Government to ensure that patients who are in a position to benefit from the programme are able to do so. Throughout my time in this role so far, I have always done my best to be constructive and I think that that is an approach that I would like to continue today. A cross-party approach to tackling the crisis in our national health service will be crucial and in the interests of co-operation we will support the Government motion today along with the Conservative amendment. In the interests of trying to make a success of the hospital at home programme, it is important that the Government acknowledge that turning it into a sticking plaster just won't suffice. If we are going to make a success of this programme, it needs to be done with the recognition that in many ways our NHS is in dire straits and that we must address the root causes of the problems that we face today and those problems are found across our national health service. One in seven people in Scotland on our NHS waiting list, a social care policy programme that is in Tatters, over 160,000 bed days lost to delayed discharge in 2023 alone and over one million bed days lost to delayed discharge since the current First Minister was first appointed as health secretary. One in 10 GP practices in Scotland no longer accepting new patients, a vacancy rate of over 11 per cent for registered nurses in district nursing and a vacancy rate of 12.5 per cent for registered nurses in community settings. I take absolutely no pleasure in rhyming off that list of problems and I want nothing more than for each and every one of them to be resolved immediately for the benefit of patients who are desperately lying on because we all have skin in the game, Deputy Presiding Officer. The reality is that those problems do exist today and the harsh truth is that for as long as they do hospital at home will fail to live up to its full potential. Of all the problems that do exist, the most egregious is the workforce crisis engulfing the NHS and social care. As I outlined briefly earlier, vacancies are at a record high. Given the multifaceted and multidisciplinary nature of the hospital at home programme, there is the distinct possibility that it fails purely due to a workforce shortage. That is why our amendment sets out the need for a long-term funding settlement for the hospital at home programme and that is something we would happily work with the Government on should they desire it. While the workforce crisis in our NHS may take some time to resolve, given the training lead times and issues around that, there is no excuse for the workforce crisis in social care. The backlog in delayed discharges is no small part down to a lack of a social care plan and one of my primary concerns about the hospital at home programme is that it will be used to try to mask the crisis in delayed discharge. We also see that play out in adjacent services such as hospice care. Indeed, I visited the Prince and Princess of Wales hospice in Glasgow just a few weeks ago and they highlighted that a third of their beds are unusable due to the lack of specialist nursing staff. Labour has set out our plan to increase the pay of social care workers to £15 an hour at a cost of approximately £150 million a year. However, we have also identified three areas with an opportunity cost value of almost £300 million from which that money could be found, which would ensure that we also have a further economic multiplier effect in our wider economy through the marginal propensity to consume. I call on the Government to back us on that commitment and increase the social care pay to £15 an hour. It would go a long way to alleviate the pressure on hard-pressed social care staff. It would go a long way to resolving the workforce crisis in social care. Fundamentally, it would ease pressure on front-line services by reducing the level of delayed discharge that is clogging up the system. In closing, the Labour Party supports the hospital at home programme. We commend it, but we are clear that there needs to be a realistic and pragmatic assessment about the extent to which it will be beneficial given those crises. Without a long-term funding settlement, without a long-term plan to fix that workforce crisis in our NHS and without a long-term prospectus for the future of our social care sector, it risks becoming a mere sticking plaster and another initiative that is doomed to failure before it has gotten off the ground. That would be a real shame, because the need for a programme like this to succeed is greater than ever before. I have done right it as the potential to enable significant progress for public health in Scotland. Liberal Democrats are committed to improving the quality of care for patients across Scotland. We believe that the hospital at home programme is a valuable way of doing so. As we have heard, hospital at home is a model of care that provides treatment and support for patients in their homes rather than in a hospital setting. It can relieve that interruption of flow that we all know too well that is causing delays in A and E and cancelled operations for people who are stuck in our main hospitals. Is patient-centred alternative to acute hospital admission reducing the number of those patients stuck in hospital wards? Removing many of the challenges associated with admission. We know that it leads to better outcomes for many people, because being at home is a better place to be. Indeed, there are clear and obvious health benefits in allowing patients to maintain their independence, spend more time with their family and their loved ones, whilst programmes like this one also reduce the risk of infection. It could also save the NHS millions of pounds every year. That is why hospital at home was in my party's manifesto at the last Scottish election and why we have consistently called for more money to be invested into the programme to roll it out more extensively. I am gratified that the Scottish Government has followed our lead with the £3.6 million investment that it announced this month. That is a welcome step, but it needs to go much, much further. That is because there are a number of issues with the service. There have been reports of a lack of co-ordination at some points between the hospital at home team and other healthcare providers such as doctors and nurses working at the hospital. That is not to denigrate their work in any way at all. It is just to recognise the immense pressures that they are under. However, the result in confusion makes it difficult to ensure that the patient receives the best care possible. This service also remains unavailable in a number of areas across the country, adding it to the list of valuable services for which a postcode lottery takes place. My party wants to see the expansion of the service to cover more areas of Scotland and an increase in the number of staff that are attendant to it. We also want to see more training for staff currently working in the service and an investment in new technology. For example, the use of more remote patient monitoring, which can help to identify problems early and prevent patients, can also assuage the need for those patients to be admitted to hospital in the first place. It is also vital that hospitals at home services are developed. Thank you very much for giving way. Would Alex Cole-Hamilton welcome the remote monitoring that has been implemented by NHS to Freeson Galloway for the monitoring of their COPD and respiratory patients, because that is working really well to keep folk out of hospital? I congratulate the health board for rolling that out successfully. Any remote monitoring for particularly long-term or chronic condition with attendant co-morbidities is to be welcome. I welcome Emma Harper's intervention. It is also vital that hospitals at home services are developed and resorted in addition to existing services, not instead of them. Those are not just my words. They are the words of Andrew Elder, the president of the Royal College of Physicians in Edinburgh. He also raised concerns about current staff shortages, both in our hospitals and in our communities. Our NHS is indeed being stretched beyond its capacity. We hear that day in, day out in debates like this in this chamber, Presiding Officer. It is no different when it comes to hospital at home, whilst the Government's total failure to tackle delayed discharge is continuing to have a significant impact. If the scheme is going to work, it needs to be valued by this Government. That is why I am calling on it to make sure that this £3.46 million investment, as welcome as it is, is just the floor. It is the beginning and that we build on it significantly, very swiftly, from here after. If they are struggling for ideas on how to pay for that, I suggest that