Restarting more health services

Patients will be able to access more health care in the coming weeks and months as NHS Scotland prepares to safely, carefully and in a series of stages, resume some services that had to be paused to ensure COVID-19 capacity and prevent further spread of the virus.

As Scotland moves into Phase 2 of the route map for transitioning through and out of the crisis, health boards will use the NHS Re-mobilise, Recover, Re-design framework to safely and incrementally prioritise services whilst ensuring that staff and patients are safe.

As services resume, the patient experience will look and feel different, and may often take longer because of the demands of ensuring safety, such as the need to reduce numbers in waiting rooms, additional cleaning and the extensive use of PPE.

From Wednesday 1 July, NHS Golden Jubilee plans to resume elective ophthalmology, orthopaedics, cardiac surgery and cardiology based on clinical priority. The Board have continued to provide urgent cancer, heart and lung services, including transplants, throughout the period.

Health Secretary Jeane Freeman said:

“Throughout the COVID-19 pandemic NHS Scotland has remained open continuing  to provide emergency, urgent, cancer and maternity care, support for social care and maintained COVID-19 capacity and resilience.

“Thanks to the efforts of our health care staff and to all of us for continuing to follow public health advice, we have been able to protect our health service and provide the urgent care required to combat the virus.

“The Scottish Government is working with Health Boards to ensure the safe resumption of paused NHS services.

“We are doing this incrementally to ensure we prioritise patient and staff safety, whilst retaining capacity to treat COVID-19 in our health service, but good progress is being made.

“Patients should not expect to see all NHS services resumed immediately as it will take time ensure physical distancing and other safety measures are in place to protect patients and staff.

“The NHS does not exist in isolation. The ongoing development of these plans needs to be founded on a whole health and care system approach, which involves primary and community care, and engagement with clinical partners, service delivery partners, local authorities and patients. 

“As we go forward, our Test and Protect strategy will also be crucial to help break the chains of transmission as lockdown restrictions slowly change. I want to reassure you that we are taking these precautions so that we can safely offer the right care, at the right time, in the right place.”

National Clinical Director Jason Leitch said:

“The reality is coronavirus is likely to be with us for some time to come and as we move to restart paused services, we have had to review how we deliver those services to ensure patients both get the treatment they require but also that staff and patients are safe.

"This work takes time and in some cases will mean that how patients access services will look and feel different. 

“We would ask the public to keep using NHS Inform as their first source for reliable health information. Community pharmacies remain a widely available resource for minor ailments and General Practice teams are fully available.”

Measures that will come into force in Phase 2 include:

• Urgent referrals and triage of routine services in key specialties such as Cardiology, Urology, and Trauma and Orthopaedics, will be resumed gradually during phase 2, with patients prioritised by clinical need and in line with guidance to ensure the safety of all patients and staff.
• Health boards will reintroduce any suspended GP services in a planned and phased way throughout phase 2. The majority of GP practices have introduced a telephone triage system and patients will be navigated to the most appropriate pathway to meet their needs, supporting them to see the right person at the right time.  Patients access to Primary Care Out of Hours Services will continue by contacting NHS 24 on 111.  There will be a greater use of telephone and video consultations and so patients are likely to have a different experience than they had before COVID-19.
• From Monday 22 June, all dental practices will be able to open and treat patients in need of urgent dental care. The capacity of the urgent dental care centres, established at the start of lockdown, will be increased and will continue to see those patients who require certain treatments involving aerosol generating procedures.
• From Monday 29 June, health boards will be able to gradually resume some screening services including endoscopies and other diagnostic tests prioritised by clinical need and in line with guidance to ensure the safety of all patients.
• From Monday 29 June, all community optometry practices will be able to resume seeing patients face-to-face who have emergency and essential eye problems, as well as continuing to manage as many of these patients remotely as possible. The Emergency Eyecare Treatment Centres, which have managed patients with emergency eye problems who needed to be seen face-to-face during lockdown and Phase 1, will close.
• From Monday 6 July, health boards will reintroduce some chronic disease management, which could include pain services, diabetic services on an incremental basis.

Background

More detail on Health Boards mobilisation plans can be read online.

You can read Re-mobilise, Recover, Re-design, The Framework for NHS Scotland online.

You can also read COVID-19: Scotland’s route map for transitioning through and out of the crisis online.

A Mobilisation Recovery Group will begin work to advise Government, from a strategic and policy perspective, on the best approaches for health and social care reform.

Updates on public health advice for coronavirus can be found on the NHS Inform website, and a free helpline has been set up for those who do not have symptoms but are looking for general health advice: 0800 028 2816.  If patients have any concerns they should contact 999 for emergencies or 111 for any urgent requests.

Anyone who has symptoms of Covid-19 should now contact the NHS to arrange to be tested - either online at NHS Inform, or by calling 0800 028 2816.

NHS Boards have submitted their initial mobilisation plans covering the period until the end of July. These plans are informed by NHS Remobilise, Recover, Redesign which is predicated on a range of national and local clinical priorities. Patients will be kept fully informed by local Health Boards as services are resumed.  

The majority of cancer treatments have continued throughout this pandemic, however some patient’s treatment plans have changed to minimise their individual risk. Those that require changes will always be done on a clinical basis and will be in discussion with the patient and clinical team.

On 4 June 2020 the Cabinet Secretary announced the Framework for Recovery of Cancer Surgery to assist NHS Scotland prioritise those most in need of cancer treatment.

The number of urgent suspected cancer referrals are increasing with referrals for patients experiencing symptoms suggestive of cancer increasing to around 83% of pre COVID average.