Table 5.

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.