NHS Shetland has begun working through the backlog of medical procedures postponed as a result of the coronavirus pandemic, with urgent planned work initially being prioritised.
Interim medical director Brian Chittick confirmed on Tuesday that day surgery had restarted at the Gilbert Bain Hospital in Lerwick as cases are “drip fed” back into the system.
“The focus is initially on the real urgent cancer work, and urgent elective work that needs to be prioritised,” he added.
People attending the hospital for planned treatment, meanwhile, will now have to shield for two weeks before taking a Covid-19 test the day prior to visiting the Gilbert Bain ensure they are not positive.
It comes after the Scottish Government announced at the weekend that services across the country’s health boards would begin to be “restored safely and gradually” based on clinical advice as part of the phasing out of lockdown.
Confirming that some urgent work has already started, Chittick said: “We may find that some patients now are going to be contacted by hospital services to say we are able to see you, but here is the preoperative routine for being seen.
“It will mean that you will need to shield, and it will also mean that you’ll need to be tested before coming in. We are starting to engage with those patients who have been identified from a clinical priority perspective.”
Across NHS Shetland every department has started pulling together recovery plans to coordinate activity.
Chittick, who is leading a recovery committee at the health board, conceded that the process has been quite complex partly due to the “links we have to the mainland via NHS Grampian” and getting patients south for treatment where needed.
“Regeneration and recovery of our services has to be linked to what Aberdeen can do,” he said.
“Hopefully we’re able to do a little bit more coming out of this using new technologies and new ways of learning that we’ve had to do for the last wee while.
“But also we are dependent on Grampian for some of our diagnostic work and our imaging as well, so it’s really working in collaboration with partners as well.”
Preparing the Gilbert Bain Hospital for the return of planned procedures is also proving to be a bit of logistical challenge, with management preparing two pathways – “one for Covid and one for non-Covid”.
“Having these two distinct pathways in a small real estate like the Gilbert Bain has [proved] to be quite tricky,” Chittick said.
“We’ve had to put one of our operating theatres as a green, non-Covid one, and one as a red. We’ve had to maintain our respiratory care unit, and the ability to undertake critical care of patients present with Covid as well.”
This means that operating capacity will initially be reduced, with one of the two theatres being assigned to the red, the Covid pathway, although it will be able to be used in an emergency.
Chittick said that carrying out procedures seven days a week is something that could be looked at in a bid to ease a backlog of cases.
The interim medical director also confirmed that the hospital’s Ronas ward – which was reopened with beds to deal with a potential surge in Covid-19 patients, but has not been used by a positive case – has been reconfigured to be “clean green – we’re trying to keep that as non-Covid as possible”.
If there is a relapse in coronavirus then the Ronas Ward can be turned back into a surge unit, Chittick said.
He stressed, meanwhile, that the process is “patient-centred”, with the decision for people to be seen in hospital made in partnership with the person.
The health board will also look to make sure patients and staff are socially distanced where possible.
“That’s another complexity, ensuring that patients are socially distanced while they’re in, to ensure that our infection control is absolutely platinum standard,” Chittick said.
“It is something that is at the forefront – it’s got to be as a safe as possible for everybody concerned.”
The Gilbert Bain has been quiet over the last number of weeks as planned work was put on hold, but it still offered emergency care.
Scottish health secretary Jeane Freeman, meanwhile, said on Sunday that the coronavirus pandemic has seen an “unprecedented response from our NHS and care staff”.
“Our fantastic staff have delivered a massive reorganisation of services in just a matter of weeks,” she said. “This has ensured that our NHS has not been overwhelmed.
“We are taking an evidence-based, cautious and phased approach to resuming services to ensure the virus continues to be suppressed. While NHS Scotland will remain on an emergency footing, this framework sets out our approach for the next phases as we continue to respond to this pandemic.
“Our approach is not only driven by clinical priorities but also what matters to people’s quality of life like pain clinics, dental treatment and preventative work like cancer screening.”
The number of confirmed Covid-19 cases in Shetland remains at 54, with the last positive case being recorded six weeks ago.
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