What is the NICE guidance around clinical decision-making?

The guidance asks parties to act responsibly and fairly in performing and enforcing contracts. They are encouraged to act in a spirit of cooperation to achieve practical, just and equitable outcomes. In essence, rather than sticking strictly to the contract as agreed, they are encouraged to give each other leeway to deliver performance differently than they are required to do under the contract.

Whilst many employees may now have the resources and equipment to work from home, an employee may struggle to effectively work from home for a number of reasons. For example, an employee may not have a suitable working environment where they can work without being disturbed or alternatively, working from home for prolonged periods of time may be having a detrimental impact on the employee’s mental well-being.

In circumstances such as these, employers must carry out a careful assessment. Unfortunately, there is not any specific guidance as to when an individual cannot ‘reasonably’ work from home – it is likely that each case will be fact specific.

In relation to employees who are struggling with their mental well-being, employers owe their employees a duty of care. It is crucial that procedures are in place which will enable an employer to recognise the signs of stress as early as possible. In the circumstances, it may be appropriate to allow an employee to attend their place of work if this would help alleviate work-related stress or to prevent mental health issues.

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.

Funding audits are being paused and no new audits will be commenced during the lockdown period.

Transparency is considered to be central to the philosophy of the COP. The guidance provides details on issues concerning transparency of proceedings and involvement/attendance of P. Whilst there will be some difficulties with ensuring that remote hearings are accessible to the public as an ‘open court’, provisions have been made for the continued presence of the press where the facilities can accommodate this.