Newly-announced rules that allow health and social care staff to be exempted from isolation rules should only be used as a last resort, according to the Scottish government.

Guidance states the option is “not mandatory” and can only be used “in extremis”.

This is despite Public Health Scotland analysis suggesting challenges posed by the exemption are “far outweighed” by the risks to patients and staff from “severe and significant” workforce shortages.

Lanarkshire health board announced last week that it had to cancel some planned operations amid “unprecedented” pressure.

Under the new guidance, only double-vaccinated staff can voluntarily return to work when they have been in ‘passing’ contact with a positive case from outside their household.

The change to the rules can only be used in a limited set of circumstances when “extreme” pressure means services cannot continue and there is a “significant” risk to the health and safety of staff and service users.

For social care, examples include not having enough staff for care at home visits and not being able to provider care packages for patients leaving hospital, according to government guidance.

The exemption can only be used once usual solutions and support from the local health and social care partnership have been exhausted.

Last week Gillian Russell, the Scottish government’s Director of Health Workforce, Chief Nursing Officer Professor Amanda Croft and Dr Gregor Smith, the Chief Medical Officer, wrote to health boards and partnerships outlining a ‘framework’ for employers considering using the exemption.

‘It is important to stress that nothing in the framework would make it mandatory for any self-isolating health and social care worker to return to work, even if asked,’ the letter states.

‘No staff member should feel under any pressure to return to work during a period of self-isolation if they don’t feel able to do so.’

Public Health Scotland analysis included in the letter describes the rules as a “final workforce contingency” that should not be used to bring back all staff who are double-jabbed and self-isolating.

Decisions on what constitutes an extreme situation will mostly be taken at an NHS board level, the letter states.

Staff who work with immunocompromised patients, such as in oncology, will not be allowed to return to work, though they may be redeployed elsewhere.

The change was opposed by some staff organisations ahead of its introduction.

UNISON’s head of health Willie Duffy last week said his union’s concerns had “largely been ignored” by the Scottish government.

“We do not believe these new rules to exempt critical staff from self-isolation is an appropriate or well evidenced response to address the current staffing crisis,” he said.

Read more: Lanarkshire: ‘severe pressure’ on services; Backlash as FM considers staff isolation exemption; Staff isolation rule change ‘under consideration’

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