Covid19 inquiry – revised draft terms of reference

In mid-March we noted the publication, for consultation and comment, of the draft terms of reference (TOR) for the independent inquiry into the national impact of Covid-19. The inquiry was set up by the Prime Minister and will be chaired by Baroness Hallett, a retired Court of Appeal judge.

Baroness Hallett’s team have analysed responses on the TOR and made several important revisions to the inquiry’s brief. The revisions proposed sharpen the TOR by, for example

  • placing greater emphasis on studying the impact on mental health of the pandemic
  • specifically including impacts on health and care workers, and on children and young people
  • examining the effects on the safeguarding and support for victims of domestic abuse
  • adding the effects of the closures of the travel and tourism sector and of places of worship as matters for consideration
  • looking at initial contacts with health services, advice lines and primary care, and
  • considering the impact on ante- and post-natal care

Other revisions of a more functional nature touch on the collaboration between national, devolved, and local government and add the use of research and expert evidence to the need to consider how data was used and made available.

The inquiry team also recommends reviewing not only how decisions were made, communicated and implemented but also how they were recorded. This point speaks to a concern that private e-mail or WhatsApp accounts may have been used rather than official departmental channels.

I am grateful to my colleague Rachel Quinn for carefully examining the documents and preparing the attached note which highlights Baroness Hallett’s proposed revisions. New text is shown in yellow and the turquoise highlighting shows text which has been moved.

The revised terms of reference for the inquiry were sent to the Prime Minister in May. At the time of writing, there has so far been no formal response. The inquiry continues to make some progress, however, and today announced the appointment of 49 junior counsel to assist with investigations, in addition to 11 QCs who were appointed at the beginning of May.

For the changes to the Annex: Recommended Terms of Reference, please click here and see the highlighted sections.

Written by Alistair Kinley, Director of Policy & Government Affairs (Alistair.Kinley@blmlaw.com).

High Court reconvenes in landmark judicial review

Over the last six days the High Court reconvened to hear the judicial review of Gardner v Secretary of State for Health and Social Care, NHS Commissioning Board (NHS England) and Public Health England.

The Defendants were accused of failing their duties to ensure the safety of care home residents due to prioritising the objective of obtaining further capacity in hospitals by discharging patients into care homes. It was also alleged they continued to fail their duty by encouraging care homes to follow a symptoms based approach in their published guidance, even when the science suggested that asymptomatic individuals could transmit the disease. These decisions were made during a critical period and involved a known vulnerable population which resulted in excess of 20,000 deaths.

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Easing of COVID-19 restrictions – how will this affect the social care sector? 

The Prime Minister this week announced the end to the majority of COVID restrictions in England There will no longer be any legal requirement to self isolate and the availability of free PCR and lateral flow tests will be significantly reduced. 

What will be the effect on the social care sector?

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The government publishes its long-awaited response to the Paterson Inquiry

The Paterson Inquiry has again reared its head as the government gives its full reply to the findings of the independent inquiry led by the Reverend Graham James, former Bishop of Norwich.

For those unfamiliar with the origins of the Paterson Inquiry, Ian Paterson is a disgraced breast surgeon who was jailed for 20 years in 2017 after being convicted of 17 counts of wounding with intent and three counts of unlawful wounding of patients he had treated in the private sector. Paterson subjected more than 1,000 female patients, including children, over a period of 14 years, to operations that were either medically unnecessary or left them exposed to a recurrence of breast cancer. Paterson later  became the subject of an Inquiry which concluded in February 2020 with multiple recommendations being made to prevent this kind of gross malpractice from occurring again.  Of particular interest to the Inquiry was the inherent failure of the system to stop these events over so many years of practice in the NHS and independent sector.  

The 15 formal recommendations made as a result of the Inquiry, though far reaching, fall short of demanding new regulatory and assurance processes. The chair of the Inquiry described a ‘healthcare system which proved itself dysfunctional at almost every level’, but did not advocate for a total regulatory overhaul. Rather, the focus of the recommendations was to ‘get the basics right and implement existing systems’ in both the NHS and private medical sectors, making full use of the resources available to ensure proper oversight and scrutiny of medical professionals.

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Court of Appeal decision in Pawley case – part 19 or 20?

Readers of this blog, particularly those with an interest in dentistry will be aware of the developments that have been taking place over the last few years in relation to the issue of whether dental practices/owners are vicariously liable for the actions of associate dentists engaged by them and/or owe a non-delegable duty of care to patients treated at their practice.

The judgments in a series of recent cases (Ramdhean v Agedo and the Forum Dental Practice; Breakingbury v Croad; and Hughes v Rattan*) have all held that they do.

