In response to the direct threat of COVID-19 to patients, the wider Scottish population and NHS Scotland services, no new treatments were started after 17 March. Those in treatment at the time had their embryos frozen to avoid pregnancy. This happened very quickly with patients having remote consultations to ensure well-being and to provide support at this very challenging time. Counsellors have continued to be available in all four NHS centres.
Restarting services has not been so quick. The four centres that provide NHS services have been working with the Scottish Government Maternal and Infant Health team and senior policy management. Fertility Network UK (FNUK) has been involved in all processes and has provided invaluable help with patient communication ensuring all patients in Scotland were provided with the most up to date information at all times. This National Group created a document 'COVID-19 and Fertility Treatment in Scotland: Plan for restarting treatment - A Framework', which has been agreed by NHS Scotland.
Every week, the group update the document due to the evolving situation we find ourselves in during the COVID-19 pandemic. Fertility services rely on multidisciplinary and cross directorate collaboration in order to provide safe and effective treatment. Therefore, service level decision-makers within areas such as anaesthetics, diagnostics, virology, microbiology, genetics, as well as cervical screening services were engaged by the group to help shape restarting the service.
Nationally agreed patient information was created to sit alongside consent forms and triage questionnaires. The staff code of conduct within an NHS setting involved NHS human resources and the head of information governance being involved.
COVID-19 is still here! All NHS hospitals are restricting the number of face-to-face appointments, therefore the capacity within each centre has been reduced. 'Scotland's route map throughout and out of the crisis' has set out five phases to varying restrictions. 'Resumption of IVF treatment, as soon as it is safe to do so, and subject to the approval of Human Fertilisation and Embryology Authority (HFEA)' is included in phase one. This is primarily due to the age sensitivities around treatment and access criteria for NHS funding.
This is challenging as, within phase one, remote working remains the default position for those who can, therefore to encourage patients to leave the safety of their own home to attend a hospital appointment, which could be regarded as non-essential at this time, is not the way we are moving in Scotland. Travel to clinics can take several hours for some patients especially if you live in the Orkney or Shetland islands.
The First Minister, Nicola Sturgeon, has also made it very clear 'we may at times need to hit the brakes on easing'. With this in mind, the group has carefully considered prioritisation of treatments whilst planning to reopen fertility clinics. Each patient and partner will need to have a consultation to assess their current medical history, and before planning a treatment cycle they must be made aware of the risks involved in undergoing treatment and becoming pregnant during the COVID-19 pandemic. Any patient that may have underlying medical conditions and whose co-morbidity places them at higher risk of complications in the event of contracting coronavirus will not commence treatment at this time. This will not affect their access to funding and there is an agreement to the time-frames that can be applied for such patients.
Access to NHS funding, or loss of it, is a great fear for many patients. The funding has strict age criteria for the patient who wishes to become pregnant. Many fear losing access due to delays imposed by COVID-19 and others fear they may not be able to access their full entitlement.
In order to be fair, equitable and ethical, it was agreed that those who are already on the waiting list will have this time paused from 17 March 2020, and extra months added whenever the clinics can offer fresh IVF treatment in order for the patient to maintain access to their full treatment journey, as long as other criteria are met.
Supporting patients throughout this time has been critical. FNUK has seen an exponential increase in the number of calls and each centre has advertised and asked FNUK to let patients know that counsellors have been available throughout the pandemic to provide Skype or telephone sessions. Yet the number of patients requesting appointments has been minimal.
Strategies for supporting staff who have been redeployed throughout the hospital, in ITU, in microbiology laboratories, and others within the maternity service have also been put in place. Each Health Board has online support networks and return to workplace plans have been put in place. Returning to a workplace that looks different, having had furniture removed and floor markings put in place, will be daunting. New ways of working will also be implemented and we all know we will not get everything right at the beginning. Every day as we walk through new pathways we learn something.
The support and ability to discuss all aspects of providing patient care with representation from all disciplines in each centre, on a weekly basis has been incredibly helpful. This is a huge project, which is also very frustrating, as each step takes a great deal of discussion and expert opinion to ensure the best service is provided for our patients and staff. Our strategy in Scotland has always been to provide safe, effective, efficient and equitable care throughout the country. The work that has taken place over the past ten weeks, which will continue, has demonstrated the passion to deliver this model nationally is as strong as ever.
Meantime I would urge everyone to 'ca canny' (to go carefully or slowly, to take care).