they scrap that multi-billion-pound takeover of social care. We move to the open debate, and I call first Claire Hawke to be followed by Oliver Mundell around four minutes, Ms Hawke. I refer members to my register of interests. We all want to be in a position that as much healthcare as possible can be provided to people closer to their homes. Over the past few years, there has been sustained and coordinated efforts in providing community alternatives to hospital, all while maintaining and improving patient experience. As evidence during the Covid pandemic, making it easier than ever to know where to go to get the right care in the right place was vitally important, saving patients time and freeing up space in our GP practices and hospitals. Whether it was through NHS Pharmacy for Scotland or the hospital at home service, those initiatives played a key role in relieving pressure on our health and social care services. During times of ill health, most of us would want to be with or close to our loved ones and in familiar surroundings. The hospital at home service allows people to receive treatment that would otherwise have required them to be admitted to hospital, such as an intravenous drip for administering antibiotics or for oxygen therapy. It also provides access to hospital tests while under the care of a consultant in an individual's own home. Hospital at home as an alternative allows patients to receive high-quality person-centred care and treatment in the right place and at the same time reducing acute admissions and supporting timely discharge. Additionally, the provision of the service has the benefit that it can help to avoid some of the risks of healthcare-acquired infection. The effects on older people of remaining in hospital too long are well documented, deconditioning, pressure sores and a loss of independence, which can make it harder for the individual to return home. We know that frail patients tend to occupy hospital beds for a longer period of time and that alternatives to that can produce a far better health outcome. That is why admission to hospital should only happen when the patient's clinical need requires it. If that level of care and treatment can be provided at home, then we should endeavour to provide it there. Hospital at home has been in existence in a number of countries across the world for around 25 years. The first service was introduced in Scotland by NHS Lanarkshire, the health board that serves my Rutherglen constituency, and that occurred in 2011. That multidisciplinary acute care service delivers specialist co-ordinated and comprehensive assessment and care to frailer older adults in their own homes. Although hospital at home is not a new approach, efforts to expand it are currently being ramped up, and only this month the health secretary announced a further £3.6 million to the service. The investment for £23.24, which will take the total funding in the programme to more than £10.7 million since 2020, will increase patients managed through hospital at home by 50 per cent, equivalent of an additional 156 beds. From the success of the scheme so far, we can see that there is a real benefit to treating people at home where possible. Looking at the feedback from patients and relatives, it is clear how valued the hospital at home programme has been and how beneficial it is for patients' care. From the hospital visits that the service has saved to how supported individuals felt in the recovery, it is clear that the service is overwhelmingly viewed as positive. However, as was highlighted by Healthcare Improvement Scotland in 2020, the hospital at home service is not a silver bullet in reducing pressures on acute hospital care provision. As a result of the pandemic backlogs, Brexit-driven staff shortages and UK inflation costs, the Scottish Government is required to look across the wider health and social care system and implement innovative approaches to meet those on-going challenges. Hospital at home, taken together with work in tackling delayed discharge, improving A&E weights and increasing NHS and social care staffing levels, will improve patient experience and ensure better outcomes. Through my own, albeit limited, life experience and my work as a constituency MSP, I am well aware that, for many people, hospital is not the best place to be. Of course, no one really wants to be in hospital at all if they can avoid it, but for some people, the disruption and change that is involved in being admitted to an acute setting can teeter on the brink of outwewing the benefits of medical treatment. For those individuals, the initiative is and has the potential to be transformative. However, if the initiative is going to work, it must be promoted on that basis. It should be for the patient's benefit, not merely to serve the system. Indeed, as Professor Andrew Elder has stressed, as was mentioned by Alex Cole-Hamilton, access to acute hospital care for older people has been a hard one right, and it should not just be given away because there is an alternative there. That alternative must meet every patient who is pushed towards its needs. Looking now beyond the individual, I have to say that I am always fearful when I hear what are still relatively new initiatives and talks of expansion being promoted by the SNP Government. Those concerns stem from the staffing and cash crisis in our NHS and from my experience of a persistent lack of rural proofing when it comes to policy implementation. In my own health board area of Dumfries and Galloway, we have the chief executive of the NHS telling the Parliament that the level of financial challenge is such that he technically cannot afford one in ten of his workforce. When I hear my colleague Finlay Carson raising the question around the future of cottage hospitals, it is hard to know and to trust the decision that the health board is making because it is operating in financial circumstances where they are making the best of the resource that they have rather than doing what is best for their patients. We see already patients unable to access core day-to-day services such as GPs and dentistry. We see challenges round recruiting and retaining specialist medical professionals. Who are these consultants that are going to be helping with patient care? Social care and care home beds are being rationed with care deserts emerging in some parts of the region. I set this out not because I do not support the concept of hospital at home but because many constituents, patients and hard working staff will be questioning the capacity to pull this off at any significant scale in the current climate. I am also concerned that when it comes to stabilising our local health service, the SNP Government is not willing to confront the realities on the ground. All the strategies and policies that have been laid out to date speak to this as they simply do not match with the scale of the challenge that lies ahead. In place of a laser light focus, for example, in this area on getting people already in hospital home, we come up with new ideas and initiatives rather than trying to resolve the very serious underlying issues that already exist. I am also equally worried about how this policy can be delivered in a constituency such as mine where people live a considerable distance from the hospital overseeing their treatment. They may even be treated outside the region altogether, never mind pushing an hour from DJI in Dumfries. Care at home means that they should have access to good quality local health care in the region. We must take account of the additional costs that rurality brings, the additional pressures and time constraints in order to deliver projects such as this across vastly sparse rural population areas. I am not convinced to date from the Scottish Government's record that they have that right. I have to admit that, until recently, with a news programme on hospital at home, I was unaware that that existed. That is my failure. I note in the Scottish Government motion that it states that this is a cost-effective alternative to acute care, but most importantly, it provides very good clinical outcomes, which is what we all want. It also frees up hospital beds and, of course, the staff to service those beds. Hospital at home is a short-term targeted intervention, providing acute-level hospital care in an individual's own home or a home setting. The impact so far has a 53 per cent increase in patients managed by hospital at home services and has prevented more than 11,000 people from spending time in hospital during 2022-23, relieving pressure from A&E and, importantly, the Scottish Ambulance Service. Again, we are in the comfort of their own home, surrounded by the familiar, all aiding in my view, to better physical and indeed mental health. To