PERSONAL P ROT ECT ION EQUI PMENT
have access to adequate PPE, but that figure dropped to 34.7% for those in the North West. In London, the epicentre of the outbreak, 33.4% of respondents stated that they did not believe their Trust has an adequate supply of PPE.
Why there is such a variation in experience of surgeons, let alone every other strand of the health and social care workforce, is yet to be explained. It is inevitable that the ability of Trusts to respond to the need for PPE will be dependent on its governance, leadership, infrastructure and budget. The procurement of medical supplies may change considerably in light of the pandemic, and action has already been taken to shift procurement centrally5
so
that Trusts can be on more of an equal footing with one another while the supply chain is strained and coordination of that supply must be a priority. Some may consider that to be a welcome and overdue development; others may be concerned that centralisation will compromise the ability of Trusts to respond to their own specific needs and demands efficiently.
The provision of PPE alone is of course not the complete answer to how frontline staff can most effectively deal with COVID-19. Many, including the Vice President of the Royal College of Surgeons, have highlighted that provision of PPE must go hand in hand4
with a comprehensive
programme of testing. The availability of tests is also another contentious issue, and illustrates that the PPE issue cannot properly be considered in a vacuum. Outside of the hospital setting, the provision of PPE in care
homes has been drawn into sharp focus as the death toll in that setting has risen and questions have been raised about, not only PPE, but the management of social distancing measures and the assessment of whether these patients should be admitted to hospital.
The immediate and long-term implications for the health and social care sector could not be more profound, yet at the same time are completely uncertain. A growing number of healthcare staff have died and sadly more are likely to follow. If the issue of supply is not rectified before another peak of infections, the same potential flaws and risks will become entrenched and the ability to combat COVID-19 will be further compromised. Efforts to ensure that reasonable steps to procure and provide PPE must be maintained and consistent, clear, evidence- based guidance must be provided to the health and social care sector to enable that. In the longer term, the implications are similarly wide-ranging, particularly until a COVID-19 vaccine is developed and more is understood about the transmission of the virus. As discussed above, the approach to procurement of equipment and resources may change, as could the deployment of staff with their own physical vulnerabilities and the landscape of working conditions generally.
Litigation will inevitably follow from employees and members of the public, and the crucial issue could be whether the state has given its citizens, in the healthcare
setting its employees, sufficient protection from the virus. What sufficient protection will mean will be multifaceted, and a judicial review5
seeks to examine whether
there is an absolute duty on the state to provide sufficient protection. It could, and should, also address the interesting issues of whether and to what extent the state has failed to take reasonable steps to provide protection by way of PPE in the context of a world pandemic and complex logistics within the supply chain.
The burning question is whether the state has done all it could reasonably have done. The answer so far appears to be that it hasn’t, but hasty analysis without all of the available information is unhelpful and superficial. As more data emerges, we are able to start assessing what the real impact of the PPE crisis has been and where the flaws in the strategy really are. As well as potential judicial review proceedings about specific policies and decision making, employers are also likely to face claims arising from the workplace, for example negligence claims resulting in physical and/or psychological injury. Like almost every aspect of the post-COVID 19 landscape, it is impossible to foresee exactly what is to come. However, employers should be aware of their responsibilities to take steps to procure adequate PPE in line with the UK Infection Prevention and Control Guidance, and be aware of the following (non-exhaustive) points: l The escalation measures given in guidance by professional bodies for those raising concerns about PPE;
l The need to document decision making about the provision and supply of PPE;
l The need to consider adjustments to the workplace to account for increased fatigue, and the serious mistakes that could be caused by extreme fatigue and stress;
l How employees have been equipped and supported if they are operating outside of normal areas of expertise.
From an employee’s perspective, many are facing the impossible prospect of having to work in conditions that they consider places them at real risk of contracting COVID-19. Some will need to make decisions about whether they will refuse to treat patients if they are placed in an unsafe work environment, be that on the frontline of hospital care or elsewhere.
Compelling employees back to work if concerns remain for their safety will also be complicated. The BMA has issued very clear guidance; an individual should not face a disciplinary process or detriment if they are confronted with serious and imminent danger in the workplace.7
The BMA has stated its intention to robustly defend employment rights in such
18 l
WWW.CLINICALSERVICESJOURNAL.COM OCTOBER 2020
©PordeeStudio -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92
