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).
Related FAQs
- Delays in preparing and submitting applications to comply with pre-commencement conditions. In this respect there can be lengthy timescales gathering evidence to support applications to comply with pre-commencement conditions, ecology, contamination and archaeology are examples of matters which can require significant periods of survey work
- Following on from the above the ability to get required experts on the site necessary to undertake the required survey work
- Delays in the determination of applications to comply with pre-commencement conditions. In this respect whilst there are deemed discharge provisions/procedures concerning certain matters, the provisions cannot be used to discharge all types of conditions
- The ability to get people on site to undertake material operations
In the circumstances, it is advisable to start considering the implementation of the planning permission early and the earlier the better. Under current legislation whilst it is possible to vary conditions, albeit potentially leading to wider issues, it is not possible to extend the life of a planning permission meaning that lawful implementation is essential to avoid the loss of that permission.
If a planning permission is lost, amongst other things it may not be granted again or may not be granted on similar terms. In the circumstances, it is advisable to seek advice given the specific facts of the case to minimise the risk of a planning permission not being lawfully implemented and expiring.
- Audit
- Identify your off-payroll contractors
- Determine the status of off-payroll contractors
- CEST – HMRC employment status checker for tax purposes
- Communication – liaise with affected workforce
- Contracts – get them compliant
- Consider the Ward Hadaway toolkit
In the event that the contractor is displaying one or more of the above signs, then it is worth considering the following actions to protect the employer’s position as far as possible:
- Closely monitor the financial and on-site performance of the contractor in order to assess the likelihood and timing of potential insolvency
- Ensure all bonds, guarantees and collateral warranties have been obtained under the building contract, and if not take steps to obtain them immediately
- Consider the terms of any guarantees to ensure that the guarantor’s obligations are not inadvertently discharged
- Bonds may require adjudication to have been commenced (or even completed) prior to insolvency so as not to be stayed pursuant to insolvency laws
- Carry out an audit of the on-site plant, equipment and materials, and evidence this (for example with photographs and written records)
- Ensure that copies of all relevant documentation have been obtained, for example drawings, specifications and anything required to comply with CDM requirements. If not, take steps to obtain these
- Review the payment position under the building contract, including whether any over payments have been made to the contractor which should be reclaimed, what retention is held or has been released, whether any payment notices may be necessary, and whether there are rights of set-off which should be exercised
- Check whether the involvement of any third party is required, for example funders, landlords, tenants or purchasers who may have rights in relation to the building contract and how it is administered
- Review the terms of the building contract relating to contractor insolvency – hopefully the parties will be fully aware of the building contract terms and have been administering it correctly to date, but if it has been hiding in a draw then now would be a good time to dust it off and ensure familiarity with the relevant provisions!
In general. there is often a stick or twist decision. If the employer chooses to financially support the contractor (for example by agreeing different payment arrangements), this may help to keep the contractor solvent and more likely to complete the project, but it also exposes the employer to greater risk if the approach is not successful. Conversely, withholding payments from the contractor may make insolvency a self-fulfilling prophecy. The precise advantages and disadvantages of the approach will be dependent on the specific circumstances of each case.
Some employers falling into the third group of organisations described above could understandably feel aggrieved that on the first reading of the guidance they are not able to furlough employees and rely on the Government scheme. Many publicly funded organisations that are not public sector employers, receive a package of public funding with little expectation on how that funding is used or applied, other than broadly for it to be used in providing the services it is contracted to deliver. Also, several publicly funded organisations have many different income streams and the element of funding that is received from the public purse can be only an element of their operating costs.
Unfortunately there is still no clear guidance on when employers falling into the third category identified above can use the scheme. The only reference in the guidance on this states that where organisations are not “primarily funded” from the public purse and whose staff cannot be redeployed to assist with the coronavirus response, the scheme might be appropriate to be used for some staff. This seems to suggest that where an employing organisation is not wholly or mainly funded by public funding and staff cannot be redeployed to work in areas in the effort to combat coronavirus, then it would be appropriate for the employer to access the scheme.
If considering applying for grants under the scheme a sensible approach would be to look at the combined total of your public funding and payments under the scheme and make sure it will not represent more than 100% of the level of total income you would have expected to receive during this period in a non-Covid scenario.
Local Authorities are expected to maintain support to suppliers and this should be considered:
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.