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NHS patients having a routine operation no longer need to self isolate for 14 days prior

Patients having an operation or treatment on the NHS no longer need to self-isolate for 14 days before going to hospital.

Updated guidance says strict social distancing and hand washing is enough to cut the risk of patients taking the virus into hospitals in England.

NHS patients will only need to self-isolate for a few days after taking a test in the run-up to them entering hospital, health bosses now say.  

Surgeons hope the relaxation of rules will help them to tackle the huge waiting lists that have built up during the Covid-19 crisis.

But they called for all patients to be given tests for the coronavirus before and after their operation to keep a lid on any potential outbreak.  

The change in advice was made because the virus is circulating at much lower levels than it was during the peak of the crisis in March and April.   

Millions of operations were cancelled in March to make room for Covid-19 patients, with the outbreak expected to flood hospitals.

Hospitals in England were told to postpone all non-urgent elective operations from 15 April at the latest, for a period of at least three months.   

NHS England statistics show 1.5million patients have been forced to wait at least 18 weeks to start treatment, the worst figure since 2007.  

In a bid to start tackling the growing backlog, which hospital bosses have warned could take four years to clear, the National Institute for Health and Care Excellence (Nice) changed the guidelines.

It said yesterday that for most people, the blanket rule for self-isolating before an operation would no longer be necessary. 

It is unclear how the rule — which came into force in May as part of NHS England’s plan to re-start elective care — was ever enforced.

Guidance says that patients having planned care ‘involving any form of anaesthesia or sedation should follow comprehensive social distancing and hand hygiene measures for 14 days before admission’. 

‘They should also be advised to have a test for Sars-CoV-2 within three days before admission and self-isolate from the day of the test until the day of admission,’ the guidance added.

For all other planned procedures, including diagnostic tests such as MRI scans, they should also be advised to ‘follow comprehensive social distancing and hand hygiene measures for 14 days’ beforehand.

Those in groups considered more vulnerable to the virus should still be told they ‘should consider self-isolating for 14 days’ before a planned procedure, Nice added.

This may include people who are more at risk of Covid-19, such people who are obese. 

Some types of surgery would carry an additional risk if the person being operated on already had Covid-19, and so they should consider self-isolating for 14 days before a planned procedure.

For example heart surgery, a major operation which would have a huge impact on someone’s health, could be detrimental if the patient has to fight off Covid-19. Their body would be weaker from the surgery and on top of that, the virus can put extra strain on organs like the heart during disease, it’s been shown.

Nice also warned those most at risk of Covid-19, including those of older age, from a black, Asian or other minority ethnic group, or with an underlying health condition, should be told so because it may influence their decision about whether to go ahead with their operation.  

In a statement, Nice said that the new recommendations aimed ‘to balance the risks associated with Covid-19 with the potential harms that can arise from delays in elective treatment and diagnostic procedures’. 

Professor Stephen Powis, national medical director of NHS England, said: ‘Local teams have made significant progress since May in bringing back services in a way that is safe for patients and staff.

‘This updated guidance, which reflects the continued decline in infections and the increased availability of testing, will help them now go further and faster.’ 

Layla McCay, a director at the NHS Confederation — which represents trusts across the country, is hopeful the new guidance will encourage people to have their operation.

She told The Times that health service leaders had said anecdotally that some of their patients had been put off going in for planned treatments because of the self-isolation rule.

These included those whose personal circumstances would not easily allow it, such as those in full-time jobs who can’t afford that much time off.

Ms McCay said that it made sense for decisions to be made locally, rather than having a generic national policy.

The Royal College of Surgeons of England welcomed the relaxation of rules, but had concerns the advice misses an opportunity to provide robust advice for testing.

Professor Cliff Shearman, vice president, said: ‘We believe the guidance misses the opportunity to provide robust advice on testing for patients and healthcare workers, which is crucial in preventing the spread of the virus and keeping surgery going.

‘In order to get through the backlog, surgery must be restarted safely, and this can only be done by having accurate and timely testing for healthcare workers and patients. 

‘This means we have to test staff regularly – preferably up to twice a week and they must have adequate and appropriate personal protective equipment (PPE). 

‘Patients should ideally be tested on the day of admission, as well as 72 hours before surgery takes place to take account of the level of false negatives in the testing regime. 

‘Adding to that, all patients should be tested upon discharge, not only when they are discharged to other care settings, but also into the community. Currently there is no mention in the guidance on testing for healthcare workers.’

He suggested patients are treated at a ‘Covid light site’ where they are at the least risk of catching the virus. 

The guidelines do state that people having inpatient surgery who stay in hospital for more than five days should be tested for SARS-Cov-2 between five and seven days after admission. 

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