Scottish ME/CFS clinical service provision

Below is a a lost and found post (since my browser got seized up some days ago when 2 hours sleep was not enough here either). Meanwhile this discussion was continued on the new thread for:

Scottish ME/CFS clinical service provision where:

2 of Dr. Scott's recent research papers are linked - re the daily stress and worry which exacerbates illnesses, and her multicentre service evaluation



National and international research programs bring many disparate applicants together. My picture of the post-pandemic research programs is extremely skimpy, not even patchy.

I could use a precise map of the lot of it. But apart from the shining examples, much of the English establishment still prefers not to distinctly map itself to its public.

So I remain provisionally loyal to Dr Scott - partly due to her 2023 mapping of this research infrastructure in the Scottish LC Inquiry.

I am looking for her recent affilations and recent research, its a lot to cover. Like others before her she has mingled with all sorts, including the Sivan and Greenwood pairing out of L... (possibly the same centre once notorious in the playing fields of MSBP - now FII)

She was already working with Pell and others on the Scottish research infrastructure, and before that on the concerted efforts to alleviate post-Ebola Syndrome which she loyally compared to Long Covid in her own terms eg:

- crippling, gaslighting, stigma, exclusion from health services for a variety of similar reasons and unless allowed self-referral (as in Wales)

- the tendency to withdraw of research funding mid-stream upon surges of other lingering contagion (as upon finding virus in post-Ebola).

In LC particulars she asserted the need for face-to-face clinics, integrated with research, and she I think she asserted that the rehab program was not suitable for all LC cases.

Reading this in 2025, I thought her quite wonderful to assert all that to her Parliament

I guess "LC" still included cases of organ damage without post-viral liability

I found that conflation dire and sneaky. But I admit I do perceive rehab programs for post-viral liablity as a rash. And as an endemic outbreak of rash fringe rehab still aspiring to become a pandemic outbreak

I would like to give her the benefit of the doubt, however we seem to be heading down the BACME route with nothing learned, and she seems to have swallowed the FND pill without much question. Perhaps chasing the research money means you have to be seen to be agreeing with certain people to gain the funds.

I don't doubt that she genuinely cares, and many are reserving judgement at the moment. I havn't caught up with the Radio Scotland piece yet ; we have had many people who genuinely cared before who were unable to see wood from trees and left a legacy of harm.

The locomotion study she keeps using as a tag on social media has much to be concerned about. It features on a couple of threads here.
If she was mentored by Bearsdworth and Peto , there is much to be cautious about.

 
Below is a a lost and found post (since my browser got seized up some days ago when 2 hours sleep was not enough here either). Meanwhile this discussion was continued on the new thread for:

Scottish ME/CFS clinical service provision where:

2 of Dr. Scott's recent research papers are linked - re the daily stress and worry which exacerbates illnesses, and her multicentre service evaluation



National and international research programs bring many disparate applicants together. My picture of the post-pandemic research programs is extremely skimpy, not even patchy.

I could use a precise map of the lot of it. But apart from the shining examples, much of the English establishment still prefers not to distinctly map itself to its public.

So I remain provisionally loyal to Dr Scott - partly due to her 2023 mapping of this research infrastructure in the Scottish LC Inquiry.

I am looking for her recent affilations and recent research, its a lot to cover. Like others before her she has mingled with all sorts, including the Sivan and Greenwood pairing out of L... (possibly the same centre once notorious in the playing fields of MSBP - now FII)

She was already working with Pell and others on the Scottish research infrastructure, and before that on the concerted efforts to alleviate post-Ebola Syndrome which she loyally compared to Long Covid in her own terms eg:

- crippling, gaslighting, stigma, exclusion from health services for a variety of similar reasons and unless allowed self-referral (as in Wales)

- the tendency to withdraw of research funding mid-stream upon surges of other lingering contagion (as upon finding virus in post-Ebola).

In LC particulars she asserted the need for face-to-face clinics, integrated with research, and she I think she asserted that the rehab program was not suitable for all LC cases.

Reading this in 2025, I thought her quite wonderful to assert all that to her Parliament

I guess "LC" still included cases of organ damage without post-viral liability

I found that conflation dire and sneaky. But I admit I do perceive rehab programs for post-viral liablity as a rash. And as an endemic outbreak of rash fringe rehab still aspiring to become a pandemic outbreak
From The Covid 19 Recover report (2023) - the rehab model is alive and well. Despite all the evidence that it is neither effective nor harmless.
I suspect that nothing has changed much since then, but now there are funds.
I would love to be proved wrong.

