Nobody in Scotland has been unaffected by the tragedy of the COVID-19 pandemic. Individuals, families, communities and businesses have been rocked by the virus as everyone ensured they played their part in preventing the spread of the virus and saving lives.

At Healthcare Improvement Scotland we are fully aware of the huge challenges the independent healthcare clinics that we regulate have faced as Scottish Government directives meant that their businesses were put on hold.

As we gradually begin to see light at the end of the tunnel in phase 1 of the easing of lockdown restrictions, we fully understand the desire and need for businesses to get back to delivering their services.

But we have a clear and important message to deliver: the sacrifices independent clinic owners have made have helped to save lives, but very little changes within phase 1 of the easing of lockdown restrictions.

“The overriding public health message changed only slightly from ‘stay at home’ to ‘stay at home as much as possible’. All businesses, including private clinics, can play their part by ensuring that people are not unnecessarily exposed to the virus by travel to and from a clinic and through the delivery of treatments that could wait a couple more weeks until we have greater clarity.”

Our helpline for independent healthcare providers has been inundated with questions from providers asking when services can restart and asking us to approve the date that a particular service re-opens. We’ve had to be blunt: it is not possible for us to give a date.

The overriding public health message changed only slightly from ‘stay at home’ to ‘stay at home as much as possible’. All businesses, including private clinics, can play their part by ensuring that people are not unnecessarily exposed to the virus by travel to and from a clinic and through the delivery of treatments that could wait a couple more weeks until we have greater clarity.

A phased approach to easing lockdown restrictions

But what can we say to providers that will be helpful to understand the way forward?

Scottish Government has written to all providers with further detail on what the phased route map means for them. It allows for good clinical decisions to be made and the right care to be given at the right time.

It has always been the case that throughout this crisis the delivery of urgent and essential healthcare can continue both within the NHS and independent services. We provided advice as soon as practicable that this essential and urgent care should continue, but anything that was elective or that could wait should wait. For phase 1, this message remains the same.

As a benchmark, if clinically you decided that there were services that you should stop as a result of the initial lockdown advice, then they probably shouldn’t start again in phase 1. If you are thinking of restarting that service, then the central question to ask yourself is what has changed between lockdown and phase 1 that makes the treatment essential?

It is acknowledged in the route map guidance [link] that there may be treatments or procedures that are not urgent or essential, but that by delaying treatment further it will have a negative impact on patients’ wellbeing. These are highlighted as being able to start again in phase 2.  

The importance of sound professional judgement

We know this is not easy. Very complex clinical decisions need to be made for patients in order to balance their need for care, but also the risk to public health. We would fully expect healthcare professionals to show sound clinical judgement on behalf of their patient and the wider society.

This is not about what’s legally right or enforceable, but about doing the right thing.

“We know this is not easy. Very complex clinical decisions need to be made for patients in order to balance their need for care, but also the risk to public health. We would fully expect healthcare professionals to show sound clinical judgement on behalf of their patient and the wider society. This is not about what’s legally right or enforceable, but about doing the right thing.”

It has been said many times that these are unprecedented times and they call for unprecedented actions and decisions – this means that the impact on the health and wellbeing of everyone is impacted by the individual clinical decisions you make that subsequently require your staff and patients to leave their homes.

We can’t thank you enough for the efforts you’ve gone to in order to keep people safe and to save lives at huge cost to your businesses. We’re moving in the right direction, but we would urge you to continue to do what’s right for a little longer and we’ll increase the chances that we all come out of this tragic pandemic together.

Kevin Freeman-Ferguson is Head of Service Review at Healthcare Improvement Scotland

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.