What is the NICE guidance around Service organisation?
- 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.
Related FAQs
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.
Whilst it is acknowledged that doctors may be working in unfamiliar circumstances or surroundings, or in clinical areas outside their usual practice. Doctors should consider the best course of action to take in these circumstances by utilising the following:
- What is within their knowledge and skills
- What support other members of the healthcare team could offer
- What will be best for the individual patient given available options
- The protection and needs of all patients they have a responsibility towards
- Minimising the risk of transmission and protecting their health.
It is unlikely that an employer can place such a requirement on staff without infringing the employee’s privacy. If the employee is acting in accordance with the rules, limiting their activity would likely be considered unreasonable.
If the business has areas requiring an increased workforce whilst others require a reduced workforce, staff can be retrained and redeployed across the organisation or even across a wider group of companies. This will not reduce the wage bill but will avoid the need for redundancies. Making fundamental changes to an employee’s role and duties will require their agreement following a fair selection and consultation process.
Undeniably and understandably BAME staff, as well as those staff who are identified as being at a higher risk, are going to have high levels of stress and anxiety. For some, this may become of such severity that those staff should be considered to be disabled under the Equality Act 2010. The question as to whether someone is disabled is one that should be answered in conjunction with appropriate medical advice. But the question about how to support any staff suffering with stress and anxiety should not be left until that stage. Proactive steps need to be taken and expert advice obtained on what support measures should be put in place. We know that many NHS organisations are already giving the mental wellbeing of their staff the highest priority.
From our perspective, we would ask managers to be mindful that stress and anxiety is likely to feature in how an individual reacts to questions about the level of risk to their health and the impact on their duties. The conversations with some staff may not be easy to have and may be met with challenge.
For those staff who’s stress and anxiety is such that it would qualify as a disability, reasonable adjustments will need to be considered to the processes that you are applying.
An additional point to consider – it might be worth writing to all staff, asking them to come forward if they have any health conditions that they think you ought to be aware of, assuring them that such information is being given in the strictest confidence. You want to make sure that you are taking the appropriate measures to ensure their health and safety.