Actions to take now for life after COVID-19
The number of coronavirus infections within the UK is not due to peak until May or June, with the crisis expected to last until next Spring
It might feel difficult to think ahead to life after COVID-19. We know that within the NHS, and the wider health and care sector, many people are just living from one day to the next, doing the best that they can, in very difficult circumstances, without the time or energy to look beyond the crisis. However, we can be sure that some decisions will be challenged, both when they are made and also months/years later. Some planning and documentation now, and throughout the crisis, will save a lot of work later.
As is common following a serious incident, the future will bring questions, investigations, complaints, claims, and possibly a public inquiry, in relation to decisions that were made during the crisis (under pressure). Further, as the pressure upon the available resources increases, hard decisions will need to be made about care prioritisation and delivery, and some of those decisions will be challenged, with demands for an escalation of care.
Given the growing pressures, and the speed with which decisions have to be made, it is entirely understandable that the reasoning behind some decisions may not be recorded or well documented. However, staff and trusts may be asked to explain their decisions days, weeks, months or even years later. Taking steps now, and throughout the crisis, can play an important role in an organisation, and its staff, protecting themselves from challenges down the line, which could come in the form of claims (e.g. clinical negligence or employer’s liability) or criticisms from Regulators or Commissioners.
There are some simple measures that will help to reduce some future problems and stresses:
- Keep a copy of any guidance, letters or directions etc., and record when it was received by the organisation. One recommended approach is to maintain a spreadsheet (or table) to keep a log of what was provided and when, with the relevant documents retained (as an electronic attachment where possible).
- If a decision is made to deliver care in a different way it is important to keep a record of thinking behind that decision, with reference to the considerations, pressures, guidance or advice at the relevant time. It is easier to record the reason for a decision at the time than trying to piece things together at a later stage. The trust needs to consider how and where these decisions are recorded. Any guidance and advice considered as part of this decision- making should ideally be cross-referenced to the tracking spreadsheet mentioned within the previous point.
Patient specific care decisions
As decisions will have to be made regarding the prioritisation of limited resources (e.g. beds,equipment and/or staffing levels), it is important to ensure that:
- There is a clear and robust process, with reasons for the decisions documented.
- Decisions should be kept under review (e.g. responding to changes in priorities, patient demand, the chance of recovery etc).
- There must be an effective mechanism for dealing with challenges/appeals, which records the reasons for the outcome of the appeal.
In normal circumstances there will be occasional disputes about the escalation/ceilings of care. These disputes may well become more frequent during the crisis, as patients do not receive the level of care that would normally be provided, or where care is taken away from one patient to be given to another instead. If a family challenges a care decision (at the time or many months later) how will the reasons for the level of care be evidenced? Will the trust be able to show why patient ‘A’s’ care was prioritised of over that of patients ‘B’ and ‘C’?
- Where staff are working in a different department, outside their usual area of expertise, or are returning/new staff, have steps been taken to ensure that records are kept of the training and induction provided to the usual good standard, to protect patients, staff and the trust.
- The availability, safe use and the appropriate type of PPE, is currently a significant point of concern for many within the NHS. Questions have been raised about the changes in the national guidance in relation to the situations where FFP3 masks should be used, linking the decision to a lack of availability – a prioritisation of resource rather than a focus upon protecting staff. It is important to ensure that records are kept about:
I. The national PPE guidance to different areas at different points in time
II. The local guidance and training to staff regarding the use of PPE
III. What PPE is available, and where within the trust
IV. In the event that the recommended PPE is not available, there should be a record of why the PPE was not available and what steps (if any) had been taken to address the issue
We are helping NHS trusts and a wide range of organisations with their preparations and response to the developing crisis. Please get in touch for specialist advice in relation to the above, or any aspect of your COVID-19 response.
The situation is changing each day and it is important for everyone to keep abreast of the latest guidance. Specialist advice to help manage the workplace risks associated with COVID-19 can be provided by Weightmans’ Regulatory Team.