Janet Scott: My colleagues in health systems research hit the nail on the head: we need clear and well-publicised pathways. However we do that, whether through primary care or a combination of primary and secondary care, there has to be a clear way. We do not have a lot of funding for the large geographical area of the Highlands, so there is some reticence to go out and really publicise services because we already have quite a backlog of people to see and we are aware of the huge unmet need out there.

We know that, if we properly publicise services, there will be a deluge that we are not equipped to cope with.
We have people sitting at home needing care and we do not have the pathways to deal with it, so we need to ensure that those pathways exist.

We need to ensure that, if a patient needs selfcare, face-to-face physiotherapy or occupational therapy, a secondary care advocate or a general physician, they can access those facilities. Then, we need to publicise it. We do not want to publicise what does not exist and, at the moment, we do not have a clinic to see those patients who need one.

We do not have a face-to-face physio service to give to those patients who need it. The need exists—we hear that from patients all the time. It is not that every patient with long Covid needs all those services any more than every patient with chronic obstructive pulmonary disease needs to come into hospital three times a year. However, some patients with COPD need that and some 21 9 MARCH 2023 22 patients with long Covid need secondary care. You need somebody to advocate to ensure that they get seen by a postural tachycardia syndrome expert or an endocrine expert, get assessed for mast cell activation syndrome or have whatever done that we will do in order to optimise everybody’s health.
 

NHS Highland is to launch a virtual support service for people with chronic fatigue syndrome.
Also known as ME/CFS, an estimated 50,000 Scots live with the condition but many find it hard to access treatment. Extreme tiredness is among the symptoms.
NHS Highland said it was expanding its long Covid service to offer online consultations to sufferers in the Highlands and Argyll and Bute.
From spring, patients referred by GPs will be offered personalised strategies aimed at alleviating their symptoms.


Dr Janet Scott, consultant physician on the health board's Covid recovery service, said a team of medical professionals would discuss a patient's individual needs and provide a treatment plan.
"ME/CFS can be a really severe problem," she said.
"Our role is to allow patients to enjoy life and remain part of society."
She added: "Everybody needs something a bit different."
NHS Highland said its long Covid service had seen about 300 patients over a two-year period.
In September, the Scottish government announced annual funding of £4.5m for health boards to invest in specialist services for chronic fatigue syndrome and similar conditions.
…
 
Dr Janet Scott, consultant physician on the health board's Covid recovery service, said a team of medical professionals would discuss a patient's individual needs and provide a treatment plan.

Presumably 'medical professionals' means 'not actually doctors'. An individualised treatment plan?
 
So Dr Janet Scott says there has been a clinic in Glasgow for years, but I thought there had only been one specialist ME person, a nurse in Scotland for a long time.
I have vague memories of an MEAction Millions Missing Event with two people dressed up as pandas. The point, at the time being: There are more pandas in Scotland (2 at the Zoo), then there are ME specialists, ie one nurse.

Or maybe that was just a weird dream....?
 
So Dr Janet Scott says there has been a clinic in Glasgow for years, but I thought there had only been one specialist ME person, a nurse in Scotland for a long time.
I have vague memories of an MEAction Millions Missing Event with two people dressed up as pandas. The point, at the time being: There are more pandas in Scotland (2 at the Zoo), then there are ME specialists, ie one nurse.

Or maybe that was just a weird dream....?
The former homeopathy hospital provides services for ME / CFS and other conditions, including LP.
Woo central
 
The former homeopathy hospital provides services for ME / CFS and other conditions, including LP.
Woo central

How was the Scottish Hom. Hospital renamed? Has it the same name as the Engish renamed one? Anyway I suppose these Long Covid merger-clinic "strategies" must be evaluated - I expect independently - by a national research platform, since these strategies seem to be offered as therapeutic treatments.

