NHS roadmap to safely bring back routine operations during COVID-19

Image of a surgeon putting on PPE to how NHS roadmap to safely bring back routine operations during COVID-19

Health leaders have set out a series of measures to help local hospitals plan to increase routine operations and treatment, while keeping the necessary capacity and capability to treat future COVID-19 patients. The BMA has responded saying “Hospitals must be allowed to recover and have appropriate PPE before beginning ‘huge task’ of redesigning routine services.”

Over the coming weeks patients who need important planned procedures – including surgery – will begin to be scheduled for that care, with specialists prioritising those with the most urgent clinical need. But, in line with measures currently in place to protect staff and patients who have been receiving urgent treatment during the pandemic, they will be required to isolate themselves for 14 days and be clear of any symptoms before being admitted.

Testing will also be increasingly offered to those waiting to be admitted to provide further certainty for patients and staff that they are COVID-free.

This approach will help to protect patients from potentially catching the virus in hospital, and help staff to ensure they are using the correct infection control measures and protective equipment.

Those requiring urgent and emergency care will continue to be tested on arrival and streamed accordingly, with services split to make the risk of picking up the virus in hospital as low as possible.

Those attending emergency departments and other ‘walk-in’ services will be required to maintain social distancing, with trusts expected to make any adjustments necessary to allow this.

As well as the requirements for those needing operations, as many outpatient appointments as possible will be conducted remotely, and those who do need a face to face consultation will be asked not to attend if they have COVID symptoms.

Those requiring a long hospital stay will be continuously monitored for symptoms and re-tested between five and seven days after admission, and those who are due to be discharged to a care home will be tested up to 48 hours before they are due to leave.

Over the last three months the NHS has created an unprecedented level of surge capacity, including critical care, which has allowed staff to treat and care for a peak of more than 19,000 patients a day with confirmed COVID-19 infection.

With the number of people requiring hospital care currently coming down to around half that level, the NHS is turning its focus to maintaining enough capacity to provide high quality services for patients with COVID-19, including in the event of any second peak, while cautiously increasing other urgent clinical services, important routine tests and planned surgery.

The guidance sets out a national framework to support local NHS teams to do this in the safest way possible for both patients and staff, falling into five principles:

  • Careful planning, scheduling and organisation of clinical activity
  • Scientifically-guided approach to testing staff and patients
  • Excellence in infection prevention and control
  • Rigorous monitoring and surveillance, and
  • Focus on continuous improvement

In line with current guidance all staff or members of their household who are symptomatic should continue to be tested, with additional available capacity used to routinely and strategically test asymptomatic frontline staff as part of infection prevention and control measures.

Responding to NHS England’s roadmap to help hospitals plan to increase routine operations and treatment, as well as the Government’s agreed deal with a technology company to deliver 70 million face masks for frontline workers, Dr Rob Harwood, Consultants Committee Chair at the BMA, said: “At time when we are only just seeing peak of this crisis begin to flatten, NHS England has issued a ‘roadmap’ to enable hospitals to increase the number of routine operations and treatments.

“Some trusts have been very heavily impacted by the huge numbers of COVID-19 cases they have had to treat; while those numbers are falling at last many trusts still have many such patients.

“Those staff and those hospitals must be allowed to recover before beginning the huge task of redesigning their services once more. NHS England have given no indication regarding timescales for change and the volume of non-COVID cases that are expected to be achieved.

“Thousands of healthcare workers are still caring for COVID patients – a large influx of routine surgery and treatments needs very careful planning, done in consultation with frontline workers.

“Doctors know well that many patients have had their care placed on hold while elective operations have had to be postponed during the pandemic. This has been incredibly distressing for those patients, who don’t know when they will be able to receive the treatment they need.

“We understand that the longer patients go without this, the greater the risk that their conditions will worsen, ultimately putting more pressure on the NHS – but reintroducing routine services must be done safely and sensibly and within NHS systems that can cope.

“As part of those provisions, the Government needs to demonstrate it is able to procure sufficient and appropriate PPE, not only for patients needing COVID care but also to protect all patients needing elective care and to protect the staff looking after them.

“The announcement by the Government that up to 70 million face masks will be produced from July shows it has at last understood some of the scale of the problem but without evidence-based calculations showing how much PPE is likely to be needed to properly protect staff and patients as demand on services rises, there’s no way of knowing how effective this will be.”


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