quote one patient, I was delighted that it was unbelievable that it was totally different from being in hospital. One thing that I have not mentioned is the fact that it is the personal between the two of us. I was not just a number, it makes a difference. In Midlothian hospital at home team is called Merrid, which is the acronym for Midlothian enhanced rapid response and intervention team. It is an acute team based in Midlothian community hospital offering an assessment of medical needs in the patient's own home or care home using a holistic multidisciplinary approach during the acute phase of an illness. It offers an opportunity to identify a potentially unwell patient, better persuade a patient to accept hospital admission as a safer place of care or direct or more appropriate service, but it should also be recognised, there may be some specific circumstances where remote triage may also be appropriate, such as seen within the last 24 hours by a GP or by another clinician. There is a very clear indication of known recurrent or stable condition or examination findings are unlikely to change the place of care. In other words, as others have said, the right treatment in the right place, which may be a hospital or home. But there is criteria to being referred to hospital at home. Here are some short examples. Obviously, if it is Midlothian, you have got to be a resident there. Secondly, your personal care requirements can be met in the community. You are safe at home, self-caring or those existing packages of care or the sport of a family. There is also strict guidance on who not to refer. For instance, if you get chest pain, acute stroke, asthma, suspected DVT, suspected fracture, other suspected acute surgical emergency or indeed the patient or family is unwilling to stay at home. So it is a discussion with the person in their home about what is most suitable to them. NHS Borders hospital home service just started admitting patients in April of this year. It is there for the newest such service in Scotland. Rurality is an issue, but it can be covered because the BGH is far away from many people, the Borders General Hospital. I welcome progress in hospital home, which seems to be to a plus all round, in particular and simply to patients. If it is practical, it is being assessed and treated in familiar surroundings, which must be good for them. I am happy to speak in this evening's debate and take the opportunity at the beginning of my contribution to reiterate my party's support for hospital to home, the hospital at home service, services that we know to be vital for delivering the healthcare of the future by bringing hospital standard care into the home using technology. Although we agree with the benefits of the hospital at home service, recognise its usefulness thus far and want to see its success continue, it is disingenuous to suggest that investment here is anywhere near enough. We need widespread resource for our NHS, which is struggling on many fronts, and we do need the Government to explain its long-term investment plan for the hospital at home service. It is right that my Labour colleague Paul Sweeney set out the reality in our health service and the backdrop of the debate today. One in seven Scots are on waiting lists, the lead discharge is alarmingly high. NHS staff, despite their greatest efforts, are being let down by a Government that, no matter how often it tries to argue to the contrary, has undervalued and underresourced a critical workforce, and our patients are being failed by the lack of support to staff. Initiatives and programmes such as hospital at home are welcomed, but the wider picture cannot be ignored. It is also correct that we ask the Scottish Government to set out its plans for delivering hospital at home services for the longer term. It seems a little bit that we do not get this long-term alternative to acute hospital care to understand it. We see it as a quick fix or a tokenistic gesture that just allows pressure to be put back on acute services when anything falls short. At this juncture, I wish to recognise the multidisciplinary nature of this service and the importance of various workforces within our NHS and social care services in delivering it. It is right that we commend Health Improvement Scotland and National Education Scotland for their work in this regard so far. I pay tribute to our allied health professionals, the third largest workforce in our NHS, who go above and beyond to deliver specialist care services for our most vulnerable people in the most challenging of times. We are all aware that without doctors, nurses, carers and unpaid carers and the allied health professionals working together to meet the individual needs of every patient, hospital at home does not work and it is right that we do all we can to support them. Therefore, it would be appropriate for the Scottish Government to listen to the concerns of, for example, the Royal College of Physicians of Edinburgh, as we have heard in their comments ahead of today's debate, highlighting concerns linked to the potential overalions on unpaid carers who are already under serious and significant pressure to look after those in their care to provide support during periods of increased patient need. Indeed, they argue that the provision of hospital at home must be in addition to existing services, not a replacement for them to ensure that the hard-won rights of older people to have care and acute hospital settings should be most appropriate for their needs not be lost. It would be useful for the Government in concluding remarks just to talk about the long-term future for hospital at home and address some of the important points that we have been doing. I know that the speaker before me mentioned that they were unaware of the service. I think that if MSPs in the chamber are unaware of the service, it gives you that sense of how people out in their communities understand the service. Although I know that the minister and the cabinet secretary are looking over it, I know that you feel that it is very embedded, but for many people it does not feel that way and it would be useful if you addressed that. We need to, as we have heard, to talk about the staff challenges that we have about how 1 in 10 GPs have formally closed to new patient lists. They are saying and confirming that community nursing teams are under extreme pressure for vacancy rates, and we also know that the HPs are under stress for vacancy rates as well. That is all underpinned by a failure thus far to fully implement the safe staffing legislation that this Parliament passed years ago. Legislation to protect our overworked workforce and we know that services like that will need strong protection for the NHS staff, so we should look back at that legislation and make sure that it is implemented appropriately within our wards and within any services such as this. I want to turn to social care, and it has been touched on. It is undermined by the whole of community services by a crisis in social care, and the Government cannot avoid that. Carers are not being paid the fair wage they deserve and serious concerns across Scotland about the provision of well-funded and locally available social care are there. It is clear that I set out in our amendment, Scottish Labour's amendment, that we will only be able to deliver the standard of social care required and a strong hospital at home programme by immediately uplifting social care pay. I also want to mention, at this point, the recommendation and the failure review about the removing of non-residential care charges. Those are important issues that have not been addressed by the Government. I reiterate my party's support for the intentions and aims of hospital at home and recognise that this is an important step forward encouraging the use of alternative care. I have a close friend of mine with community nursing experience of many years, which tells me that patients seem less anxious, and that this must be a really good thing for care. However, it is clear that we have issues and support for resources in the NHS and social care workforce. I hope that the cabinet secretary and minister will address that in closing tonight. I remind members that I am a registered nurse and former employee of NHS in Freeson-Galloway. As members and the cabinet secretary have indicated, the purpose of hospital at home is to reduce hospital admissions by providing treatments in the comfort and familiarity of a person's home, and it is clear that hockey has described the types of treatment received, such as intravenous infusions or oxygen therapy. Evidence shows that those benefiting from the service are more likely to avoid hospital or care home stays after a period of acute illness. For older patients, it means