Doctors in Unite statement on payouts for those who die in service with COVID-19

It is an insult for the government to claim that a life assurance pay out of £60,000 to the families of a health or social care worker who dies of COVID-19 in any way compensates for the loss of life.

Despite their protestations that they “will do whatever it takes”, this again shows the scant regard the government has for frontline workers.

It follows the abject failure to ensure that staff are properly protected at work, and a testing and contract tracing regimen that is too little, too late. The government has now neglected to correct historic inequalities in the provision of death in service benefits.

On April 27th Matt Hancock announced the £60,000 payout. But the conditions that go with it are an insult to those who are lost and those left behind.

One of the criteria is that the deceased must have been in work within two weeks of developing symptoms.

We do not yet know enough about COVID-19 to be able to confidently state that the longest period from exposure to symptoms is fourteen days.

Many health and social care workers do not qualify for full death in service benefits. These include people who have opted out of the NHS pension scheme due to an inability to afford contributions, or because their jobs have been outsourced to the private sector. 

GP locums who die on a day they are not in work, and retired health and social care workers who have generously returned to work during the pandemic are also not eligible for the full amount.

Widowers will also only receive a pension based on their spouses membership of the pension scheme after 6th April 1988.

Families of those with less than two years membership of the pension scheme will receive no short term pension or long term adult dependants/child’s pension.

Full death in service benefits should extend to all health and social care workers regardless of bureaucratic caveats. The criteria that the deceased must have been in work two weeks before developing symptoms should be dropped.

Doctors in Unite statement on retired health workers returning to work during the coronavirus pandemic

The UK government has asked the General Medical Council to contact doctors who have retired within the last six years and grant them temporary registration, a licence to practice and return to the GP performers list or secondary care equivalent. 

Without consulting the individuals concerned the GMC passed their details to local health services. Tens of thousands of retired doctors will be contacted, encouraging them to return to practice.

Doctors are able to opt out, but if they do choose to start working again they must be assured of protection.

They should:

  • Complete a short survey to help determine skills.
  • Complete identity checks including a declaration of honesty letter, Disclosure and Barring Service declaration, and occupational health questionnaire.
  • Have a choice in what work to be involved in.
  • Expect to be tested for SARS-Cov2.
  • Not be expected to work if they choose not to for any reason.
  • Not be expected to work if they have co-morbidities.
  • Not be expected to work in direct patient facing roles. This recognises that increasing age is most likely an independent risk factor for severity of illness. Several retired health care workers who returned to work have died. Early epidemiological data suggests that BAME health care workers may also be at increased risk.

Suitable roles include:

  • Telephone support for NHS 111.
  • Helping in out-patients or GP surgeries by telephone.
  • Backfill for clinicians in direct patient facing roles.
  • Training other clinicians.
  • Psychological support and mentorship for clinicians on the front line.
  • Support for public health and community roles e.g. contact tracing.

Employment working conditions as laid out by the four devolved governments [1], [2], [3], [4] and GMC [5] guidance includes: 

  • Suitable pay and remuneration.
  • Six month contracts of employment.
  • Annual leave.
  • Employment by one organisation.
  • Pension protection.
  • Death in service benefits.
  • Free government indemnity cover with advice and support from defence unions [6].
  • No need for revalidation.
  • Induction and suitable training including Information Technology.
  • Provision of suitable equipment including IT, laptops, mobile phones, smartcards and passwords.
  • Proper home working facilities.
  • Suitable Personal Protection Equipment (PPE).
  • The expectation to work within limits of competency and the right to leave at anytime by submitting a notice period of no more than a week.

[1]    https://www.england.nhs.uk/coronavirus/returning-clinicians/faqs-doctors/#do-i-need-to-be-included-on-the-nhs-england-medical-performers-list-the-list-to-work-as-an-emergency-registered-practitioner-erp-in-primary-care

[2]    https://gov.wales/doctors-returning-nhs-assist-covid-19-guidance-html

[3]    https://www.gov.scot/publications/coronavirus—returning-to-registered-professional-practice-guidance/

[4]    https://www.health-ni.gov.uk/Covid-19-returning-professionals

[5]    https://www.gmc-uk.org/registration-and-licensing/temporary-registration/information-for-doctors-granted-temporary-registration/returning-to-work

[6]    https://bma-mail.org.uk/JVX-6TQS5-S0FWOA-40RGIL-1/c.aspx

Medical ethics during the coronavirus pandemic

Treatment without prejudice

We believe that all people are of equal value. Whether old or young, rich or poor, disabled or not disabled, we all share a common humanity. This was true before the coronavirus pandemic, and it remains true today.

Coronavirus is affecting different people in different ways. Many have a mild illness, but for some, it threatens their life. When severe disease strikes, there will be a choice about the types of treatment doctors offer. These decisions, though difficult, are made every day in hospitals and clinics across the country. Will a drug work? Will an intervention succeed? Or, will the side effects, the negative consequences, and the harms, outweigh the potential benefit to a person’s life?

Intensive care will not work for some patients. Ventilator support will sometimes not succeed. Doctors must judge who is most likely to improve with these measures, and who is not.

These decisions have previously always been made on a case-by-case basis, where the risks and benefits to an individual patient are carefully considered. The arbitrary condemnation of one group or another is inexcusable. Being old, living in a care home, or having a pre-existing disability should not lead to an automatic exclusion from possible treatment. Blanket categorisation of large groups of people in such a way is prejudice. There is no place for it in the NHS.

Rationing of care

There may come a time where our healthcare system is overwhelmed. But we have not yet reached that point. How we act now affects whether the country runs out of ventilators, oxygen, protective equipment, and medication. The single priority for all UK manufacturing must be the production of these goods. There is nothing more important. We must never reach the point where a person goes without a lifesaving treatment only because it is in too short supply. 

Secondary harms

The needs of those without coronavirus, but with other acute medical problems, remain despite the new pandemic. Their health must not be squandered while our attention is focussed elsewhere. 

Informal palliative care

Families must never be placed in the position to go without the support of either community-based, hospice, or hospital-based palliative care for a dying relative. Many already act as carers for their loved ones. They should not shoulder the further responsibility of administering palliative care that would otherwise only be conducted by a trained healthcare professional. Palliative care staff should not be routinely redeployed to other parts of the health service during the pandemic.

Telemedicine

The necessary shift to telephone and internet consultation presents a challenge in ascertaining objective measures of health. In normal times, a record of oxygen saturation would be a routine examination for a respiratory illness. It should be no different now. Pulse oximeters should be made widely available to all patients with coronavirus symptoms other than the most mild cases.

Unsafe working

It is immoral to request that a health or social care worker looks after patients without appropriate personal protective equipment. It jeopardises the health of the worker and their patients.

Volunteers and the newly unemployed

Volunteers are not a substitute for qualified staff. Their generosity is humbling, but they must only be offered jobs that maintain their safety and the safety of patients. 

The expertise of those now without work should not be squandered. Those with life support training and other transferrable experience may be utilised as key workers. Appropriate training, well-defined roles and written contracts must be always provided.

Immunity

The immune response to COVID-19 is not yet fully understood. Immunity may be relatively short lived. Any policy that relaxes social distancing and isolation measures must be based on robust understanding. Using ‘immunity passports’ without evidence will be futile. 

The improved civil liberties for those perceived to be immune would likely create social disharmony, and those still susceptible may seek out infection in order to resume their previous lives. This may well lead to many unintended harms.