The Scottish Government

Decision-making

Command and control procedures are in place.

Structures are in place to enable decisions to be disseminated from health authority/health board ( HA/ HB) level down to the service prioritisation group of each facility and thereafter to frontline services.

Each facility (hospital, care home etc) has a service prioritisation group to implement strategic prioritisation decisions at an operational level.

The specific roles required for the service prioritisation group to function have been agreed, with 'role cards' available if appropriate.

Members are aware of their roles and responsibilities, and deputies identified.

An audit trail is in place to record all decisions taken by the group.

The operating procedures of the group have been agreed (location, frequency etc).

Post-surge plans are in place to return working practices to normal.

The point at which the service prioritisation group should be stood down has been identified.

Information

Clear lines of communication within the organisation are in place.

Clear lines of communication to partner organisations, the media and the public are in place.

Information requirements for maintaining services within the organisation have been identified. This should include the frequency with which information is required.

Information requirements to enable other organisations to maintain their services have been identified. This should include the frequency with which information is required.

Mechanisms are in place to collect the required information.

Capacity

Use of space within the facility has been assessed and additional temporary capacity identified.

An assessment has been carried out of the resources that will be required to make this capacity usable.

Contingency plans detail the process for bringing additional space into operation, ie in stages/at the same time, and how long this will take.

All plans for using additional space incorporate infection control requirements as recommended in Government guidance.

Arrangements are in place which ensure that flu patients are separated from those without flu.

Areas have been identified for cohorting patients.

Provisions

Key clinical supplies have been identified.

Key non-clinical supplies have been identified.

Space for storing supplies has been identified.

Key supplies have been stockpiled (where possible/appropriate).

Contingency plans detail the process for ordering more supplies and the points when this should be carried out.

Contingency plans detail alternative routes for obtaining supplies when normal channels have been exhausted.

Arrangements are in place to inform the service prioritisation group about the levels of supplies.

A mechanism is in place to prioritise supplies as directed by the service prioritisation group.

People

Arrangements are in place for managing staff shortages.

Minimum staffing levels required to maintain services have been identified.

Key skills that will be required to run services have been identified.

Key staff for crossover roles and specific pandemic support have been identified.

Contingency plans detail arrangements for the redeployment of staff where necessary.

Staff have undergone training in infection control.

Where appropriate, staff have undergone training to upskill as previously identified.

Plans for staffing have been discussed with partner organisations.

Any staff insurance/liability issues have been identified and procedures put in place to address them.

Prioritising services

A review of all services offered by the facility has taken place and core services have been identified.

The service prioritisation group has agreed how services will be prioritised in order to maintain core services as far as possible. This has been carried out in accordance with direction from HA/ HB and national guidance.

The service prioritisation group is aware of the triggers for deferral of services.

The service prioritisation group has decided how essential medical services will be maintained for people with chronic illness.

Where a decision has been taken to defer services, plans are in place to mitigate the impact of deferral on both patients and partner services.

Where a decision has been taken to maintain services, consideration has been given to alternative methods/locations of delivery.

Deferring treatment

The service prioritisation group has agreed which treatments will be deferred.

The service prioritisation group is aware of the triggers for deferral of treatment.

Where a decision has been taken to defer treatment, plans are in place to mitigate the impact of deferral on patients, eg by offering telephone support services.

A mechanism is in place to keep track of patients whose treatment has been deferred.

Restriction of treatment

Where a decision has been taken to maintain services, 'model of care' plans or 'patient pathways' identify alternative methods of treatment which can be offered when the range of treatments is restricted, eg using oral rather than IV antibiotics.

The service prioritisation group has considered whether treatments can be offered in advance of the surge and patients fast tracked.

Admission criteria

The service prioritisation group is responsible for the process of evaluation and admission to the service and has recorded all decisions.

The current admission criteria for services have been reviewed and consideration has been given as to how these should be modified. This should be carried out on the basis of capacity.

Alternative support has been identified for those who may not be admitted to the facility.

Criteria and protocols are in place for closing the facility to new admissions.

Discharge criteria

The current discharge process has been reviewed and potential problem areas have been identified.

Criteria and protocols have been put in place for initiating rapid early discharge.

Patient groups where rapid early discharge could occur, if needed, have been identified.

Any additional support that will be required for rapid early discharge has been identified.

Decision-making

Command and control procedures are in operation.

Information management strategies are in operation.

The service prioritisation group is managing the surge.

Information

There is ongoing monitoring of surge related triggers for action.

Capacity

Additional capacity is being operated as directed by the service prioritisation group.

Provisions

Key clinical and non-clinical supplies are being monitored and that information is being passed on to the service prioritisation group.

Supply needs are being anticipated and ordering is being carried out appropriately.

Supplies are being managed in accordance with contingency plans.

People

Arrangements for managing staff shortages are in operation.

Redeployment of staff is in operation as set out in contingency plans.

There is ongoing retraining/upskilling of staff.

There is ongoing communication with partner organisations about staffing levels.

Prioritising services

Core services are continuing to be offered.

The service prioritisation group is using information from HA/ HB and the front line to assess when trigger points for service restriction have been reached. All decisions are being recorded.

Prioritisation of services is being carried out as directed.

Mitigation strategies for deferred services are in operation.

Deferring treatment

Criteria and protocols for treatment deferrals have been activated by the service prioritisation group.

Treatments are being deferred as directed.

Records are being kept of patients whose treatments have been deferred.

Mitigation strategies for deferred treatments are in operation.

Restriction of treatment

The service prioritisation group has disseminated decisions on which treatments are being restricted.

Individual patient prioritisation is in operation if the service is overwhelmed.

Admission criteria

Criteria and protocols for modifying admission on the basis of capacity have been activated.

The service prioritisation group is monitoring the evaluation and admission of patients and recording decisions.

Alternative support is being offered to people who have not been admitted to the facility.

Criteria and protocols for closing the facility to new admissions have been activated when capacity is reached.

Discharge criteria

Criteria and protocols for initiating rapid early discharge have been activated.

Additional support is in place for rapid early discharge.

Decision-making

Command and control procedures are in operation.

Information management strategies are in operation.

The service prioritisation group is managing the surge: looking at resuming normal operations through a return to normal capacity, bringing back on line deferred services and treatments, and factoring in the availability of staff and other resources. All decisions are being recorded.

The service prioritisation group is reviewing resources and capacity to enable catch-up of deferred treatments.

Arrangements are being put in place to manage a possible second wave. Arrangements take account of the effectiveness of the surge capacity response and any modifications that are required.

Information

There is ongoing monitoring of surge-related triggers for action.

Capacity

Temporary additional capacity is being reduced as directed by the service prioritisation group.

Provisions

Key clinical and non-clinical supplies are being monitored and that information is being passed on to the service prioritisation group.

Supply needs are being anticipated and ordering is being carried out appropriately for catch-up of deferred treatments.

Restocking is being carried out in anticipation of a second wave.

People

Arrangements for managing staff shortages are in operation.

Normal working practices are being reinstated as appropriate/possible.

Prioritising services

Core services are continuing to be offered.

Services are being resumed where appropriate/possible.

Deferring treatment

Deferred treatments are being resumed where appropriate/possible.

Patients whose treatments have been deferred are being identified.

Work is ongoing to catch up on treating patients whose treatments had been deferred.

Restriction of treatment

Treatment restrictions are being lifted where appropriate/possible.

The service prioritisation group has considered the likelihood of a second wave and whether treatments can be offered in advance of the surge and patients fast-tracked.

Admission criteria

Normal admission criteria have been resumed.

Discharge criteria

Normal discharge criteria have been resumed.