that they remain at home longer without losing independence, as that has contributed to overall improvements in patient satisfaction and improving wellbeing. I am a member of the health, social care and support committee, which is currently undertaking scrutiny of the NHS boards, including the rural boards in my south Scotland region. NHS Borders chief executive, Ralph Roberts, told us that reablement work is being implemented in his board, and reablement refers to the care a person receives after experiencing an illness or injury. The main aim of reablement is to allow people to gain or regain their confidence, their ability and the necessary skills to live as independently as possible, especially after an illness, injury or deterioration in health. Reablement is a person-centred approach, and support is usually delivered in the person's home or even in a care home. That work has led to an increase in people receiving hospital at home care, and that is welcome. Delayed discharge is one of the largest issues facing boards in Scotland, and I welcome as the motion indicates that the Scottish Government is providing on-going support to boards in a range of areas, including discharge planning. To give me a wee sec, home teams are a new health and social care model of working, which is being delivered in Dumfries and Galloway to help people to live healthier lives in their home and also to tackle delayed discharge. Will the member recognise that there are huge gaps in the provision that home care is providing in Dumfries and Galloway and what is to do with the rurality and the lack of staff? Will he agree with me that step-down facilities such as our Scottish hospitals or similar facilities are needed in our rural towns to ensure that people can be looked after close to home and not form the record-breaking figures for delayed discharge in DGRI? The issue of rurality is hugely important for us in Dumfries and Galloway and the Scottish Borders, and I acknowledge that NHS and social care partnerships are doing a consultation right now about community bed provision. I look forward to the results, but I absolutely agree that we need to be looking at whatever care can be provided as close to home as possible, so I support whatever mechanism we can do to take that forward. Similarly to the hospital at home, home teams, as I was describing, pull together the multidisciplinary team and resources within the community under one team. They are doing this to ensure that there are less referrals to acute care and they are ensuring that people tell their story once without repeating it. They are also ensuring that reduced waiting response times is also delivered. The provision of a holistic approach is taken to look at the whole person. Again, it is a person-centred approach that home teams have taken forward. Home teams have led NHS Dumfries and Galloway to redeploy 52 community staff to support 102 packages of care that equates to 120 individuals receiving the hospital at home model. There are 18 beds that are being created in the mountain hall treatment centre as an intermediate care facility, as a step round from acute care. That is similar to what Mr Carson was talking about earlier. I do not think that I have time for another intervention because it would take a six-minute speech to go into the detail about the provision that is required across the whole rural area. I apologise, Mr Mundell, that I cannot do that. What I am interested in focusing on is looking forward to the community bed provision consultation responses, because we all know that people want their care closer to home. I thank NHS Dumfries and Galloway for the innovative work that they are taking forward to make a difference to patient outcomes. As well as hospital at home, the outpatient, parenterial and microbial treatment scheme and respiratory community response teams now offer more than 600 virtual beds to treat patients for conditions that would traditionally need hospitalisation. I welcome the support, and I look forward to decision time, because I will be supporting the Government's motion. As we have heard, hospital at home allows patients to receive acute care in their own home or homely setting. The success of the service has clearly shown that it alleviates pressure on unscheduled acute care in hospitals by reducing admissions. Between April 2022 and March 2023, 11,686 patients were supported by hospital at home services, a 53 per cent increase on the previous year. Healthcare Improvement Scotland has said that the equivalent emergency admissions to in-patient hospitals may have equated to significantly more occupied bed days due to the likelihood of delayed discharges. Further, more hospital at home is now growing to be the fifth biggest hospital for older people emergency in patients, as the number of people benefiting from the service is similar to the latest published numbers of people 65 and over admitted as emergency in patients to Aberdeen royal infirmary or Victoria hospital in Kirkcaldy. As I said, hospital at home services are clearly reducing pressure on A&E's and the Scottish ambulance service, but they can also vastly improve the patient experience, which is what I would like to focus on for the rest of my contribution. Hospital at home has high satisfaction and patient preference across a range of measures. We can see that from the increased demand that I referenced earlier. It allows people to be cared for in their own home, where they are comfortable and where family and friends can easily visit them, where their things are, their home comforts, pets and things that we all take for granted until they are not there. That impact alone cannot have a price tag put on it and we often lose the humanity for individuals when talking about large-scale programmes. In hospital at home services, care is co-ordinated in the community by GPs and district nurses and it therefore ensures continuity of care and the building of positive relationships between patients and healthcare staff. You are absolutely right about how GPs and primary care need to be there. The closure of GP packs, such as Invergary, would make that really challenging. I can absolutely say that it would. It can also positively impact social care delivery. A patient losing their care pack is due to hospital admission and can lead to delayed discharge, with patients being stuck in hospital when they do not need to be. We know that longer stays in hospital can lead to increased frailty in older patients. By preventing hospital admission, however, the hospital at home service enables patients to keep existing agreements for carers visiting their home to help with essential needs. That again maintains continuity of care and allows people to build relationships with their carers, which can be of great comfort to vulnerable patients. I would now like to read one testimony from within my region posted on the care opinion website, which demonstrates the positive impact hospital at home can have on patients. I would like to thank the HNH team in Coatbridge for the level of care from the team that exceeded mine and my mum's expectations. The care and attention can only be described as excellent. Not only did this prevent my mum from having to go into hospital on two occasions, but the communication advice and support from the team not only helped my mum but gave me the confidence that I was treating her to the best of her ability. The testimony clearly shows how hospital at home and the incredible teams working within the service can improve patients' experiences and provide comfort and stability when they are unwell. More broadly, the health and social care alliance Scotland has said that the hospital at home service reflects a positive change in the culture of how health and social care is delivered by focusing on shared decision making and delivering the personalised outcomes that matter to individuals and their families. It enables more person-centred care, which empowers patients to make choices about their care in an environment that is safe and familiar to them. Although hospital at home services alone will not eliminate pressure on acute services, they will form a vital part of a wider system transformation that aims to reduce hospital admissions and ensure that more people can be treated at home or in a homely setting. I now call David Torrance to be followed by Bob Dorris. Around four minutes, please, Mr Torrance. Thank you, Presiding Officer. I welcome this opportunity to speak in this important Scottish Government debate on hospital at home programmes in Scotland. This extraordinary initiative has reshaped the landscape of healthcare delivery and quality within our nation, touching and transforming life within my own constituency of Kirkcaldy and across