New guideline on arranging planned care in hospitals

NICE has published a guideline on the arrangements the NHS should put in place for patients needing elective surgery and other planned treatments and procedures during the coronavirus pandemic.

The guideline makes recommendations about how these services should be organised in order to balance the risks associated with the virus with the potential harms that can arise from delays in elective treatment and diagnostic procedures. It promotes a flexible approach based on individual circumstances and the type of procedure and aims to support the prompt recovery of elective care, while advocating shared decision-making, balancing the risks and benefits.

The guideline emphasises the need to discuss with people having planned care factors such as older age, sex and whether they are from a black, Asian or other minority ethnic group, or have any underlying conditions that could increase their risk of getting coronavirus.

In order to minimise the risk of transmission to other patients and healthcare workers, the guideline says that people having planned care involving any form of anaesthesia or sedation should follow comprehensive social-distancing and hand-hygiene measures for 14 days before admission. They should also be advised to have a test for SARS‑CoV‑2 within three days before admission and self-isolate from the day of the test until the day of admission.

For all other planned procedures, including diagnostic tests and imaging, people should be advised to follow comprehensive social distancing and hand hygiene measures for 14 days before having planned care.

The guideline also says that people should be informed that their planned care is likely to be postponed if they test positive for SARS-CoV-2, have symptoms of coronavirus, are not clinically well enough or need to self-isolate after contact with someone with coronavirus.

Dr Layla McCay, director at the NHS Confederation, said: “If we are serious about addressing NHS waiting lists, we will need to move from generic national policy to allow for local variation, opportunity and needs. It is right that this policy is adjusted so that more decisions can be made locally, taking into account the patient’s personal circumstances, staffing, estates, cooperation with other health and care organisations, and local variations in infection rates, all while adhering to testing, hand hygiene and social distancing requirements.

“The NHS faces a huge challenge in getting through the millions of planned procedures that had to be paused and that have built up as part of our initial response to containing the spread of the disease, alongside supporting an exhausted workforce, maintaining capacity for a possible second wave and preparing for flu outbreaks this winter. Public expectations must continue to be managed in what the NHS can deliver safely and by when, and as that the immediate national threat of the virus continues to subside, more decisions on resuming services should be deferred to local leaders.”