What are the NICE protocols around a patient’s ongoing treatment whilst in critical care during the pandemic?

The Chief Coroner supports the position, communicated by NHS England and the Chief Medical Officer that Covid-19 is an acceptable direct or underlying cause of death for the purposes of completing the Medical Certificate of Cause of Death (MCCD) and is considered a naturally occurring disease. This cause of death alone is not a reason to refer a death to a coroner under CJA 2009.

If the cause of death is believed to be due to confirmed Covid-19 infection, there is unlikely to be any need for a post mortem to be conducted and the MCCD should be issued, and guidance is given on how this is delivered to the Registrar in the event of the next of kin/informant being in self-isolation. 

In a hospital setting the MCCD process should be straightforward because of diagnosis and treatment in life. This may be more complex in a community setting. The Coronavirus Act 2020 however expanded the window for last medical review from 14 to 28 days. Outside of this, the death will need to be reported to the coroner.

Although Covid-19 is a naturally occurring disease, there may be additional factors around the death which mean it should be reported to the coroner; for example, the cause of death is unclear, or where there are other relevant factors. Guidance is given to coroners on how to manage such reported deaths, particularly where post mortem examinations may not be readily availability.

There should be some data collected as to the type and number of interactions MHFA are having, to ensure no one individual or individuals are overloaded. MHFAs should be encouraged to maintain regular self-care practice, to lean in to all support provisions available in their organisation, to engage in peer support, and to take a break from their role as a  MHFA to prioritise their own wellbeing as needed. It is also important that those who volunteer to be MHFAs have the support of their managers.  So they have the time to do both their core role and their MHFA duties without feeling pressurised to cram work into spare time to make up for time spent on MHFA duties.

Because they all have devolved governments, when there are changes to spending levels in England, the Government makes adjustments to the amount of public expenditure allotted to Scotland, Wales and Northern Ireland.  In this case £60 million will be made available for all of the devolved administrations as a result of the £370 million funding allocated to charities in England. This is broken down as follows:

• £30 million for the Scottish Government
• £20 million for Welsh Government
• £10 million for the Northern Ireland Executive

There may be further allocations, dependent on the final projects funded, through the £360 million direct grant pot.

• Trusts should allow for telephone advice rather than face-to-face review from critical care when clinically appropriate.
• Hospitals should discuss the sharing of resources and the transfer of patients between units, including units in other hospitals, to ensure the best use of critical care within the NHS.

Please note, the above is intended to provide a summary of the key recommendations which emerge from this guidance. Access to the full guidance can be found here.

The parties to litigation should still take the steps they have been ordered to take and comply with any Orders made by the court. If for any reason it looks as if a direction cannot be complied with because of the Covid-19 virus then an extension of time can be agreed with the other party (up to 28 days) or through the court. We are aware that Orders have been made extending the time for certain steps to be taken by 56 days.