Scotland. Presiding Officer, there is widespread agreement that our health and social care system has faced a number of challenges and obstacles. We have all stood in this chamber at a complex of pronounced and rentless change. Brexit, the cost of living crisis and Scotland's changing demographics in combination with the challenges of post-pandemic world has emphasised the urgent needs for innovative and pension-caisered healthcare solutions. In this content, the hospital at home programme thrives, ensuring that our constituents receive the right care and the right place at the right time. I therefore very much welcome the additional £3.6 million that has been allocated to hospital at home to support the more than 150 extra virtual beds. In 5,000s of patients have benefited from hospital at home service and in 2021-22, over 1,000 patients had been supported. Additional funding will help to reach more of our constituents and continue to provide comfort and reduce anxiety for people across Scotland. Hospital at home is a safe and dignified alternative to acute hospital omission. Bines passes anxiety, disruption and disorientation, often associated with hospital stays, are still delivering the same, if not better, quality of care, where it be cardiology, geriatrics or a piffer of other specialties. This programme transcends conventional barriers and opens the doors to healthcare that is truly personalised and patient-centred. Last year, hospital at home offered over 63,000 beds days for adults. That is over 60,000 days when old adults could heal in the comfort of their formality, of their homes surrounded by loved ones. That is over 63,000 days when the dread of an acute hospital omission was replaced by compassionate care that respected their routines, their homes and their dignity. By reducing the pressure on our hospitals, we are creating a vicious cycle of care. Few acute omissions mean more time for hospitals to focus on complex cases, less strain on our developed healthcare professions and more efficient utilisation of resources. The hospital at home programme is not just beneficial for patients, it is a holistic solution that aids the entire healthcare ecosystem. None of these achievements would have been possible without relentless dedication and concerted effort by Healthcare Improvement Scotland, National Education Scotland and clinical networks, whose tireless work has supported the development and implementation of hospital at home. I also want to recognise the invaluable service of our dedicated doctors, nurses, therapists and other healthcare professions who make hospital at home a reality, who navigate through the complexities of our individual patient needs, often at and sociable hours and who continue to learn and evolve to serve their patients better. Hospital at home is not a replacement for hospital admissions, only an alternative and I have full confidence that the Scottish Government and our health ministers are continuing to manage the pressures that remain on the services across the health and social care system. It is vital that we build a health service that best meets the needs of the people it will serve, which is why the Scottish Government is committed to doing it all it can, so those with experience of social care support and community healthcare have sufficient chance to share reviews. That includes patients who have experienced the hospital at home service and will allow anyone who uses the service as a loved one who relies on care or has worked in the sector to help others in the future of the healthcare landscape. In conclusion, hospital at home represents a leap in the evolution of healthcare delivering Scotland. Bodies and ethos that recognises the holistic needs of patients upholds their dignity and optimises the resources of health of a country. As we continue to tackle many challenges facing Scotland, I welcome a continuation of hospital at home so that everyone can receive the right care at the right time and in the right place. I now call Bob Doris, who will be the last speaker before I ask the closing speakers to make their contributions. Around four minutes please, Mr Doris. Thank you very much, Presiding Officer. I am pleased to speak in this debate, recognising the contribution of the Scottish Government's hospital at home strategy. In Glasgow alone, I am aware that a test of change pilot for hospital at home was introduced by the Glasgow Integrity Joint Board in January 2022. By March of this year, it was reported that up to 1,200 at-home bed days has already allowed many Glasgow residents over 65 to leave hospital earlier or avoid admission to hospital and instead receive enhanced care at home. That is both better for patients and to take strain off their NHS within an acute setting. Receiving the care that we need at home from nurses, advanced nurse practitioners, GPs, pharmacists, occupational therapists, consultant geriatricians and a rat-brown service has allowed over 300 Glasgow residents to be at home rather than in hospital. That is a success story, but I would be very keen to hear about any qualitative data collected regarding the views of those who have benefited from hospital at home and any changes that they have suggested for adopting. I would also be keen to hear about whether, as part of hospital at home, those patients who require the running of essential medical machines and other equipment, or indeed air mattresses or electric hoist, for example, in their own homes, have been offered support for their utility bills. More generally, those living at home with medical conditions for the longer term have more expense, perhaps due to a more frequent need to wash and dry clothes and bedding, or to keep their homes at the right temperature to support the cared for person. Any information that the Scottish Government can provide on how it offers assistance would indeed be welcome in the summing up of the debate. However, I recognise that hospital at home is a success and should be expanded. I also welcome that £10.7 million investment in hospital at home since 2020. Given that I understand that this initiative is funded by channeling money via integrated joint boards, I would be interested to learn more about how the Scottish Government monitors the wider budget pressures on IJBs given their financial challenges. I have written to the cabinet secretary about concerns regarding some changes to provision in my area, which may impact on frail elderly. We do not want any unintended consequences and I look forward to a detailed response and due course on that matter from the cabinet secretary. I want to mention the hospital to home service offered by Ches Hart and Stroke Scotland. I would note that this week I am sponsoring that exhibit within the Scottish Parliament promoting that very initiative. Hospital to home is not just for over 65s for everyone, it offers a very significant support. As Ches Hart and Stroke Scotland have stated, every day in Scotland people are leaving hospitals scared and alone, but our amazing nurses, support workers and volunteers, are here to make sure that you do not have to recover alone. They offer free practical help, support and advice. This is often faced to face in one-to-one through community support teams and home visits. Many who have suffered a cardiac arrest or stroke may have been previously active, or they may have previously just lost the confidence to be active itself, or lost their networks that enables them to be connected, active and avoid social isolation. The work of Ches Hart and Stroke Scotland can make a real difference in that context. Hospital to home can lower read mission rates to hospital and avoid unplanned care and scheduled care such as presentations to A&E. So, hospital to home clearly has an important part to play and surely complements hospital at home. I look forward to the further expansion of hospital at home and a way that is informed by patient experience is iterative and is delivered as part of a broader range of services that will be supporting the Government motion here this afternoon. We will now move to closing speeches. I would advise members that we have some time in hand. On that note, I call on Paul Spiny to close on behalf of Scottish Labour around six minutes, please. Thank you, Deputy Presiding Officer. It is a pleasure to close this debate on behalf of the Labour Party. I think that there is broad consensus across the chamber this afternoon on the benefits in principle of hospital at home. I know certainly from personal experience, I am sure many others, that being in hospital is a rubbish experience. It is frustrating and deeply tedious. It is certainly for a younger person but for an older person it can also be potentially life-threatening. We have heard of the