What is the NICE guidance around clinical decision-making?

Follow up to date UK Government advice. This can be found at: https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19/guidance-for-employers-and-businesses-on-coronavirus-covid-19

For best practice and more detailed information; consult the HSE’s website at https://www.hse.gov.uk/news/coronavirus.htm

Failing to follow the guidance is likely to be regarded as failing to take all reasonably practicable steps.

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.

Small suppliers (defined by reference to certain financial indicators) are temporarily exempt from these new restrictions until 30th March 2021 in order to account for the difficulties to small suppliers during the Covid-19 pandemic.

There are also certain industries that are exempt from these restrictions (for example financial services).  The Secretary of State may also create further exemptions framed by reference to kinds of company, supplier, contract, goods or services or in any other way.

The Chancellor has announced that all retail and hospitality firms will be exempt from paying business rates for 12 months in a bid to combat the financial damage caused by the outbreak.

This covers pubs, restaurants and shops. After initially covering businesses with a rateable value of less than £51,000, this has now been extended to cover firms of any size, “irrespective of rateable value.”

Smaller businesses have also been offered the option of a £25,000 grant to cope with the impact of coronavirus.

Since the announcement, the Government has also introduced a wide-ranging package of targeted measures to provide financial support to businesses during the coronavirus crisis.

It remains the case that anyone who has symptoms, however mild, or is in a household where someone has symptoms, should not leave their house to go to work. Those people should self-isolate, as should those in their households.