(click on the arrow above to find the broken battery video giving the BBC interview with Dr Scott and a patient in need of virtual reality)

- where virtual reality is the only NHS contract in town, it has a sure-fire monoply, as did ME/CFS rehab clinics

I was wondering, could this face-to-face Glasgow ME/CFS service be a service extended to ME/CFS patients by a Long Covid clinic in Glasgow, maybe one of the forerunners of these newer clinics merging the 2 conditions as if either:

- co-morbid or

- one and the same or

- one being the severe form of the other or

- one then exacerbated by the other (and vice versa) or

- whichever, correlating with repeat infections

These optional coded definitions will be an interesting read as provided in the format and guideline for the referrer assessments, the referrals, and the intake assessments

I note that Dr Scott adds - in her BBC interview - that there will be provision for a face-to-face ME/CFS service if needed, which I take to mean where and when its needed

Question being, is this face-to-face service available from a doctor with what knowledege of ME/CFS, or from some other "needed" clinician said to be a "specialist" in ME/CFS. but:

- distinctly not a specialist as one understands the word "specialist" to mean: qualified as a hospital consultant or at that level. Maybe specialist in the variation of standard rehab & CBT

So yes, a duke or an earl might be demoted to a christian name, King can become a surname, but this is the NHS whiuch delivered the demotion of "specialist" to mean any "therapist" in a dedicated clinic.

The reason for this question is:

* the provision of this new service - with its option(s) on face-to-face service - was much appreciated by the patient whom the BBC also interviewed.

She was very re-assured because there of events which GPs might not recognise, as did sadly happen to her in the past, so put her off GP consultations. Dr. Scott reported such aversions.

But now this patient can iroutnely take new symptoms, which might or might not be ME/CFS, into a real specialist consultation, and if need be see the specialist "face to face".

Eg for a phsyical examination (by a doctor).

The reason given for a primary care service to be, as launched, predominantly online for all initial consultative purposes, is because of NHS coverage still falling short (like fuel, water and comms coverage) in all the remote isolated rural districts across Britain

- exactly where the MEA app, and all the other traded apps are being so heavily promoted, since these still need a monoploy to be fully appreciated (by people with no other options) so won't go down so weell, in more populated, NICE-compliant areas

- all due to rural staff shortfalls for clinics, home visits, outpatient transport, district nurses and home helps. Like the rural shortfalls of plumbing, power-grid, mobile fone, cable and wi-fi coverage also taking years to catch up (across the world wherever out-sourced to commerce)

But maybe Wales in particular developed another problem with byzantine reluctance to cater for the isolated or house-bound
 
- exactly where the MEA app, and all the other traded apps are being so heavily promoted, since these still need a monoploy to be fully appreciated (by people with no other options) so won't go down so weell, in more populated, NICE-compliant areas

So did Dr Scott mean it in 2023 when she told Parliament that we must:

""develop experts in long Covid, which means seeing the patients, so that we can come up with the right studies, and the right questions to move things ...

""come up with the right studies and the right questions to move things from characterising - which is what we did in 2020 - on to, as Professor Doiminczak says, understanding the underlying aetiology and then providing proper management stt=rategies and treatments""

I look forward to an adept and independent evaluation of PROMS on offer (patient-reported outcomes), including the patient reports on the outcomes of the outcomes of the clinic assessments and toolkits.

How might these researching evaluation-platforms be evaluating PROMS and all other forms of the MEA promotion in rural Scotland - before buying into any of it - be that MEA endorsed or:

- like Russell Fleming and his H4ME team, unresponsive at arms length, for which the MEA won't be at all responsible let alone respond

I expect prompt disclosure of such national research programmed method for evaluating these "treatment" therapies a.k.a strategies. Since these "treatments" purport to treat ME/CFS as if NICE compliance is the new contractual benchmark, but:

- these homogeneous clinics still seek to rebrand and renew a monopoly on ME/CFS contracts 2006 - 2026. Yet none were able to collect any validating clinic data beyond their own selected and directed patient-reports

I also expect prompt disclosure by the MEA promotion, and by its regulation authority. Prompt disclosure of the applications for registration, disclosing also - any actual registration agreed before offering it to NHS commissioners.

I have big problems with systems which do not tell me if I am dealing remotely in virtual ... tbc

Edited to clarify quotation marks
 
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There have been queries re what's happening to the £4+ million specifically allocated to health trusts a for long COVID and ME/ CFS services

MEA posted a survey for Ayrshire + Arran NHS Trust on their Facebook page re the service proposal which you can complete even if you do not live in Ayrshire .

I can't copy the direct link from Facebook.

 
BBC Radio Scotland interviewed a lady who says her GP had put her off asking when she needs a routine GP service. For example: a doctor to consult and a nurse to: take lab samples, check skin, pressure, weight, temperature, advise, take photos, do dressings and inform the GP.