potential impacts on frailty, on acquiring an infection and that can potentially lead to a fatal spiral. So, any measure that can move the emphasis of care away from acute settings and into home settings is to be commended and that is why we are all in broad support of the scheme. I think that the member for Glasgow, Merrill and Springburn made an important point about that in itself. How do we ensure the resilience of the home setting? There is one emphasis on hospital, but how do we emphasise the resilience of the home setting? I think that there is much more work to be done in that space. Mr Doris mentioned, for example, how do we ensure that adaptations are made to homes to ensure that there is a sufficient facility available for people? I think that we need to do much more in respect of housing associations and register social landlords to ensure that they are able to be supported. Yes, I have to give way. I thank Mr Sweeney very much for giving way on that point. Not only is it about adaptions to the home, but it is making sure that the correct equipment follows the patient to home. That has been a problem across the Highlands. Has that been a problem in his area and does he think that more work should be undertaken on that? Absolutely, I recognise that. I think that it is a major issue and one that is not well understood. I think that the call for extra data and understanding of that cost of experience is essential for us to ensure that this works as best as it can. There is not only the issue about facilities, about the costs of running equipment, that it can be quite energy-intensive, particularly in a cost-living crisis, but also the complex needs of individuals in the home setting. There was a very striking exhibition that has been held by a series of hospice care providers in Glasgow called The Cost of Dying at the University of Glasgow. It was quite harrowing to see some of the experiences of people who wanted to die at home, wanted to have a good death, but were prevented from doing so because of the failure of their registered social land laws to make unnecessary adaptions to their homes. So they ended up languishing in hospital in their final days, not acceptable. I think that we need to do so much more to ensure that the rights of the patient are upheld. That was something that the member for Olegland mentioned, about the patient focus being essential. Also, not necessarily if someone cannot stay in their home, there are maybe a second step down services that was mentioned by the member for Galloway and West Dumfries about cottage hospitals, that kind of setting being potentially an opportunity, potentially having more sheltered accommodation where there is a semi-supervised activity. And certainly some housing associations are exemplars in providing those facilities. Let's look at how we can build on that capability across Scotland. I think that that is something we need to look at to ensure that this hospital home concept is better embedded. And I think that that was something that was recognised by members across the chamber today as well, that it might not be as well known as maybe the ministers think it is, because certainly some members have alluded to the fact that they weren't aware of it prior to today, or have only recently become aware of it. Whilst it is a relatively recent innovation, it's to be welcomed, I think that we do need to do more to disseminate the information about how this can function well. And I think that's often fed back to me certainly, particularly when it comes to palliative care as well, that often people don't know their rights and they're so stressed by the situation that they don't realise what they could have achieved for the person and their responsibility for care until it was too late and they'd already passed away. So I think that we do need to look at that. But also we need to look at how we build resilience. It was mentioned by Mr Doris about the budget, £10.7 million since 2020, but that's set against the fact that even in Glasgow, as the member will be aware, the integrated joint board is facing £20 million of cuts that's financially alone and has had to dip into its savings or its reserves to the tune of £17 million. That's a really shaky peg to be hanging the system on and we really need to look at the underlying fragility of the integrated joint boards and the ability to step this up when we're facing 200 jobs being lost from the IGB service providers in Glasgow alone. That is a major risk to the resilience of the hospital home system. So whilst we recognise the huge opportunity, we have one of the most acute hospital centric healthcare systems in the OECD. We need to move the emphasis out of the hospitals and into the community. We really need to look at putting serious resource into that and I would argue that the cabinet secretary has to recognise the need to ramp this up and be serious about it. And that was what my colleague Miss Mocken member for South Scotland mentioned about the long-term plan. We really need that long-term vision for how this develops. We need stable budgeting. We need the ability for the IGBs to properly plan for the long term and to build those pathways for career development, for training, and actually to increase staff wages as well because we're really having a problem with retention and morale. We've heard about the issues of hospices and not being able to fully staff their beds. This is just a tip of the iceberg situation. So yep, huge issues there, huge issues on the practicalities between urban settings being one thing but rural settings when other than there's a number of members across the chamber today who have mentioned the practical challenges of managing hospital home when you're faced with such wide geographical constraints. That needs to be looked at as well. And I think that is something that is essential to be fed back. What does this look like in a city? What does it look like in a rural setting? It's not a one-size-fits-all thing. And I think that would be good if the minister highlighted some of the challenges faced in those different geographical environments. I think also there is a major issue about the opportunity of freeing up capacity, I think. Miss Mockenai member for Central Scotland mentioned that. It's a huge opportunity to free up bed space, to reduce costs in the healthcare system, but how do we really ensure that it's not simply displacing capacity in terms of staff from other parts of the healthcare system and thus exenciating the problems we're having across the entire healthcare ecosystem, as a member for Caudi mentioned. So whilst we're all for it, we're all very supportive of it, we have to be cognisant of the major practical constraints that we are facing. It's essential that Scotland achieves the best possible healthcare system. For us all, but we must be aware of the acute problems we're facing today and work through them in a collegiate and cooperative way. And with that, happy to support the Government's motion this evening. Thank you. Thank you, Mr Sweeney. And I now call on Edward Mountain to close on behalf of the Scottish Conservatives around seven minutes. Please, Mr Mountain. Thank you, Presiding Officer. And I welcome today's debate at a time when our health service is in crisis like never before. Patients do need smart and resourceful solutions which do not compromise their care. That's exactly why the Scottish Conservatives support this hospital at home programme. Providing, of course, that care at home will free up capacity in our hospitals. It's initiatives like this that are vital for reducing hospital admissions for elderly patients, especially for those who prefer treatment in the comfort of their own homes too. And I'll give credit where credit's due because I think it is important. Those that benefit from this programme are far more likely to avoid hospital care and care home stays for a period of up to six months after acute illness. And that's good news. That saves our precious hospital beds and creates space for all the other patients to receive the treatment they need, the patients that often sit on long waiting lists. That's why, though, it's disappointing that this Government has failed to deliver the promise to double the capacity of the hospital at home programme by the end of last year. My question, how many patients would have benefited but haven't because of that failure? Because that is a real question we need to address. Because this programme can make a difference. It is only a parcel solution, though, to the hospital backlog that has grown under the SNP. Indeed, hospital at home is not appropriate for every patient, much like the rollout of NHS near me. It can act as a complement rather than a replacement to acute patient care. The