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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

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.

If you have to undertake collective consultation do you also have to carry out individual consultation?

Once the collective process concludes, an employer can make the decision to proceed with the restructure. They will then have 1-on-1 meetings with employees about the impact of the restructure on them. This will include consideration of alternative employment. There is no need to consult further about the proposal, merely the effect of the restructure on the individual.

What happens if a patient is admitted to critical care during the pandemic?
  • On admission to critical care, the risks, benefits and likely outcomes of the different treatment options should be discussed with patients, families and carers so they can make informed decisions about their treatment wherever possible.
  • A member of the critical care team should be involved in these discussions whenever the patient or team needs advice about critical care to make decisions about treatment.
If an employee refuses to wear a face mask at work, can I discipline or dismiss them?

In appropriate cases, disciplinary action and then dismissal may be fair if an employee refuses to wear a face covering in the workplace. For example, if this is in breach of the government guidance or if  employer has issued a reasonable management instruction to this effect due to an identified health and safety risk.

It is important that employers use a fair and reasonable procedure when deciding whether to discipline and/or dismiss an employee and that its actions does not unlawfully discriminate against employees who have legitimate reasons for not wearing masks, such as those individuals who have health conditions like asthma.

What was included in the Government’s self-employment income support scheme?
  • A taxable grant worth 80% of the average monthly profit over the last three years (one or two years will be reviewed for those who do not have three years of tax returns)
  • The grant will be capped at £2,500 per month
  • The scheme was initially available for three months and has been extended as necessary
  • Individuals claiming a grant can continue to do business (unlike employees who must not work when furloughed)