Coronavirus: Routine surgery must not restart until hospitals fully prepared, medical leaders warn

Medical leaders have warned NHS bosses that routine surgery must not restart until hospitals are confident they have enough drugs, nurses, doctors and protective equipment for their staff.

The warning from the Royal College of Anaesthetists comes as new NHS England rules will see thousands of patients being told to self-isolate at home for 14 days before they go into hospital for surgery in an effort to try and limit the spread of the virus within hospitals.

The Royal College of Anaesthetists told The Independent planned surgery should not resume until it is confirmed that “sufficient anaesthetic and critical care drug stocks have been secured” and it said “staffing numbers, personal protective equipment (PPE) and testing capacity all need to be secured before planned surgery is resumed”.

The NHS has been hit by shortages in key anaesthetic drugs in recent weeks while supplies of protective equipment have been beset with problems and remain on a “just in time” delivery routine as the government sources new supplies from around the world.

Separately, the Royal College of Surgeons has called for the NHS to extend its contract with private sector providers to help create Covid-free hospitals and wards due to the risks for weaker patients if they catch the virus after surgery.

Professor Derek Alderson, the president of the Royal College of Surgeons, said there was some early evidence that surgical patients suffer worse outcomes if they contract the virus.

He added: “It is essential we create ‘Covid-negative’ areas within hospitals, or where possible separate sites allocated only to non-Covid treatment. We are calling on the government to renew and extend its contracts with the independent sector, so that there continues to be this additional capacity in the system.”

He said there were many “hidden” patients who had not yet been referred for surgery with many now suffering pain and deteriorating health.

Since the start of the coronavirus outbreak the NHS has cancelled thousands of operations and appointments to free up beds with the Nuffield Trust think tank warning this week the the waiting list total could hit 8 million by the autumn.

In new advice to hospitals, NHS England said patients should only be admitted to hospital if they “remain asymptomatic having isolated for 14 days prior to admission and, where feasible, tested negative prior to admission”.

Prof Alderson said self-isolation before surgery was important, adding: “If the patient keeps up their end of the bargain, they should rightly expect – in return – that when they turn up for their operation, their local hospital also has swift testing available and enough PPE for their operation to go ahead.”

He said people must be supported to be at home isolating and warned that the NHS needed improved speed and access to testing for NHS staff.

“If we have staff coming to work on public transport, picking up the infection, and bringing it to the wards undetected, that will make life much more difficult, and potentially put patients at risk.”

NHS England’s framework for hospitals added that all emergency patients will be tested when admitted and those who test negative will be re-tested between five and seven days later.

Patients discharged to a care home will be tested up to 48 hours before they are due to leave hospital.

Many patients will have to get used to seeing doctors virtually with NHS England saying hospitals should “maximise all opportunities for remote, multi-professional virtual consultations”.

It also called on hospitals to ensure patients in waiting areas could practice social distancing and those who test positive can be isolated.

Stephen Powis, NHS England’s medical director, said: “Now that we are confident that we have passed the first peak of coronavirus, it is important that we bring back those services where we can, but only where that can be done safely – the virus is still circulating and we don’t want to put our patients, the public or our staff at greater risk.

“So our message to any member of the public who might have been putting off seeing their GP about treatment they might need is: the NHS is open and is working to deliver safe services, so please help us help you, and come forward for care when you need it.”

An NHS England spokesperson told The Independent hospitals would need to make sure their plans took account of issues such as testing capacity, medicine supplies and the availability of protective equipment.


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