truth is, however, it's not going to solve the problems of delayed discharges. We know that there are 1700 beds still being blocked every day and the effects on those patients are so destroying. It's leading to increased waits at A&E as well as the length of delays in vital procedures. My colleague, Dr Gilhoney, has mentioned in his speech the SNP promised to eradicate delayed discharges in 2015. But every health secretary since has failed miserably to do so. And let's be honest, patients are paying the price. The former health secretaries who broke their promises include the first and deputy First Ministers. It's not good enough. So turning to the speakers in this debate, I'd just like to make a few points on what I heard. I appreciate the cabinet secretary's point and I wonder if he should reflect on the fact that he should be asking and the health services should be asking not should we do this but can we do this? Let's make it possible. Let's urge doctors to ask that question. Can we do it? Remember that there are risks to sending people home but the risks may not be as high as keeping them in hospital. I remember when my father was waiting to go home he was told, I was told clearly that there was a risk in sending him home. He was dying. We knew what the risks were. Let's make it possible where we can. Dr Calhanni has also mentioned the importance, as we've heard, about delayed discharges. And we've got to work harder at sorting that out and we've got to make sure that when people go into hospital we have a way of ensuring that there are people there who can ensure that their discharges happen and go out at the right time. And that might require people to give them power of attorney over decision making processes in the medical front. It's taken by Paul Sweeney's comments about supporting the principle and making sure that it's important for social care to be there to step up when the need comes for that person to go home. But I think it's also important to remember the very point you made about that it won't be suitable for everyone. And not everyone can afford the costs of going home and the extra costs that be required for them to have a sensible care package at home which may require extra heating and extra electrical use. Alex Cole-Hamilton recognise the staff shortages and I think we all recognise that and I think we understand that to make this work we've got to recruit additional staff on top of the staff that we see already in the system. And I agree with Clare Hawley's point is high quality person-centred care has got to be at the centre of all of this. It's really important and I think she also made the point that we need to increase the funds and what about the extra kit that's needed that I raised with Miss Sweeney? It's really important that we make sure that we have the kit to follow people when they're home. Yes, of course I'll take a point. Clare Hawley-Hamilton I thank everyone for taking the intervention and I think yes at the heart of this is about being patient-centred and allowing patients to be where they need to be whether that be to be at home to recover or whether at that be they be at home to die surrounded by their loved ones. I did mention funding but what I referenced was the funding that the Scottish Government has already committed to this. Thank you and I'll accept that qualification not on the point but the point I'm trying to make is that extra funding will always be required because caring for people at home brings additional costs getting extra staff they're getting extra equipment there and all of those and we need to be responsive to it because there is a cost involved. Now Oliver Mundell made the point and I think really important point that I think Finlay Carson also made about the importance of cottage hospitals and how much they will pay in stepping down from hospital and allowing patients to go home. Now I thought Christine Graham was going to she started off her talking about extra equipment that was needed and that then dropped away and I may have misheard but I do think that she made the point about having the importance of having teams who could help people at home and I would say that just if I've got time Presiding Officer but I would just make the point we do need teams that are probably a little bit more advanced than we have in the local community which is why in the Highlands we've got the pre-hospital immediately care team that can deploy if they're needed to to do care at home where perhaps local doctors are not able to. Sorry, I'll give way to Ms... Thank you everyone just to clarify I don't think I mentioned extra equipment but I did say a full assessment has to be made if it's the right place the right time for the right person and by implication that also might involve equipment. Another qualification but great we've got there that the extra equipment might be needed after a full assessment so I very much take that point and I think Emma Harper's point was actually an interesting thing and I think that you know with her experience in nursing we should be aware that I think a lot of what she was saying about being at home is a tonic to speed recovery and aids people to get through their illness is better and I think there's general agreement from all other speakers on this and so in conclusion Presiding Officer I would say that I welcome the small but significant progress that has been made in the hospital at home programme however I think patients still need to see some big ideas and big investment from the government we need to see sufficient kit to allow patients to go home and we need to see sufficient care support to allow those people who have gone home to go home in the comfort and knowledge they will get the best possible care but the problem is we haven't seen the real tackling of the problem which in my mind is the whole issue of delayed discharges long A and E waiting times and the social care crisis until we see some fresh thinking on these I believe our hospitals will continue to run out of beds despite this programme because I think the government has run out of steam on how to resolve that and I would ask them to do that as a matter of extreme urgency thank you Presiding Officer Thank you Mr Mountain I now call on Minister Marie Todd to close on behalf of the Scottish Government around nine minutes or perhaps more Thank you Presiding Officer I really welcome the opportunity to close this debate which has provided members with an update on the benefits of hospital at home and the action that we are taking to support the development and expansion of hospital at home programmes I'd like to take this opportunity to recognise the hard work and commitment of our partners who have worked to establish and expand this crucial service These services are by their nature both personal and person-centred They are delivered by highly skilled and valued health and care staff and are intently focused on delivering for the needs of the individual in their own environment I want to thank Health Improvement Scotland for the support they've been given to local areas since 2020 to grow an active learning network of health and social care partnerships This support has enabled the expansion of hospital at home from seven to 21 health and social care partnerships but I would like us to go further and have even wider geographical spread I also want to thank NHS Education Scotland for their work in developing training materials for the hospital at home programme and to our health boards and health and social care partnerships for their on-going support and commitment to delivering more acute care in the home I want to thank everyone across the chamber for that input and reflections through today's debate There's clear consensus here today that providing person-centred care which takes full account of an individual's wishes and balances that with safety and clinical need is a priority Turning to the certainly Finlay Carson I really appreciate the minister giving way You touch upon the views of the patient but in areas like Dumfries and Galloway hospital at home is not always going to be the ideal situation and some patients would prefer to be in the surroundings similar to a cottage hospital or where services that a cottage hospital would traditionally deliver right at home rather than potentially having to travel 50 or 60 miles to the acute hospital or as Emma Harper said 50 or 60 miles to 18 beds that are being delivered in Dumfries Can you tell us what role you think step-down facilities like cottage hospitals should play as part of the package in rural areas? I remind members we need to speak through the chair Minister I appreciate it Presiding Officer as the cabinet secretary said in response to Finlay Carson's intervention on him