What is the NICE guidance around clinical decision-making?

We don’t recommend this. Status determination statements must be issued before 6 April 2021 for current engagements and the appropriate deductions are to be made on payments for services carried out on or after 6 April 2021.

• On admission to hospital, all adults should be assessed for frailty, irrespective of their age and Covid-19 status. Regard should be had to any comorbidities and underlying health conditions.
• If a patient is identified as potentially having Covid-19, the UK Government guidance on infection prevention and control measures should be followed.
• If Covid-19 is then diagnosed in someone who is not isolated from admission or presentation, the UK Government guidance on actions required when a case was not diagnosed on admission should be followed.

• Yes, if contributions to a defined contribution (“DC”) scheme exceed statutory minimum for auto-enrolment purposes, it may be possible to reduce employer contributions to the statutory minimum, but not further.
• However, the processes required for reduction of DC employer contributions will necessitate obtaining legal advice:
  • Reducing employer contributions may require changes to the employment contracts of affected staff (as does the furlough process).
  • Reducing employer contributions may also require negotiation with trade unions or other staff representative forums.
  • Where group personal pensions are used, the contractual format may not permit changes of employer contributions, and hence it may also be necessary to enter into a new contractual arrangement. Choosing a new group personal pension plan is a not insignificant task in itself.
  • Employers with at least 50 employees are required to conduct a 60-day consultation process with affected employees if they propose to reduce employer contributions (but please see below).
  • Finally, it may require a change to the scheme rules and engagement with the scheme trustees if the scheme is operated under trust.
• For DB schemes, specific considerations apply (see the last section, below).

There are four criteria which must be satisfied if an agreement is to be considered exempt:

• It must improve production or distribution, or promoting technical or economic progress – the guidance suggests that cooperation ensuring essential goods and services can be made available to the public, or an important sub-set of the public such as key workers, will satisfy this criterion.
• It must allow consumers a fair share of the resulting benefit – the guidance suggests this will be the case where the action prevents or reduces shortages.
• It must not impose on the undertakings concerned restrictions which are not indispensable to the attainment of the above benefits – the guidance suggests this will be the case where the cooperation is the only reasonable option due to the urgency of the crisis and where the cooperation is temporary in nature.
• It must not afford the undertakings concerned the possibility of eliminating competition – therefore the parties must endeavour to retain competition in respect of the products (in particular price competition).

• 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.