Other scared people with other conditions also report that their local providers avoid providing a GP service. I don't get it. Is there a shortage of GPs and district nurses in isolated rural areas? Or did GPs & nurses stop all home visits? Are they allowed to pick which ill people to exclude?

We are told that everyone, from the top down, agreed that ME/CFS is still an abominably stigmatised condition, for some reason. Whole nations admitted this horrible, inexplicable exclusion. Everyone expressed distress. Our inclusion is on the syllabus and in the plan.

Dr Scott took charge, highlighting GP prejudice and the other gaps which a new, dedicated ME / CFS / LC service will fill. The MEA informed this pilot project, rolled out across the Highlands.

But thousands of us - still excluded - are not being welcomed back by routine GP services.

NHS, BBC and MEA press-release says nothing about the fund being divided to provide for the missing GP and district nurse service. Will the new dedicated service replace all the refuse-nik, stigmatising GPs who will not show care, offer visits, send nurses, offer triage, do referrals.

Must GPs be told? Or by-passed? No-one said one word about resuming GP services. I guess its very diplomatic and discreet because the prejudiced GP service is in place but suspended. What is the Highland problem with correcting avoidant GPs? Does all this diplomacy fail?

In view of the nation declaring programs to end this horrible stigma and exclusion - why subsidise GPs allowed to totally avoid people with ME? However a special interest in ME is aroused to develop a dedicated new ME/CFS service, it won't replace the GPs who will not welcome us.
 
Must GPs be told? Or by-passed?

Why does the bulk of Dr Scott's cohort want phsyio, for what? How informed is that choice? Physio won't replace a GP either. Is it undiplomatic to correct GPs? How about informing them?

Muscle weakness post-COVID: a practical guide for primary care (Bangor and Oxford)

Trisha Greenhalgh warned the Royal College of GPs that GPs need to do a hands on phsyical examination for nerve damage, before referring LC for rehab. Because Greenhalgh insists that GPs need telling:

"It takes 2-3yrs to repair damaged nerve fibres if a virus or immune response does direct damage to motor neurones, and adjacent muscle. Check for Guillain Barre or prolonged muscle weakness.

"In these cases brain tissue may also be affected"

The neurophysiologists say in so many words: don't dare assume it is psychogenic in most cases. Greenhalgh confirms that most LC patients will examine normal even with signficant damage, so it does not exclude an organic cause for that old Long Covid muscle weakness.

But physical examination will find indications in the others when the GP checks for:

* myasthenia gravis, peripheral neuropathy, Guillain Barre,

* anterior spinal chord myelopathy (sensory-motor or sensory), wasting, strength and sensation

* brachial neuritis and lumbosacrial plexopathy (patterned patches of axonal damage - mostly unilateral else bilateral)

* and vitamin D deficency, polymyalgia rheumatica, and polymoysitis

* differentiated muscle weakness

I might add facial, sensory-motor and load-bearing loco-motor ... nerve and muscle

A detailed history should be taken and an examination performed in order to avoid inappropriately sending patients for rehabilitation who actually have an underlying neuromuscular disorder.
Conclusion: COVID is known to cause muscle, nerve, and metabolic damage. Many patients presenting with post-COVID weakness, exertional symptoms, or fatigue will have identifiable defects on neurophysiological examination.
When managing these patients, excluding treatable conditions such as myasthenia gravis, managing concomitant problems such as vitamin D deficiency, and explaining that improvement is likely over a period of 2–3 years can support the patient while nature heals what medicine can not.

If correct, it gets better:

Clinical judgement should guide further investigation and referral. Further investigations are often difficult to access in the UK setting unless a patient has evidence of a specific deficit such as in brachial neuritis or a well-recognised illness such as myasthenia gravis.

Where available, electromyography (EMG), performed by Neurophysiology Departments, has a high diagnostic yield in these patients and often pinpoints the mechanism of muscle damage.

However, it is not readily available across the UK. Patients may need to be referred to a neurologist in order to access EMG; a very clear history in the referral letter should be provided in order to avoid diversion to other services.

