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What is the NICE guidance around clinical decision-making?

  • Be alert to the fact that guidance on treating Covid-19 may change with emerging knowledge/scientific data and this may require subsequent modifications to treatment.
  • Critical care staff should support healthcare professionals who do not routinely work in critical care but need to do so.

Related FAQs

One of my employees has contracted Covid-19, should I report it under RIDDOR?

You must only make a report under RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) when:

  • An unintended incident at work has led to someone’s possible or actual exposure to coronavirus. This must be reported as a dangerous occurrence
  • A worker has been diagnosed as having COVID 19 and there is reasonable evidence that it was caused by exposure at work. This must be reported as a case of disease
  • A worker dies as a result of occupational exposure to coronavirus.

Last updated on 27th March, 2020

I would like to make a Lasting Power of Attorney. How do I and my Attorney(s) get our signatures witnessed and who can be my Certificate Provider?

As with a Will, your solicitor can take instructions by telephone, Skype or a similar tool. Your solicitor can then post or email the documentation to you. As with Wills, your signature and those of your proposed Attorneys will need to be witnessed, but in this case only by one other person. However, there are specific requirements as to who can witness your signature. The witness must be aged 18 or older and cannot be your Attorney but they can be your Certificate Provider.

Your Certificate Provider must either be someone you have known personally for at least two years or an appropriate professional. However, they must not be your Attorney and they must not be a member of your family or the partner, boyfriend or girlfriend of a member of your family or a business partner or employee of yours.

Also, if you are living in a care home, the Certificate Provider cannot be the owner, manager, director or employee of the home you live in.

Given the current restrictions on movement, if you have regular medical checks you could ask your GP or another medical professional to witness your signature and act as your Certificate Provider when you go to see them or they come to you. Alternatively, if someone you have known for two years or more is dropping off essentials, they could act as a witness and Certificate Provider remembering to retain the necessary distance and protective measures.

Concerning your Attorney(s) you cannot act as their witness. Otherwise, anyone aged 18 or older can act as their witness, including the other Attorney. Ideally, a witness to your or your Attorney’s signatures should not be a family member for the sake of impartiality and to avoid disputes. If necessary they can be.

Last updated on 1st April, 2020

How are the Courts applying the new guidance?

Overall it is our experience that the Courts are quickly adapting in the context of the Coronavirus epidemic and making pragmatic decisions. The Judges seem live to the difficulties currently been faced by practitioners dealing with litigation and they are applying the new guidance.

The Courts are also mindful of pressures on NHS frontline staff and are taking steps not to put additional pressures on them at this time, including in our experience vacating an imminent Trial.

Last updated on 15th May, 2020

Can I wait until April to carry out assessments?

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.

Last updated on 4th February, 2021

What is the guidance in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards during the Covid-19 pandemic?

The Department of Health & Social Care has published guidance for hospitals, care homes and supervisory bodies on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) during the coronavirus pandemic.

In many scenarios created or affected by the pandemic, decision makers in hospitals and care homes will need to decide:

  • if new arrangements constitute a ‘deprivation of liberty’ (most will not), and
  • if the new measures do amount to a deprivation of liberty, whether a new DoLS authorisation will be required (in most cases it will not be).

If a new authorisation is required, decision makers should follow their usual DoLS processes, including those for urgent authorisations.

A summary of the key points to be taken from the guidance is outlined below:

Use of the MCA and DoLS due to Covid-19

  • During the pandemic, the principles of the MCA and the safeguards provided by DoLS still apply.
  • It may be necessary to change the usual care and treatment arrangements, for example to provide treatment for people with Covid-19, to move them to a new hospital or care home to better utilise resources or to protect them from becoming infected.
  • All decision makers are responsible for implementing the emergency Government health advice  and any decision made under the MCA must be made in relation to a particular individual, it cannot be made in relation to groups of people.

Best interest decisions

  • In many cases, a best interests decision will be sufficient to provide the necessary care and treatment for a person who lacks the capacity to consent to the care and/or treatment arrangements during this emergency period.
  • If an individual has made a valid and applicable advance decision to refuse the treatment in question, then the relevant treatment, even for Covid-19, cannot be provided.

Delivering life-saving treatment

  • Where life-saving treatment is being provided in care homes or hospitals, including for the treatment of Covid-19, then the person will not be deprived of liberty as long as the treatment is the same as would normally be given to any person without a mental disorder.
  • The DoLS will therefore not apply to the vast majority of patients who need life-saving treatment who lack the mental capacity to consent to that treatment, including treatment to prevent the deterioration of a person with Covid-19.

The full guidance can be found here.

Last updated on 14th April, 2020