NHS Lothian takes steps towards 'a new normal'

Over the coming weeks, some priority clinics, appointments and diagnostic tests that were paused during the Covid-19 pandemic will gradually resume.

Coronavirus, according to an NHS Lothian spokesperson, still poses a risk to both patients and staff.

They said that “clinical assessment and risk analysis will support all our decisions regarding what services can be initiated or increased”.

Wards and departments will need to change and be altered to support physical distancing and enhanced infection control measures.

As a result, routine appointments will not be available for months to come.

NHS Lothian is working with an initial carefully planned mobilisation programme to begin the redesign of some of its services where possible.

This will ensure that patients who require urgent medical attention, based on their clinical need, can be seen, while ongoing preparation work continues to support the resumption of non-urgent routine appointments.

As of June 29, urgent referrals and triage of priority services in key specialties started to gradually resume; patients will be prioritised based on their clinical need.

The home birth maternity service started up again and community optometry practices started to see patients with emergency and essential eye problems on the same day.

Some screening services are working towards a gradual resumption; patients will also be prioritised based on their clinical need.

As of June 21, community dental practices reopened.

Despite these developments, NHS Lothian stressed that the return of all routine services was not going to happen for some time. Due to the ongoing risk Covid-19 poses, the need to maintain separate areas for patients with the virus, protect those who are shielding and incorporate physical distancing and other infection control measures, services will not be able to resume for several months.

Jim Crombie, deputy chief executive at NHS Lothian, said: “I would like to thank our patients for their continued understanding and support during these difficult times when many have had their appointments delayed.

“Over the last few months, we have adapted our entire system to meet the demands of a pandemic, while continuing to provide emergency and urgent care and maternity services, as well as support for social care.

“We are remodelling our clinical pathways and access points, taking the first steps in the journey towards a new kind of normal. It is important to grasp, however, that ‘normal service’ will not be resuming and unfortunately this means many people will have to wait longer for access to services, particularly non-urgent, routine appointments.

“We have learnt a great deal from the unique challenges of recent months and this has helped us in planning new ways of delivering the best possible patient care. For example, we have rapidly increased the use of digital resources such as telephone and video consultations, as well as online clinics in services such as children’s and adult mental health and in a range of other outpatient services.

“Following positive feedback from patients and staff, these will continue to be used to deliver appointments in some circumstances and where appropriate. Working days have been extended, evening and weekend appointments are being offered and waiting rooms are being redesigned.

“I understand how frustrating it is to have appointments delayed, but would like to offer assurance that across NHS Lothian, we are working extremely hard to get things moving again.”

Health boards across Scotland are using a ‘remobilise, recover, redesign’ framework to safely increase priority services.

Mr Crombie stressed that things would look different in both hospital and community settings for patients with urgent appointments; for example screens may be in use, PPE will be worn, and waiting rooms will be quieter. Appointments could take longer.

He said: “It is really important that if you need care or treatment, you attend your appointment. We have made adjustments to enhance stringent infection prevention and control measures and to ensure that physical distancing requirements can be met, helping services to run as safely as possible.

“Appointment letters may ask people to come by themselves, arrive only five minutes early and to maintain social distancing when they are in waiting rooms.

“While we work to rebuild our services, we would urge patients to continue using NHS Inform for health advice, community pharmacies for minor ailments, our Call MIA service for minor injuries and, of course, their GP.”