Image copyright
Getty Images
The number of people who died in Scotland last winter hit a 18 year high, new statistics have revealed.
There were 23,137 deaths between December 2017 and March 2018, according to the National Records of Scotland - the highest figure since 1999/2000.
It also revealed that the seasonal increase in mortality - the number of "additional" deaths in winter - was significantly higher than in 2016/17.
The main underlying causes of the deaths were influenza and pneumonia.
Nicola Sturgeon admitted in January that Scotland's health service was facing "exceptional" pressures following an increase of people with flu.
Many patients had to wait longer for treatment but the first minister said at the time that hard-working staff were ensuring that the NHS was "coping well".
The Scottish Liberal Democrats said the rise in winter deaths were a "cause for concern" and called for Scottish Health Secretary Jeane Freeman to take action.
Anne Slater, the chief executive of the National Records of Scotland (NRS), said there was a long-term downward trend of winter deaths since the early 1950s.
"However, the average value for the latest five years (which smoothes out much of the year-to-year fluctuation) is now above the level that had applied since the early 2000s," she said.
"It is too soon to say whether there has been a change in the long-term trend: it could just be a short-term rise, like that seen roughly 20 years ago, after which the average fell for several years."
The NRS report found that the total number of deaths in 2017/18 increased by 2,191 on the previous winter, when 20,946 deaths were recorded.
Last winter's death total was the largest number since 23,379 deaths were recorded in 1999/2000.
It also found that there were 4,797 additional deaths last winter, compared to the average number of deaths in the four months before December 2017 and after March 2018.
It was the largest increase in seasonal mortality since 1999/2000 when the figure stood at 5,190, and a significant increase on the 2,730 recorded in 2016/17.
The NRS said the seasonal increase was larger than in most of the previous 66 winters and exceeded the level seen in 19 of the previous 20 winters.
The underlying causes of most of the "additional" deaths included respiratory diseases, heart disease, stroke and dementia.
Very few deaths were caused by hypothermia and only a small proportion directly by influenza.
The Scottish Liberal Democrats' health spokesman, Alex Cole-Hamilton, called on the Scottish government to ensure the NHS was ready for this winter.
"While our NHS staff have done fantastic work in ensuring that the long term winter mortality rate is in decline, last year's steep rise in winter deaths is a cause for concern," he said.
"There are staff shortages across health and social care and this is clearly having an impact.
"The health secretary must set out what lessons have been learned from these tragic deaths and what changes have been made to ensure that our NHS is ready for another cold winter."