Scottish Government

• people should be kept as informed as possible
• people should have the chance to express their views on matters that affect them
• people's personal choices about their treatment and care should be respected as much as possible
• when people are not able to decide, those who have to decide for them should take decisions based on the best interests of the person as a whole rather than just based on their health needs.

A draft version of the guidance was made available for the public to express their views on the processes and criteria outlined in it.

It is also recognised that communication with the public and health professionals will be important, should it become necessary to implement triage and prioritisation.

• help other countries to fight a pandemic if it starts abroad, to stop it developing further and reaching this country
• try to minimise the spread of a pandemic if it reaches this country. Everyone has a role to play, for example by covering the face when sneezing, or staying at home when ill
• minimise the risk of complications if someone is ill, for example by the appropriate use of antiviral treatment
• learn from experience both at home and abroad about the best way to fight the pandemic and to treat people who are ill
• minimise the disruption to society caused by a pandemic.

Unless scarce health resources are prioritised during a pandemic, then at the peak of the pandemic the maintenance of even a limited emergency service may be compromised.

• everyone matters equally
• people with an equal chance of benefiting from health or social care resources should have an equal chance of receiving them; however, it will not be unfair to ask people who could get the same benefit from an intervention at a later date to wait.

Wherever possible, physiological, evidence-based triage criteria have been proposed or recommended so that people with an equal chance of benefiting from health or social care resources should have an equal chance of receiving them. Deferring the treatment of elective patients where there will be no adverse effect on their health can be justified on the basis that it is fair to ask people who could get the same benefit from an intervention later to wait.

• working together to plan for, and respond to, a pandemic
• helping one another
• taking responsibility for our own behaviour, for example by not exposing others to risk
• being prepared to share information that will help others.

Effectively managing the surge in healthcare demand will need all parts of the health service to work together and the cooperation and support of the public. Without these prerequisites, the provision of even an emergency service could be compromised.

• if people are asked to take increased risks, or face increased burdens, during a pandemic, they should be supported in doing so, and the risks and burdens should be minimised as far as possible.

The guidance recommends that the difficult decisions relating to clinical prioritisation should be made across primary and secondary healthcare services, where possible, rather than expecting any single group of clinicians to make these decisions for all patients. The approach to service prioritisation incorporates the need for consideration of alternative methods of service delivery to mitigate any adverse effects of having to defer services.

• those responsible for providing information will neither exaggerate or minimise the situation and will give people the most accurate information
• decisions on actions that may affect people's daily lives, which are taken to protect the public from harm, will be proportionate to the relevant risk and to the benefits that can be gained from the proposed action.

The use of prioritisation criteria will have a profound impact on some people. It is therefore essential that these measures reflect the local resources and disease incidence and are introduced for as short a period as practicable.

• plans will be adapted to take into account new information and changing circumstances
• people will have as much chance as possible to express concerns about or disagreement with decisions that affect them.

The guidance is not fixed, and it will be changed to reflect new information on the clinical course and outcomes of the pandemic strain or the impact of new countermeasures. The guidance also allows local health services to adapt their response in light of local attack rates, staff and equipment shortages, and patient demand.

Respect for this principle involves the following components:

• openness and transparency
• inclusiveness
• accountability
• reasonableness.

The publication of the provisional surge capacity and prioritisation guidance enabled public and professional engagement. The guidance provides information on why prioritisation will be necessary, how decisions will be made and the prioritisation criteria that it is proposed to apply.

As far as possible, the guidance is evidence-based. Where there is no evidence, the underlying rationale is explained.