NHS hospitals are gradually reopening for planned operations and tests, from cataract treatment to heart operations. But many will remain sick, the treatment they need still out of reach.
Under rules laid down by NHS England, all patients must strictly self-isolate, and not attend work, for fourteen days before attending hospital. And openDemocracy has uncovered a major flaw in the plan: people in this situation could be left without a penny of income for the fortnight before they attend hospital.
openDemocracy asked the Department of Work and Pensions if people who were self-isolating under NHS instruction before attending hospital were legally entitled to Statutory Sick Pay (SSP). “The answer is currently no,” the department replied.
Some hospitals are also telling patients that all members of their household should also strictly self-isolate and stay home from work, or consider moving out for the two weeks before the patient’s hospital appointment.
Jon Ashworth, shadow health secretary, told openDemocracy, “This is deeply concerning and a huge hindrance to people who need treatment. Lack of financial support and security for people who need to isolate will exacerbate health inequalities. We’ll be raising this issue urgently with ministers.”
Martin McKee, member of Independent Sage and Professor of European Public Health, told openDemocracy that “those who must self-isolate for any reason must be given adequate support. Otherwise, we will simply increase the disadvantage of the most vulnerable and give some people little alternative but to break the rules.”
The government has extended Statutory Sick Pay to cover some situations specific to COVID-19, such as when people are told to self-isolate under the ‘track and trace’ scheme. But for people due to attend hospital, and not able to work from home, the DWP told openDemocracy it would merely “encourage” employers to pay them.
People staying off work to recover after their operations should be eligible for Statutory Sick Pay during that period, although the current level of £95.85 per week has been widely criticised and there are at least 2 million workers who don’t meet other requirements to get SSP.
The new normal in the NHS?
Helgi Johannson, a member of the council of the Royal College of Anaesthetists, last week tweeted his concerns about the “probably discriminatory” impact of the self-isolation requirement, saying it meant “anyone whose job is in danger will not want to have surgery… Elective surgery cannot wait forever. Hernias become strangulated, gall bladder disease can cause pancreatitis and death”.
His comments prompted an outpouring on social media from doctors, nurses and patients. Many voiced concerns that the ‘new normal’ in the NHS would see poorer patients delaying medically important procedures because they or their families can’t afford to take time off work.
Another doctor, Emma Young, tweeted “There is no doubt in my mind the rules around social isolation pre-surgery disproportionately affect people from lower socioeconomic backgrounds widening our #HealthInequalities further.”
A colorectal consultant said “I am struggling to get patients who desperately need it to come for surgery because they say they are too worried about their employers to self-isolate for two weeks.”
Still another doctor said the policy had “been designed by someone who’s never lived on SSP”. In fact as openDemocracy has discovered, a patient in this situation is not even entitled to SSP.
And the lack of financial support for households as well as patients themselves means it’s not just working-age patients who are delaying operations. “My 79 year old mum is putting off her urgently needed hernia surgery (it's been trapped and released once) as she's worried about the impact on my dad and sister's jobs having to isolate for so long. And there is nowhere else she can go and she will need them to look after her post op”, one Twitter user commented.
Other doctors raised concerns about the impact on the NHS as it works to get back on its feet.
One said “Despite the enormous backlog of operations to get through, we are struggling to fill our (limited capacity) elective theatre lists”. Another added that a third of patients were refusing surgery specifically because they “can’t isolate”.
Help patients follow the rules
Doctors’ organisations support the self-isolation rules but say the government needs to do more to ensure patients can afford to follow them.
Helen Fidler of the British Medical Association told openDemocracy: "It is imperative that patients undergo two weeks’ of self-isolation ahead of surgery in the interests of their very safety,” as well as to protect staff. She pointed to research showing there is a higher risk of complications and death for people who are operated on while they have COVID-19, adding that testing alone was not adequate to protect the patient.
But she added that “we would be very concerned if patients are putting off life-saving operations over worries around self-isolation and loss of income. Some of these procedures may already have been postponed due to the pandemic, and delaying further could have serious health implications. For those who cannot work from home during the two-week period, the government should provide financial protection so that no patient is penalised for following these important rules.”
The lack of financial support was also slammed by unions. The head of the TUC, Frances O’Grady, told openDemocracy: “It’s not viable to ask people to self-isolate if they are pushed into hardship. The government needs to ensure that anyone who has to self-isolate has access to decent financial support, meaning access to sick pay."
A DWP spokesperson commented: “Throughout the current emergency we have put extensive support measures in place such as increasing welfare benefit spending by £6.5bn to support those who are unable to work and making sick pay more generous by starting it from day one. Employers can and do provide their own sick pay on top of Statutory Sick Pay, something that we encourage.”
Research has found that lower paid workers are far less likely to have employers who enhance their sick pay arrangements above the legal minimum. These are also the workers less likely to be able to work from home.
The government was warned that that patients and doctors were already raising concerns about the issue back in May. The British Orthopaedic Association wrote to NHS England pointing out that the government had not addressed the issue of “individuals who are self-isolating ahead of surgery regarding eligibility for Statutory Sick Pay (SSP) if they cannot work from home.” They said the issue was causing patients “uncertainty” and needed to be “urgently” addressed, “to ensure there is equitable access to treatment (rather than easier access for those in a stronger financial position).”
Are you a patient or relative affected by the situation in this story? Contact caroline.molloy[at]opendemocracy.net in confidence.