Tuesday, June 25

Weakest patients could be denied NHS care



NHS patients could be denied lifesaving care during a severe coronavirus outbreak in Britain if intensive care units are struggling to cope, senior doctors have warned.

Under a so-called three wise men protocol, three senior consultants in each hospital would be forced to make decisions on rationing care such as ventilators and beds, in the event hospitals were overwhelmed with patients.

The medics spoke out amid frustration over what one said was the government’s dishonest spin that the health service was well prepared for a major pandemic outbreak.

The doctors, from hospitals across England, said the health service’s existing critical care capacity was already overstretched and would crumble under the demands of a pandemic surge in patients who may all need ventilation to help them breathe.

Those denied intensive care beds could be those suffering with coronavirus or other seriously ill patients, with priority given to those most likely to survive and recover.

Doctors said this would lead to tough decisions needing to be made about the wholesale cancellation of operations to free-up beds.

One consultant said the three wise men protocol had been discussed at his hospital in recent weeks while another from the north of England said it had been raised informally.

One doctor explained: If you can imagine the real worst-case scenarios where supply is massively outstripped by demand we would have to refuse to admit many people who would normally get ventilated.

The Committee on Ethical Aspects of Pandemic Influenza developed Three Wise Men for that circumstance everyone matters equally, but not everyone gets treatment equally the goal is to minimise the harm the pandemic causes.

He added: We barely coped with a standard winter which helpfully had an early flu spike, so everything didn’t hit at once the idea that we can cope with a pandemic is nonsense.

He explained his own hospital plans included cancelling elective operations for things like hip and knee surgeries while taking over theatres and recovery areas to put ventilated patients adding the trust would drop staffing ratios as low as we dare.

If this is like the 2009 flu it’s going to be very bad. We’re in a worse position than we were then. If it’s worse than that we’re going to be in deep trouble.

He added the reduction in UK intensive care beds in recent years was scandalous. Another critical care consultant from a major south London hospital said: We would be making decisions about people’s lives. There just isn’t any slack in the system. We are grossly under resourced.

Asked about the government’s claim the NHS is well prepared they said: “It is dishonest. I hear them say the NHS is well prepared. We are not well prepared, it is media spin.

As a member of the public you might get coronavirus but your chances of being ill and in hospital is not high. On a person by person basis it is nothing to worry about.

As an NHS we would crumble under the weight of those who need critical care.

A geriatrician from the West Midlands added: The public health messages seem well planned but there has been no sense of a plan to grow capacity. It is all spin.

A senior consultant from north London added the NHS was prepared for the odd one or two cases but anymore would mean a major incident being declared. He added: Intensive care capacity is a precious and limited resource, and if there were a large surge in demand some very difficult decisions would need to be made.

We cannot simply expand into other areas because the necessary capacity isn’t available. Intensive care nurses are highly specialised and are in short supply nationwide.

I think the government is right about being prepared, and we are, but it’s really difficult to manage a surge when capacity is already stretched with emergency work and especially when staff themselves may end up sick.

Separately, the British Thoracic Society (BTS) warned respiratory wards, where many coronavirus patients could end up being cared for, are understaffed and overstretched.

A survey of senior respiratory department staff found three quarters believed staff shortages were impairing the ability of their hospitals to cope and 57 per cent said they had no extra staff to rely on.

The BTS said many departments were being forced to cancel clinics and other non-emergency work such as training while extra winter beds were now never being closed.

Professor Jon Bennett, chair of BTS, told The Independent: A severe coronavirus outbreak will be very challenging. I have tried desperately not to think about it because when you do it is a very worrying situation. We would be in serious trouble.

According to the World Health Organisation more than 80 per cent of patients who are infected with coronavirus have a mild disease with 14 per cent suffering severe infection such as pneumonia with 5 per cent needing critical care.

The UK government is aiming to prevent the spread of the virus and if it becomes a pandemic to try and delay any impact into the spring or summer when the NHS could be better placed to cope.

The Department of Health and Social Care has been approached for comment.