NICE has published a new rapid guidance on arranging planned care in hospitals and diagnostic services during the Covid-19 pandemic. 

The guidance recommends a flexible approach based on individual circumstances on how elective surgery and other planned treatments and procedures should be organised. This is to be balanced with the risks associated with Covid-19 and the potential harms that can arise from delays in services.

It emphasises the need to discuss with people having planned care factors such as older age, sex and whether they are from a black, Asian or other minority ethnic group, or have any underlying conditions that could increase their risk of getting Covid‑19 and of having a severe illness, because these may influence their decision to go ahead with their planned care.

In order to minimise the risk of Covid‑19 transmission to other patients and healthcare workers, the guideline says that people having planned care involving any form of anaesthesia or sedation should follow comprehensive social-distancing and hand-hygiene measures for 14 days before admission. They should also be advised to have a test for SARS‑CoV‑2 within three days before admission and self-isolate from the day of the test until the day of admission.

People transferred to other care settings should be tested before discharge

For all other planned procedures, including diagnostic tests and imaging, people should be advised to follow comprehensive social distancing and hand hygiene measures for 14 days before having planned care.

For people who are at greater risk of getting Covid‑19, or having a poorer outcome from it, the guideline says they should be advised that some types of surgery, for example cardiac, carry additional risks for people with Covid-19, and that they should consider self-isolating for 14 days before a planned procedure.

People having inpatient surgery who stay in hospital for more than five days should be tested for SARS-Cov-2 between five and seven days after admission, in line with current NHS England and Improvement advice. The guideline also recommends that all people going from hospital to other care settings are tested before they are discharged.