If correct this, is what heartsink GPs could get their teeth into. Be fruitful. Go forth and multiply. And there is a £4 million fund. So if this is all true: would an informed patient want it spent on the phsyio offered and/or on neuromuscular electromyography, and free printouts for all GPs
 
Hi

I live around two minutes from Raigmore on Inverness and have been ill for about fourteen months. I've not seen any specialists and my GP still cannot refer me to a service at Raigmore. It's now expected to be in place by the end of the year but at this point I don't trust anything they say.
 
Hi
I live around two minutes from Raigmore on Inverness and have been ill for about fourteen months. I've not seen any specialists and my GP still cannot refer me to a service at Raigmore. It's now expected to be in place by the end of the year but at this point I don't trust anything they say.

Hallo @kaz2026 (from England), and thankyou for this update. Also it got me thinking and seeking a clue. I may repeat stuff as I can't read all this thread.

So much suspended for so long. 14 months is far too long to wait in the dark like this with a very obstructive mystery illness, not knowing what to expect.

I remember a news report that NHS Highlands did not dare open clinics before it built capacity for so many neglected people, who would be very upset if a clinic opened with no capacity, and were upset enough already.

The doctors were in the dark too. Even the mystified professional service network complained (to Parliament in 2023). Unexplained delays and bottlenecks were still never-ending. That Official Report looks dense in small print but no rush, extracts will follow.

Dr Shackles may become famous for insisting that nevertheless: “belief in collaboration persists”. Linda Currie is the lead clinician at Raigmore Hospital, Long Covid Clinic.

While still closed to referrals there is no waiting list. Fingers crossed there will not be a wait once open. When open, your local had better have capacity got ready for everybody still waiting for referral gateways to ripen, sorry, I meant to type "open". Too many people on a referral waiting list to then stick onto a clinic waiting list. Enough for a party.

If my reply gets too long and too dense, please say so and someone can make the info-bits readable for me. I don’t know your margin, if available to read, type, hop around the internet and browse.

I got detoured in the informations from different places so it took me 3 touring days to find the updated Highlands information with an amulgamated Highland GP Guideline.

Thankyou in advance for waiting. I am posting it in case it helps anyone and in case you don’t have it already. I will put the document in the next post.

First a note: I had thought TBC means “To Be Continued” but I checked and no, it means “To Be Confirmed”. This GP Guideline gives the code for a coded Long Covid referral. The code for an ME/CFS referral still says TBC (in red), which might be why GPs are still waiting for the gateway to open. However:

- when this document (Version 4) was uploaded with its Latest News, it had no version date to give, so the Latest News (at the top) said the date of the document is also TBC. But at the end of the page, the version date is given, so maybe the codes are ready too, just not uploaded on this website (like the version date).

Maybe someone could ask. I expect the Raigmore Long Covid Clinic will soon be the Raigmore PACC Clinic. Its contact is:

- phone: 01408 664 074

- email: nhsh.covidrecovery@nhs.scot

But its GP who reviewed this PACC Guideline is only there 1 day a week so the contact for her is given out by the clinic as at her Glasgow University post: - Janet.Scott@glasgow.ac.uk

I must take it that everything Scotland says about Long Covid probably applies to ME/CFS too. More so since NHS Scotland and regions give more info on Long Covid, not much on ME/CFS, and some clinics are merging the two. Also because anyone with suspected or diagnosed ME/CFS can acquire Long Covid before they know it.

NHS Scotland lists LC symptoms for a GP to spot and refer. That looks like the longest list. It did not yet include the red, purple, blue legs.

On S4ME, the sub-forums under Discussion topics, have Members-only options for a little more privacy eg Symptoms and signs (Members-only).

Tbc (to be continued)
 
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Continued:
I turned up nothing searching ME/CFS on Right Decisions (NHS Scotland). CFS turns up all sorts but Myalgic turns up trumps with 5 results and this here Highland document:

Post-infectious and Associated Complex Chronic Syndromes (PACCS) (Guidelines)

EDIT:
- the 2nd post below reproduces the chart from this GP Guideline, showing the procedure, for a quick reference

It was updated in September by the eminent GP at Raigmore’s Long Covid Clinic. I found its documentation data at the end of its page:

Last reviewed: 24/09/2026
Next review date: 01/10/2027
Author(s): NHS Highland PACCS service.
Version: 4
Approved By: TAM subgroup of the ADTC (awaiting retrospective approval)
Reviewer name(s): Dr J Scott, GP, Dr C Forsyth, GP.
Document Id: COVID104

At the top of the page:

News and Latest updates:

• Scope widened from Long COVID to PACCS:
Long COVID, ME/CFS, PoTS, post-treatment Lyme disease and similar conditions.

