What happens if a patient is admitted to critical care during the pandemic?

There has been a significant amount of press coverage talking about institutional racism within the NHS not only in terms of the treatment of patients but also in terms of the low representation of ethnic minority staff in management positions. Whilst tackling that issue is beyond the brief here, it is important to recognise that sub conscious bias can, regrettably, play a part in decision making processes. An Employment Tribunal will explore a alleged discriminator’s conscious and sub conscious decision making and working in an environment which has not set out sufficient controls to avoid such sub conscious stereotyping places someone at a greater risk of being discriminated against.

In the context of the issues we are addressing here, i.e. risk assessments around BAME staff, as we have stated above, it is essential that BAME staff are represented at all levels in the discussion. Trusts need to be mindful that BAME are underrepresented in management positions.

BAME staff need to be included in the dialogue and need to have a safe place where they can challenge decisions that are being made in relation to them. There needs to be accountability in the processes applied. Meaningful conversations need to happen and concerns should not be dismissed.

It is the individual assessment by an organisation of its Covid-19 risk in its workplace that will be central. There may be common features across sites or areas of a site but every workplace will have a different risk profile depending on the service it offers and the workers who deliver those services.  No one size fits all.

The context of managing Covid-19 risk is the need to tie in with UK government guidance and HSE advice – which despite being a lot more comprehensive than it was, is not a panacea and will continue to evolve.  The difficulty we have with this in the context of the known increased risk to BAME employees from Covid-19 is that our understanding of the risk is, we would suggest, at a pretty early stage which makes it more difficult to address. However we know the increased risk exists and we owe our BAME workers a duty to manage that risk and keep them safe.

We also have a duty to consult employees.  This is critical in managing this risk – ensuring BAME workers have a loud voice in the assessment process will be very important.

Where an individual has a particular characteristic, for instance they’re pregnant, they have physical or mental disabilities etc, the law requires us to look at that individual or, where it is a group, that group of individuals and assess the risk to them and take any reasonably practicable steps to control the risk to them.

Risk control hierarchy is key. In “normal” businesses we reduce our Covid-19 risk by keeping people away from the workplace – “avoid, eliminate and substitute” then changing work practices (e.g. social distancing measures) before we arrive at PPE. In a healthcare context, we arrive at PPE a lot more quickly.

We need to ensure our people are given sufficient information, instruction and training so they can do their jobs safely and we must consult workers and involve them in workplace safety – this is going to be critical in the context of Covid-19.

The Cabinet Office has published a helpful Procurement Policy Note (“PPN”) on relief available to suppliers due to Covid-19 (available here). This can include making advance payments to suppliers, if necessary. The PPN sets out actions that public sector bodies should take (until at least 30 June 2020) to ensure continuity of service and to ensure that its suppliers can resume normal contract activity once able to.

The actions public sector bodies should be taking include:

• Informing its suppliers (that they believe are at risk) that they will continue to be paid as normal until the end of June 2020 (even if service delivery is currently interrupted). Risk might include supply chains collapsing and/or significant financial implications for a supplier
• If a contract involves a payment by results mechanism, basing payments on previous months (e.g. the average monthly payment over the previous 3 months), and
• Ensuring that invoices submitted by suppliers are paid immediately to maintain cash flow in the supply chain and help to protect jobs.

If you are a supplier to a public sector body, you must act transparently and on an open-book basis, making cost data available to your public sector clients. You must also continue to pay your employees and subcontractors / suppliers. Suppliers to the public sector must not expect to make profits on any undelivered elements of a contract. The PPN makes clear that, should suppliers be found to be taking undue advantage, or failing to act transparently, a public sector body can take action to recover payments made to that supplier.

The PPN requires public sector bodies to urgently review their contract portfolios and take steps to support suppliers who they believe are “at risk”. However, no definition of “at risk” is given in the document.  We would suggest that if you are a supplier and you have yet to hear from a public sector client, you should seek to get in touch with them as soon as possible, particularly if you have concerns about your supply chain, staff retention and/or are experiencing financial difficulties currently. Given the requirement for transparency, you may be required to provide evidence, so it may be helpful to have any relevant documentation ready to send, if necessary, as this may help ensure a decision is made by the public sector client more promptly, particularly as the public sector body may have a number of contracts to consider.

No. You should always treat employees consistently and fairly, but this doesn’t mean treating them all the same, or applying the same requirements. For those employees who have been homeworking and doing so without any problems, then they should be allowed to continue to do so.

We would anticipate that the vast majority, if not all, businesses will be approaching the return on a phased basis, which inevitably means some employees returning to work sooner than others. In reality then, you aren’t treating everyone the same, but try to be fair and consistent; you need to do what works best from a business perspective, but can you rotate people, require them to come in at different times etc. Where people perceive that the planned return is being worked out fairly they are far more likely to buy into this, which will help avoid resentments building up between colleagues.

CEST stands for Check Employment Status for Tax and, although this should do exactly what is says on the tin, there has been criticism of its accuracy and effectiveness. The CEST tool does not test whether there is ‘mutuality of obligation’ in the relationship which is a key factor in determining status.

You are not obliged to use CEST if you are happy with your own assessment process. If you do use CEST keep a record of the certificate given at the end of the assessment and keep this on the contractor’s file. HMRC will stand by the outcome of a CEST assessment provided the information has been honest and accurate. However, you must have entered information honestly to rely on it – you can’t just say what you want to get the right answer, as HMRC may test what you have said.  Also, many people are unhappy with the CEST tool and consider it leans too much towards employed status.