The practical difficulties for those working in the field of dentistry thrown up by these decisions arise in part due to the fact that dentists are required by The Dentists Act to have an indemnity arrangement in place which provides appropriate cover for acting in that capacity. The dentists are generally engaged on a contract for services i.e. are self employed and practice owners have relied upon that status and the statutory (and regulatory) requirement for a dentist to arrange indemnity. The practice owners have not previously arranged separate practice cover for injuries sustained by patients in the course of treatment.

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The APPG Report: what kind of changes can we expect to see in the regulation of aesthetic non-surgical cosmetic treatments? 

The All-Party Parliamentary Group on Beauty, Aesthetics and Wellbeing (APPG) is a cross-party group established in May 2019 to champion the aesthetic industry in Parliament.  It has recently published  its comprehensive report following a year-long inquiry into the standards for non-surgical cosmetic treatments. The APPG’s report sheds  light on the absence of legal framework in this area.

The APPG identifies “a need for the beauty industry and the medical professions to work together to seek solutions that raise standards and protect the safety and wellbeing of consumers”.  This article will outline some of the APPG’s key recommendations which are likely to have a significant impact on all parts of the industry.

A national minimum standard

The report criticises the current lack of regulation defining who can carry out these treatments. At present, procedures can be carried out by virtually anyone and there is no legal obligation for the provider to be insured. The APPG has proposed that both aesthetics practitioners and medical practitioners must be able to prove their competence by passing a minimum standard of training before administering treatments. The report considers how CPD could be used as a mechanism of ensuring this minimum standard continues to be met by practitioners.

Mandatory regulated qualifications

In response to the rising popularity of self-accredited courses, the report calls for stricter qualification rules to be put in place. There is strong support from the likes of the British College of Aesthetic Medicine that high-risk procedures, such as dermal fillers, should be restricted to being carried out by medical practitioners. The APPG recommends reclassifying dermal fillers as Prescription Only Medicines. This change in regulation would likely result in a higher proportion of doctors carrying these treatments out in the future, if non-medically qualified aesthetic practitioners are unable  to continue offering them.

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New ‘Speaking up’ guidance for GOC registrants

On 28 October 2021, the General Optical Council (GOC) launched new ‘Speaking up’ guidance, previously known as ‘Raising concerns with the GOC (whistleblowing) policy.’ The guidance is aimed at helping both individual and business registrants identify where they need to consider the professional requirement to speak up when a patient or public safety may be at risk. It should be read alongside the GOC Standards for Optometrists and Dispensing Opticians, Optical Businesses and Optical Students. It should also be considered in conjunction with the GOC’s professional duty of candour. The guidance is split into two parts, with Part 1 applying to individuals and Part 2 to business registrants.

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Care rates continue to increase, but by how much?

On 26 October 2021 the Office for National Statistics released the latest data from the Annual Survey of Hours and Earnings (ASHE). These are provisional figures based on estimates of income from a 1% sample of workers’ HMRC records for the tax year ending 5 April 2021, and they will be revised and updated in due course as the data is finalised. The provisional data provides a steer on how the earnings across all industries are changing. Those dealing with catastrophic injury claims will be particularly interested in the data relating to care workers as the rates are directly applicable to the recalculation of existing periodical payment orders.

The latest data shows an average increase in care rates across the 60th-90th percentile of 2.6%. Practitioners will be aware that the hourly rates actually compensated within a catastrophic injury claim are typically significantly higher than those quoted in ASHE, given that ASHE covers all care workers (most of whom are state funded) whereas a catastrophic injury claim is typically compensated on the basis of a private care package which can be twice the hourly rates quoted within ASHE. That being said, the rates might offer an indication of trends in care costs generally.

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The Assisted Dying Bill: the potential regulatory implications for health professionals

On Friday 22 October, Baroness Meacher’s Assisted Dying Bill progressed to the Committee Stage after being debated in the House of Lords. If enacted, it will undoubtedly be a seminal moment in healthcare law. It would permit medical professionals to lawfully prescribe end of life medication to terminally-ill adult patients of mental capacity who are reasonably expected to die within six months (and voluntarily making such a request), essentially legalising physician-assisted suicide. Although the majority of speakers were in favour of the bill, Hansard reveals how many members hold great concern for the safeguarding of vulnerable individuals and for the impact the bill may have on the public’s trust in doctors. It is therefore entirely understandable why this issue is prompting such widespread debate.

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Gardner v Secretary of State for Health and Social Care – Judicial Review Further Update

The public challenge brought by claimants Dr Cathy Gardner and Fay Harris in respect of the government’s COVID-19 hospital discharge policy reconvened on Friday, 22 October. The days’ submissions followed from the adjourned hearing on Tuesday, 19 October, reported here. This blog will explore the key issues addressed at the hearing, and consider the way forward for the claimants’ case.

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