What is the NICE guidance around clinical decision-making?

The current guidance issued by Mr Justice Hayden confirms that remote hearings may be conducted using the following facilities and that this will be the default position until further direction:

• By way of an email exchange between the court and the parties;
• By way of telephone using conference calling facilities;
• By way of the court’s video-link system, if available;
• The use of the Skype for Business App installed on judicial laptops;
• Any other appropriate means of remote communication, for example BT MeetMe, Zoom or FaceTime.

Yes, but as a last resort. In summary, the law requires employers:

• to assess the workplace risks posed to new or expectant mothers or their babies;
• to alter the employee’s working conditions or hours of work to avoid any significant risk to them;
• where it is not reasonable to alter working conditions or hours, or would not avoid the risk, to offer suitable alternative work on terms that are not “substantially less favourable”;
• where suitable alternative work is not available, or the employee reasonably refuses it, the employer should consider whether it is appropriate to suspend the employee on full pay.

We recommend that ongoing support is provided to all MHFA’s beyond completion of the MHFA training. It is necessary to do refresher training (approx. every 3 years) and ideally ongoing ‘continued professional development’ should be provided as well as regular opportunities for debriefing / seeking support. One way of supporting your MHFAs in the workplace is by creating a buddy system amongst the MHFAs. That way the individuals carrying out the role of MHFAs have a support structure in place amongst themselves. All trained MHFAs can also reach out to management to discuss any concerns they have or to seek any further support they need.

If the duties are so fundamentally different from their contracted role, then yes. For example, if you are asking a frontline clinical member of staff to undertake administrative tasks in another area, then this will be a fundamental change to their terms and conditions for which you need their consent.

If there is a minor alteration to their duties, or the clause within their contract is wide enough to cover their amended duties, then arguably to do not need their consent but best practice would be to obtain their agreement.

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.