• NHS Highland Covid Recovery Service (CRS) closed on 31 March 2026. Its function has transferred to the NHS Highland PACCS service. Referral route and contact details below.

• Aligned to Guidance for the Initial Assessment of Patients with Post-infection and Associated Complex Chronic Syndromes (PACCS), National Strategic Network for the Long-Term Effects of COVID-19, March 2026.

• Long COVID is no longer described as a diagnosis of exclusion. Exclude co-morbidities and reversible causes, then make a positive diagnosis.

• Vitamin D: recommend rather than prescribe, October to March.

• PESE replaced by PEM (post-exertional malaise) as the preferred term.

• Epworth Sleepiness Scale should not delay referral.

Previous updates

• CRS closure announced; new referrals ceased 15 August 2025 (V3).
• NHS Highland PoTS pathway replaced with PoTS UK information (V3).
• NSS assessment pathway replaced with NHS Highland assessment pathway.
• Link to NASA lean test instructions added.
• Extra information added re vitamin D.

Scrolling through stuff:

General considerations

• Manage individual symptoms as you would normally

• Refer to specialists as you would normally

• Refer via SciGateway to the NHS Highland PACCS service, and to appropriate third sector support

• Consider referral to a community link worker or equivalent where available

Codes for Vision​

• Post COVID-19 Syndrome:
AyuJC

• Search keywords:
POSTCOVID POSTCOVIDSYN

• ME/CFS:
CODE TBC


• PoTS:
CODE TBC


• Post-treatment Lyme disease: CODE TBC
 
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The Highland PACCS Guideline for GPs is:
• Aligned to Guidance for the Initial Assessment of PACCS,
National Strategic Network for the Long-Term Effects of COVID-19,
March 2026.

National Strategic Network for the Long-Term Effects of COVID 19

- Guidance for the Initial PACCS Assessment of:

Patients with Post-infection and Associated
Complex Chronic Syndromes (PACCS),
such as
- Long COVID,
- Myalgic Encephalomyelitis/Chronic FatigueSyndrome (ME/CFS)
- Postural Tachycardia Syndrome (PoTS),
- Post Treatment Lyme Disease (PTLD)
- and similar conditions

----------------------

Best Practice for Professionals
- PACCS Initial Assessment

This guidance has been developed to support healthcare professionals across Primary and Secondary Care in Scotland to undertake an initial assessment of patients with Post-infection and Associated Complex Chronic Syndromes (PACCS).

This is an expansion on the original Initial Assessment for Long COVID as services evolve to cover other similar long-term conditions.

------------------

PACCS Initial Assessment

POTS Interim Signposting Document......
This Interim Signposting Document provides signposting to current evidence-based resources for the management of Postural Tachycardia Syndrome (POTS) in adults with Long COVID and post-viral syndromes in NHS Scotland secondary care services.

UK consensus guidelines are currently in development by the British Society of Cardiovascular Medicine in collaboration with PoTS UK and other stakeholders (expected December 2026). This Interim Signposting Document will be superseded upon publication of those guidelines.

POTS Interim Signposting Document

NHS Education for Scotland | NES
 
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You're welcome @Peter T, my pleasure and thankyou for your precisions.

So, not too much info then. It was looking to me like a bit too much. If I had not stumbled over this Highland Guideline, yesterday, there was a small encyclopaedia of info from other places to file somewhere instead.

It does look like the Highland got a model together on paper. And no more PESE, its now PEM-only. I am not sure, but the "community link workers" might be the "3rd sector" reported on in 2023. A GP can refer to get one allocated, but one could self-refer at least in some regions.

The Long Covid Inquiry turned up a 2023 Report from the service network to Parliament, in which the Highland's Raigmore Clinic Lead - Linda Currie - explained that her clinic had partnered from the start with a well-known 3rd sector service: Let’s Get On With It Together (LGOWIT).

This was in reply to the question: why was the CHSS (Chest Heart and Stroke Scotland) not being offered to patients since CHSS uniquely took Long Covid on board, but was inexplicably not signposted, and so remained under-used with spare capacity (adding to its unique position)?

CHSSS capability includes home visits, a buddy system, practitioners on a Helpline, problem-solving and referrals. Can anyone review this service? And the local equivalence in the Highland provided by LGOWIT.
 
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