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Coronavirus (COVID-19): supporting elective care - clinical prioritisation framework

The framework provides NHS Scotland with clear guidance for prioritising elective care whilst ensuring appropriate COVID-19 safety and priority measures are in place.

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Protection of service

Health boards should continue to maintain essential and urgent services of critical care capacity, maternity care, emergency services, mental health provision, and critically timed planned procedures (e.g. priority 2) including critical cancer services.

Protecting capacity should now be actively considered to support the restarting of planned care activity and to help mitigate against future pressures on the whole system. This may include ways of working differently to flex resources, capacity and infrastructure, or the wider roll out of service redesign.

Additionally, continuing to work in collaboration with the Centre for Sustainable Delivery (CfSD) will be key to exploring options to manage and create capacity, improve efficiencies and increase productivity. This includes CfSD exploring different models, to enable service redesign in support of recovery and provide a consistent approach to national capacity assessment, allocation and address variation across the country to both share best practices and remove any barriers.

Where there is likely to be pressures on health board capacity to carry out planned care procedures, such as seen in Covid and winter demands, local whole system arrangements should be in place to ensure appropriate response measures are in place. When clinically prioritising patients and planned care capacity, health boards should consider: 

  • forecast of number of people needing to be hospitalised or in ICU against NHS bed use and capacity. This would be based on a two, four and six-week forecast
  • utilisation of critical care capacity (ICU and HDU)
  • local workforce pressures, including the need to isolate, care for others or illness
  • current pressures on the four-hour Emergency Access Standard
  • the specific proportion of service provision on a local, regional and national basis
  • the local characteristics of the hospital estate and pressures within it
  • local understanding of delayed discharge and links with IJBs
  • community resilience

Where there is limited capacity, health boards should consider local, regional and national collaboration to support patients. This may mean treatment out with local board areas to meet demand. When boards are providing or requesting mutual aid this should be considered in line with current tier system.

The NHS Golden Jubilee should be considered and its capacity utilised (where appropriate). This should be in line with current infection control measures.

Health boards are expected to use this data and principles to make active decisions regarding stepping up or down planned care activity, and that operational teams escalate appropriately to us when they deem it necessary to do so.

Contact

Waiting Times Team: WTIP@gov.scot

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