SURGERY in Scotland is expected to operate at just 60 per cent capacity for at least two years as a result of the Covid pandemic, according to a paper published by the Scottish Government.

The document warns that the return to normal levels of theatre use could be delayed even longer “if there are further surges in Covid-19 incidence”.

The estimate is set out in the ‘Framework for Recovery of Cancer Surgery’, which details how health boards should go about prioritising cancer patients’ treatment in the face of a “limited surgery resource”.

Under guidelines drawn up to deal with Covid, cancer patients would be divided into five categories depending whether their operation was urgent - required within 24 or 72 hours - or less urgent, meaning it could be scheduled within four or 12 weeks.

The least urgent cases would be earmarked for surgery after 12 weeks.

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It will be up to local Clinical Prioritisation Groups (CPGs) to monitor this on a weekly basis “to ensure that prioritised patients are apportioned appropriate, and preferential, access to all green-site theatres”.

‘Green’ sites refer to areas of the NHS which are closed to any patients or staff who have tested positive for Covid-19, in order to minimise the risk of exposure among the most vulnerable patients.

Cancer patients in particular will be admitted only to ‘green’ theatres and hospital bays.

The paper states that health boards “are expected to upscale elective cancer surgery capacity to meet local demands and to equitably address any backlogs that may have accrued during the Covid-19 outbreak”.

However, it accepts that “this is a challenging task” which may require patients to be referred to neighbouring health boards or national centres - such as the Golden Jubilee - if local demand exceeds theatre capacity.

The paper also acknowledges the long-term impact of the pandemic on patients waiting for all kinds of planned operations.

It states: “As surgery services enter into the recovery phase in the coming weeks and months there will be competing demands from various surgical specialties to gain access to a limited surgery resource.

“Current estimates are that surgery services will operate in most health boards at around 60% of pre-Covid levels for the next 24 months, and perhaps longer if there are further surges in Covid-19 incidence

“Scottish Government therefore recommends that health boards (and hospitals) implement local governance policies to ensure fair and reasonable access to a limited surgery resource in terms of both hospital beds and elective green-site theatre capacity.”

Marion O’Neill, Cancer Research UK’s head of external affairs in Scotland, said it was “extremely worrying” that surgical services are expected to operate “on such a profoundly reduced basis”.

She added: “This reduction is largely due to implementation of infection control measures, which mean that providing cancer services has become more intensive and time-consuming.

“Current levels of equipment and staffing may also pose critical limits on how many patients can be treated.

“The Scottish Government has taken welcome and sensible steps to prioritise and find surgical capacity across Scotland at this difficult time.

“This will allow some patients to access surgery faster, although they may have to travel further than usual to be treated.”

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Professor Michael Griffin, president of the Royal College of Surgeons of Edinburgh, said a reduction in surgical capacity was "completely understandable" as the health service adapts to the stringent health and safety measures required to mitigate the risk from Covid.

But he added that more use should be made for surgery of sites such as the NHS Louisa Jordan.

Prof Griffin said: "While these are absolutely necessary, it means surgeons will be facing a significant challenge in working through the backlog of patients.

“In order to effectively work through the waiting list, we must increase the capacity of suitable locations to carry out operations in.

"This could be achieved particularly by working with the independent sector, or by using Nightingale Hospitals to care for patients not requiring surgery in order to increase capacity in other hospitals.”

It comes as an investigation was launched into a cluster of eight linked coronavirus cases in the NHS Greater Glasgow and Clyde region. 

A pharmacy in Port Glasgow is reportedly among the premises associated with the outbreak.

A worker at the Amazon depot in Gourock has also tested positive.

In a statement, NHS GGC said: "Contact tracing of individuals has identified a number of businesses across Greater Glasgow and Clyde including a pharmacy in Inverclyde as being linked to the cases.

"An NHSGGC-led Incident Management Team is working with Scottish Government, Health Protection Scotland (HPS) and local environmental health teams to provide advice and support.  

"None of the cases are experiencing anything but mild symptoms."

Nicola Sturgeon confirmed yesterday that 22 new cases of Covid-19 had been detected in Scotland - 14 of them in NHS GGC, including the cluster of eight.

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NHS GGC has reported 120 new cases in total since June 29 - 50 of them (42%) in the past week.

The health board, which makes ups 22% of Scotland’s population, has also accounted for 35% of the 339 new cases reported nationally in the past month.

According to the latest National Records of Scotland, the region’s death rate from Covid has been the highest in Scotland at 11.3 per 10,000 population, with mortality particularly high in the Inverclyde and West Dunbartonshire council areas.

Higher rates of deprivation among residents and factors associated with it - such as obesity, respiratory and cardiovascular diseases, smoking and crowded accommodation - are believed to be at play.

The NRS report also shows that there were eight deaths from Covid recorded on death certificates last week, including four in hospital.

This is despite no deaths at all having been recorded in official daily data - which relies on test results - in the week to July 26.

Ms Sturgeon said the patients had not been included in last week’s figures because they died more than 28 days after testing positive for the virus.

She said: “The reason why the 4 deaths in hospitals weren’t captured by our daily figures, is that those daily figures record people who have died within 28 days of testing positive for Covid.

“However some people who test positive receive care for more than 28 days afterwards, but sadly some of them do not manage to recover.

So if these people die after the initial 28 days, but have Covid recorded on the death certificate as a contributing factor, then they would be included in the NRS report, but not in the daily figures.”

Ms Sturgeon added that she is “very likely to adopt a very cautious approach” today when she updates the Scottish Parliament on the route map out of lockdown.

Keeping virus levels low enough so that shielding can be paused and schools safely reopen in August would be the priority, she said.

“We have made very significant changes over the past three weeks, including the resumption of indoor hospitality and tourism, and it is still too early to be completely assured about the impact - or hopefully the absence of impact - of these.”