these decisions are really best made by the local health board who absolutely are well aware of the needs of the local community Let me just put to bed the issue around rural areas A number of people have raised the challenges of delivering hospital at home in a rural area and I as a rural representative a member for Caithness, Sutherland and Ross am well aware of the challenges but I would say could be argued that it's even more important to deliver this in rural areas because admission is much more disruptive to patients and their families and I would have to say NHS Highland are delivering hospital at home they're delivering it in Skag it's being delivered in the western isles by the NHS western isles if it can work in Skag and the western isles it can work anywhere Turning to the specific questions which have been raised during the debate to respond to Carol Mawchen's point we've been using hospital at home for over a decade it started in December 2011 and we've expanded it recently it is absolutely here to stay the reason it's here to stay is because people are absolutely at the heart of hospital at home programme they value the flexibility and the security that being in a home setting brings and particularly for elderly people those familiar faces and spaces reduces the potential for adverse incidents ultimately it's about creating the options that best suit people and communities and ensuring access to the right care in the right place that's a direct quote from alliance director Eileen Oldfather the alliance also spoke to hospital at home patients Steven Greene who said if you fancy a cup of tea or if you fancy a sandwich it's there you know if you fancy a chat with your wife or on the phone or whatever it's there for something like what was ailing me hospital at home is ideal this has done me a lot of good I know and I would recommend it to anyone it suits in terms of the number of people benefiting from hospital at home we talked a little bit about the numbers the latest published data on number of people 65 and overadmitted as emergency inpatient state Aberdeen royal infirmary that's 12,262 people or victoria hospital curcodi that's 10,919 nine is pretty similar to the number of people who are benefiting from hospital at home that makes hospital at home the fifth biggest hospital for older people emergency inpatients a number of people raised the issue of impact on unpaid carers and it is absolutely essential that we ensure that our valued unpaid carers are supported and aren't overwhelmed particularly when their loved one is in crisis now the feedback from Alliance Scotland indicates that hospital at home transfers control back to the patient and carer and they value that it's providing care on their terms in their environment and that obviously as many have said indicates that patients recover quicker and feel involved in decisions along the way some people mentioned impact on GPs and on primary care and there has been a concern that it put places a burden on an already over burdened area of our health and care system now Professor Ellis our DCMO was asked about this and he said I know this was a concern when I met with GPs prior to starting in Lanarkshire but there's no evidence that hospital at home creates additional work to routine hospital admission and in reality it's about partnership between primary and secondary care in the patient's interests it should be recognised one moment it should be recognised that routine hospital admissions can create potential work for GPs and that arguably the debate is about what patients need not about whose workload is affected certainly happy to give way Oliver Mundell I thank the minister for giving way does she accept that there are now parts of Scotland where primary care has broken down completely and people are unable to routinely see a GP how can a programme like this work without that key linchpin minister so what I would agree with is that GPs are absolutely a linchpin there the front door of our NHS and they are key which is why we are investing in general practice and which is why we value it so much addressing the issues of delayed discharge we have a hospital occupancy action plan addressing delayed discharge is of absolute critical importance and although over 97 percent of all discharges are without delay we've already made available earlier this year up to £8 million of funding to support HSCPs purchase around 500 interim care beds to increase interim capacity these are in addition to around 500 interim beds that are already helping patients in the system there's a delayed discharge and hospital occupancy plan building on best practice to address the issues that we experienced last year let me tell you we are well into planning for next winter already and it is being implemented at pace delivering the actions that we know work there's a whole system oversight and planning group in place to assess progress in implementation of the action plan and to plan for future peaks so there is a lot of work going on right across the board in a system which we all acknowledge is under pressure let me just pick up on the point that Christine Graham raised around Midlothian I had the absolute delight of visiting the Midlothian community hospital in recent weeks and I met their teams multidisciplinary teams but mainly allied health professionals physiotherapists occupational therapists who I was absolutely inspired by they were working in an incredibly flexible way a patient-centred way a holistic way to ensure that people got the right care in the right place at the right time and of course they were keen to emphasise to me how much better it was to be able to assess people's abilities in their own homes and their wider needs were much more visible than they would have been if the assessments took place in the hospital hospital at home is a tried and tested concept deployed across the globe and in many ways Scotland's at the forefront of this growing movement internationally evidence has been accumulating across a range of clinical specialties including older people respiratory cardiology pediatrics infectious diseases as to the benefits of this approach it offers comparable care to that provided in an impatient bed but with reduced risk of the harms that the cabinet secretary for NHS recovery, health and social care set out in his opening remarks but beyond the benefits to the patient of providing care at home and reducing pressures on the NHS we also know that it can reduce the need for older people to be admitted to a care home evidence from a large study conducted across the UK found that hospital at home for older people reduced nursing home admission by as much as 42 per cent being able to stay safely in your own home when your unwell or receiving treatment matters hugely to many people but we also know that hospital at home is able to deliver the best hospital care to people who are in nursing homes minimising the disruption for some of the most frail in our society so as noted by the cad set we've pledged a total of 11.2 million to develop and expand hospital at home since 2020 given our firm commitment to offering the service to more people across Scotland we'll regularly review our funding for the programme to assess whether it matches our ambition we're committed to the continuing expansion of hospital at home across a range of specialty areas and I'd be very happy to return to Parliament with an update on this in due course in conclusion I do not support the opposition amendments to this motion for the reasons set out during this debate but instead I commend the motion lodged by the cabinet secretary for NHS recovery health and social care I look forward to working with our partners to continue the expansion of the hospital at home programme and to ensure that the public is aware of its benefits and that we remain committed to patient safety and the highest quality of care by taking an approach that puts the person and their needs and their wishes firmly at the centre we'll provide the type of careful and kind care that we would wish to exemplify in all of our services and help more people to receive acute care in a familiar setting within their own communities thank you thank you that concludes the debate on hospital at home programme in Scotland it's now time to move on to the next item of business there are three questions to be put as a result of today's business the first is that amendment 9191.2 in the name of Sandesh Gulhani which seeks to amend motion 9191 in the name of Michael Matheson on hospital at home programme in Scotland be agreed are we all agreed the Parliament is not agreed therefore we'll move to vote and there'll be a short suspension to allow members to 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