Cancer patients may have to travel to a different health board for surgery and a traffic light system will be used to try and segregate those with coronavirus, under an action plan unveiled by the Scottish Health Minister.
Jeane Freeman unveiled guidance to health boards on how to prioritise cancer surgery, including ensuring patients in the most need are offered the earliest possible appointment.
The document raised the prospect of patients being treated in different health board areas where there is a "mismatch between demand and current capacity."
"Where possible", it said there should be "physical separation" between cancer sufferers with Covid-19 and those without the virus.
Surgery should take place in "green zones" that are designated as being free of coronavirus. But the blueprint said designated areas in "amber zones" could be set up "if fully Covid-19 free sites are not available or feasible."
These would "allow separate streaming of proven or suspected Covid-19 patients" into "red zones" of the hospital.
The document warned health boards that "appropriate arrangements should be made to minimise movement of staff between red and green sites" to try and prevent the virus spreading.
It was published as Ms Freeman disclosed there have been 125 Covid-19 "incidents" in parts of hospitals not treating patients with the virus.
She confirmed in a parliamentary written answer that the first recorded incident of coronavirus in a non-Covid-19 ward was on March 18, when elderly patients were being transferred into care homes without testing.
Official figures disclosed on Wednesday that Scotland's coronavirus death toll in care homes has overtaken that in hospital since the pandemic started. Almost two-thirds of deaths south of the Border have occurred in hospitals.
Ms Freeman also wrote to all health board chief executives ordering them to provide greater detail on their testing plans for care homes, including when they expect to complete testing of staff and residents of all institutions with an outbreak.
With test numbers lagging far behind capacity, she said the blueprints they have provided the Scottish Government "do not provide the level of detail required to give assurance to me and to the public that commitments on testing will be fulfilled."
On March 17, the NHS was placed under emergency measures. Boards were asked to suspend all non-urgent treatment to clear wards and operating lists of patients in expectation of an influx of Covid-19 cases.
Only 2,948 hospital operations took place in April, compared with 24,894 in the same month a year earlier, as much of the NHS ground to a halt during the outbreak.
Scotland's Health Secretary Jeane Freeman has written to the 14 regional health boards making clear she's not happy that they are meeting her pledge of May 19 to test all care home workers routinely (and earlier pledge for residents at homes with outbreaks) pic.twitter.com/Yx5MzW40hA— Chris Musson (@ChrisMusson) June 4, 2020
Ms Freeman published a recovery plan for the NHS on Sunday that prioritised cancer services and the framework on cancer surgery aimed to provide more detail.
Unveiling the new document, the Health Secretary said: "The postponement or delay of some cancer treatments, knowing the profound impact that would have on so many people, was one of the most difficult aspects of dealing with coronavirus.
“That is why we are acting to ensure the continued prioritisation of cancer as we begin to resume NHS services. We are asking health boards across Scotland to prioritise cancer treatment in the same way and work together to ensure patients are treated as early as is possible within those prioritisations."
She added: "That appointment may be outside their local board area but that's to be able to allow us to ensure that prioritisation is the same across the country, no matter where patients live, and that they're given the earliest possible opportunity."
Following my questions to @JeaneF1MSP she has today confirmed 125 outbreaks have occurred in wards for non-Covid19.— Monica Lennon (@MonicaLennon7) June 4, 2020
The 1st outbreak was confirmed mid-March. Up to 3 June, Health Protection Scotland has been told of 125 incidents involving COVID-19 cases outside COVID-19 wards. https://t.co/QG3O3gNHi5
The Scottish Government has also established two groups on cancer, the national cancer recovery group - which will provide "strategic national oversight" of cancer services - and the national cancer treatments group, which will be tasked with ensuring the surgical prioritisation of services.
Marion O'Neill, Cancer Research UK's head of external affairs in Scotland, said the plan would provide "welcome focus" but argued testing needed to be radically ramped up to ensure diagnosis and treatment areas are safe.
She added: "In Scotland, this would mean scaling up the nation’s testing programme by between just 1,700 and 3,000 tests a day."