The Coronavirus Act 2020 (the Act) received royal assent on 25 March 2020, allowing the provisions initially for a period of two years, with the powers to be lengthened or shortened, and will be reviewed every six months. Not all measures will come into force immediately as the Government has the power to switch these new provisions on and off when necessary. An overview of some of the provisions affecting health care professionals is outlined below.
The emergency registration of healthcare professionals
This is one of the changes with most impact at present, and has the aim of increasing the workforce available to the NHS. Although a power already held by the GMC, the Act gives healthcare regulators such as the NMC and HCPC the emergency registration of suitable individuals, such as those nearing the end of their training, or recently retired. The Act suspends the restrictions on hours worked for retired staff returning to practice, allowing them to return to increased commitments (over that of the previous 16 hours a week) without having pension benefits suspended.
Last week the GMC published that they had granted temporary registration to 11,856 doctors since opening the temporary register due to COVID-19. The NMC temporary register went live on 27 March, with more than 7,000 former nurses and midwives returning to practice to support health and social care services across the UK.
Additionally, there is provision for individuals to take emergency leave from employment to assist by volunteering to work in health or social care. Compensation will be provided by the Government for loss of earnings, travel and subsistence. To qualify, emergency volunteers must have approval to be an emergency volunteer from the relevant authorities. Upon application, they will be provided with an emergency volunteering certificate, and should provide this to their employers. It is estimated there have been around 750,000 volunteers so far.
Easing pressure on NHS and local authorities
For patients undergoing general investigations or non-emergency treatments; some healthcare services will be cancelled or delayed preventing unnecessary visits to hospitals and clinics, and allowing healthcare professionals to be redirected to areas of higher need. Readers will be aware that all non-urgent surgical procedures have already been cancelled. For dental practitioners the Chief Dental Officers issued guidance last week relating to dental care, more on which can be found here. The Act also makes changes to the Care Act 2014 enabling authorities to prioritise services offered according to the most urgent and serious needs. This unfortunately may mean that not everyone’s needs will be met over the coming months and there is likely to be a delay in some assessments for needs, care and support if workforces are depleted.
The Act allows NHS providers to delay assessments for continuing healthcare for those being discharged from hospital. However, only in exceptional circumstances will the requirement to conduct a needs assessment be eased and it is important to remember that all NHS providers are still very much under a duty of care towards an individuals for a risk of harm.
As an aside, the GMC has recently confirmed that those whose revalidation was due between now and the end of September will be deferred for deferred by one year to allow for efforts to be focussed elsewhere.
Mental health and mental capacity
The Act allows for patients needing urgent detention and treatment to be implemented using one doctor’s opinion rather than two, if the need to obtain two would cause an undue delay. There is specific provision for administration of medication for more than three months for certain detained patients in hospital without a second clinical opinion, again only if it is considered that a delay in detention would be undesirable or arranging a second opinion is impractical.
The 2020 Act also provides for temporary extensions or removals of time limits in certain situations, allowing for greater flexibility where services may be strained of resources. Emergency detention for those in hospital can be extended from 72 to 120 hours, and nurses’ holding powers can be extended from 6 to 12 hours. The cap on how long someone can be held in hospital while awaiting a report (currently 12 weeks) can be lifted. This provision should be brought in only when staff numbers are severely depleted, in a bid to continue to support the safe running of Mental Health services.
Health service indemnification
In usual practice NHS staff would generally benefit from claims indemnity through their employers, the NHS Trusts under the CNST or CNSGP. Those returning to practice should seek clarification with their Trusts that they too will be covered under State indemnity provisions . Having said that, as many returners will be temporarily registering with their regulators their positions will be different to that of ‘employees’ covered by employers indemnity schemes. In response, the 2020 Act provides for indemnity to be offered for NHS work undertaken by those on the temporary register.
Importantly, this applies only to clinical negligence, and so regulatory investigations would not be covered under this provision. Individuals returning to the register should personally ensure they are covered by indemnifiers/insurers for regulatory matters arising in the future.
State backed indemnity will also not apply if there is already an alternative insurance protecting that registrant, that will provide cover.
Registration of deaths
The Act looks to implement provisions that enable the systems in place to manage deaths to deal with increased demand for its services. Previously a death was required to be registered in person at a registry office. The list of those who can register a death is now to include funeral directors on behalf of their families, and the deaths can be registered by telephone. Provision of the required documents to register a death can now be done electronically.
The Act has removed the requirement for a second confirmatory medical certificate in order for a cremation to take place.
The Coroners and Justice Act 2009 provides for a requirement for an inquest to be held with jury if there is reason to suspect death was caused by notifiable disease. Whilst COVID-19 has been made a notifiable disease, it is not regarded as a notifiable disease for which the duty to hold the inquest with a jury applies. This should in the long run, speed up the time it will take to process inquests once the court systems are running more effectively again.
As more time passes, it will be interesting to see how the changes made by the Act impact on healthcare service provision and inquest proceedings (see our summary of the Chief Coroner’s latest guidance for further details on postponement of inquest proceedings found here). We will provide further updates and information as and when available.
Holly Paterson, solicitor, BLM