Reset phase ethical framework inductively developed through the review (adapted from the UK Government’s Pandemic Flu Policy Ethical Framework17)
| Ethical principle (from Pandemic Flu Ethical Framework) | Subdomain |
| Respect | Involvement (ie, right to express views on matters affecting them, engaging those affected by decisions, active communication/outreach including public health messaging). |
| Respecting choices about personalised care (best interests of person as a whole including decisions in best interests of children and young people). | |
| Collaborative working/engagement (organisational coordination including redeployment; NHS volunteer scheme, clinical teams, CCGs, local authorities, nightingale and independent hospitals; coproduction with voluntary sector, patient orgs, equality, diversity and inclusion of the workforce, etc). | |
| Recognising harms and balancing against benefits (physical, psychological, social and economic) – proportionality | Recover operation of healthcare (including addressing backlog of care needs, resuming home visits for vulnerable /shielding where appropriate; resources (staffing, spaces and equipment). |
| Safety of NHS staff (physical, psychological, systemic inequalities, flexible working and meeting staff training needs). | |
| Embrace new ways of working (eg, telemedicine, home visits, COVID-19 testing protocols and pathways for low-risk and high-risk care). | |
| Enhance crisis responsiveness (second wave). | |
| Accelerate preventative programmes (obesity reduction, seasonal influenza, outreach to marginalised groups, antenatal and postnatal care). | |
| Responsiveness (adapt plans to new circumstances/information). | |
| Patient safety (individualised risk protocols and support person/visiting protocols). | |
| Reciprocity | Concept of mutual exchange: take responsibility for own behaviour and reduce others expose others to risks. |
| Protect those at risk of COVID-19 (physically, socially, BAME, etc). | |
| Fairness | Inclusivity in service recovery (eg, barriers or access needs, support those with unequal access to care). |
| Patient prioritisation (to address backlog, ie, clinical urgent/longest waiting, option of continuing to wait and postpone treatment, ‘reason to reside’ criteria for timely and safe discharge). | |
| Reduce health inequalities (social inequalities and social determinants of health). | |
| Everyone matters equally and weighted equally in policies and any disproportionate impact on one particular group is accounted for. | |
| Accountability | Transparency (ie, document decisions, clarity of who is responsible for decisions, governance arrangements, assess against milestones and sharing information to help others). |
| Finance. | |
| Sustainability (of NHS services (eg, staffing); environmental sustainability). |
BAME, black, Asian and minority ethnic; NHS, National Health Service.