What are the NICE protocols around a patient’s ongoing treatment whilst in critical care during the pandemic?
- Start critical care treatment with a clear plan of how the treatment will address the diagnosis and lead to agreed outcomes.
- Review critical care treatment regularly and when the patient’s clinical condition changes.
- Stop critical care treatment when it is no longer considered able to achieve the desired outcomes. Record the decision and the discussion with family, carers and the patient (if possible).
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In most circumstances the answer will be no. It would be an infringement of their human rights. It could also be a criminal assault.
However where there is a high risk to employees of exposure to COVID-19, such as care homes and healthcare environments, you might be able to make it a requirement of their role to have the vaccine.
First, consider whether you need to have a blanket requirement covering all employees or whether only certain groups who work in the most high risk areas require the vaccine.
You will need to do a thorough risk assessment balancing the amount that the risk of exposure would be reduced against the interference with the employee’s human rights. Consideration will need to be given as to whether insisting on the vaccine is proportionate to the risk and whether other less invasive steps could be taken instead, such as maintaining social distancing, wearing a mask, washing hands.
Any requirement for employees to be vaccinated should be communicated clearly to employees and trade unions together with a clear explanation for why it is necessary.
On 13 March 2020 the Secretary of State for Housing, Communities and Local Government issued a Written Statement in respect of delivery restrictions.
In this respect, many supermarkets, food retailers and distribution centres in England operate under planning restrictions (conditions and/or obligations) which limit the time and number of deliveries from lorries and other delivery vehicles which can take place particularly at night primarily to protect the residential amenity of nearby residential property.
Key points in the Statement include;
- Given the exceptional challenges facing the UK from the coronavirus, it is vital that deliveries of food, sanitary and other essential products over the coming weeks can be made as quickly and safely as possible, minimising disruption to the supply chains. The likely pressures on driver capacity mean additional flexibility is needed so that retailers can accept deliveries throughout the day and night where necessary.
- That planning enforcement is discretionary and that local planning authorities should act proportionately in responding to suspected breaches of planning control.
- That local planning authorities should not seek to undertake planning enforcement action which would result in unnecessarily restricting deliveries of food and other essential deliveries during this period having regard to their legal obligations.
The Statement acknowledges that the increased frequency of deliveries particularly at night could have a temporary impact on residents. It therefore concludes that the Government will review the need for the flexibility outlined in the Statement after the pressure from the coronavirus has reduced and that it is the intention to withdraw it once the immediate urgency has subsided.
A link to the Written Statement is below.
- On admission to critical care, the risks, benefits and likely outcomes of the different treatment options should be discussed with patients, families and carers so they can make informed decisions about their treatment wherever possible.
- A member of the critical care team should be involved in these discussions whenever the patient or team needs advice about critical care to make decisions about treatment.
With the outbreak of coronavirus leading to a requirement for more employees to be working remotely, especially following Government advice that all non-essential travel including to and from work should be avoided, there has been an increased requirement for businesses to be more flexible in their approach to signing contracts.
The traditional approach has been for contracts to be printed and signed with a “wet ink” signature. However, this is not a strict legal requirement in the majority of circumstances and contracts can be formed without this degree of formality. English law recognises that contracts can be formed by electronic means – including the exchange of emails or the typing of a name into a document to signify agreement to it.
Whilst this approach offers a lot of flexibility, more sophisticated electronic signature tools are recommended for important documents, to enable the identity of the signatory to be validated and reduce the possibility of fraud.
If businesses are considering changing their contracting processes because of coronavirus, or because of a general shift towards paperless working, it is important to ensure that proper approval processes remain in place, and to consider whether a software tool should be used to complement them. Systems such as DocuSign are widely used.
There also remain some situations where legal advice is recommended before relying on an electronic signature:
- Where the other party is abroad – as local laws that are different from English law might apply
- If executing a deed – the law requires certain types of document to be executed as a deed (for example, transfers of land and powers of attorney), and the issues around electronic signature and witnessing are more complicated here
As their employer, you have an overriding duty to provide a safe system of work. The Trust would not be able to run a defence to say that an employee “waived their rights” and chose to continue to work. Provided the decision around restricting duties has been carefully thought out, a full risk assessment undertaken and the employee has been truly consulted about the impact on them, then the decision taken will be a reasonable management instruction. Failing to follow that reasonable management instruction could amount to a disciplinary offence.