Publication - Advice and guidance

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

Published: 16 Nov 2020

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

Contents
Coronavirus (COVID-19): supporting elective care - clinical prioritisation framework
Protection of services

Protection of service

Health Boards should maintain essential and urgent services including critical care capacity, maternity, emergency services, mental health provision and critical cancer services.

The Framework for the Recovery of Cancer Surgery remains applicable and boards should continue to follow that guidance.

Protected capacity should be considered to determine which services could continue to run at a reduced outpatient or surgical level.

Where COVID and/or emergency and winter demands are likely to present pressures on Health Boards capacity to carry out elective procedures, local whole system arrangements should be in place to ensure appropriate response measures are taken.  When clinically prioritising patients and elective capacity Health Boards should be considering: 

The number of cases per 100,000 people (COVID19 infection rate), including for particular age groups, using the latest actual data and a two week forecast.

  • positivity rates for testing. This should be based on actual data.
  • 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) - levels are included in the Guidance noted in the reference section
  • local Workforce pressures, including the need to isolate, care for others, or illness
  • current pressures on the 4 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 patient throughput.  This may mean treatment out with local Board areas to meet demand.

The NHS Golden Jubilee and the NHS Louisa Jordan should be considered and that capacity utilised (where appropriate).

When Boards are providing or requesting mutual aid this should be considered in line with the current ‘tier’ classification.

This should be in line with current infection control measures ensuing there is appropriate pre-operative testing for patients.

We would expect Boards to use this data and principles to make active decisions regarding stepping up or down elective activity, and that operational teams escalate appropriately to Scottish Government when they deem it necessary to do so.


Contact

Waiting Times Team: WTIP@gov.scot