COVID-19 Healthcare: RCAs to be undertaken for all healthcare-associated infections
UK & Europe
On 2 July 2020, the Government published the Health Service and Social Care Workers (Scrutiny of Coronavirus-related Deaths) Directions 2020 ("the Directions") to ensure that NHS Trusts and NHS Foundation Trusts prioritise the services of Medical Examiners to scrutinise the deaths of health service and adult social care staff from COVID-19. These Directions came into force on 3 July 2020, but they also apply to deaths which occurred before this date.
Prior to the publication of the Directions, deaths of health care workers and social care staff due to COVID-19 had to be reported to NHS England/NHS Improvement ("NHSEI") or the Department of Health and Social Care respectively. The Directions now also require these deaths to be scrutinised by Medical Examiners.
Medical Examiners are practising or recently retired medical practitioners who have been fully registered with the GMC for at least 5 years and have still have a licence to practise. The purpose of the Medical Examiner system is to provide greater safeguards for the public, by ensuring proper scrutiny of hospital deaths, ensure the referral of appropriate deaths to the coroner, and provide a better service for the bereaved to raise concerns to a doctor who was not involved in the care. The Medical Examiner should review the medical records, speak with the healthcare staff and the bereaved family and address these questions:
And as a result of these new Directions, in relation to health and social care staff, the Medical Examiner should also:
The Directions do not apply in respect of a healthcare or social care worker's death where the coroner is already considering whether to conduct an investigation, if a coroner has sought a post-mortem or if the coroner has begun an investigation. However, they do apply to both hospital and community deaths. The Directions will be reviewed by 31 December 2020.
As a result of these Directions, the deaths of all health care and social care staff from COVID-19 will now receive some form of scrutiny, whether that is via a coronial investigation, or at least a review by a Medical Examiner. Trusts must co-operate and prioritise Medical Examiner reviews for COVID-19 related deaths of staff members, including where they do not currently employ a Medical Examiner. As the Medical Examiner must explicitly consider whether the death was due to a 'work related infection', this means the decision will no longer rest solely with the employing NHS Trust.