United Kingdom

Secret NHS pandemic plan could have meant premature babies were denied care

Secret plans drawn up by the NHS said doctors may need to consider denying premature babies lifesaving care in a severe pandemic, the Telegraph can disclose.

The confidential report created by NHS England and sent to government advisers three years before the outbreak of Covid 19 set out “patient triage scenarios” during an influenza pandemic where some people would be denied treatment when resources were limited.

Officials wrote that if the pandemic became very severe, “patients would be assessed on probability of survival rather than clinical need” – a process known as “population triage”.

In a table setting out different scenarios, officials said the decision to ventilate a baby born at 26 weeks would “depend on local availability of specialist care staff”, even though the child’s odds of survival could fall from 90 per cent to between 1 and 15 percent without such specialist care.

They also warned that doctors would have to consider the risk of the baby “not actually dying” and “surviving with poor [health] outcomes” instead.

According to the document, the “move to population triage would require ministerial approval” and would be enacted “once all capacity in the NHS was exhausted”.

On Friday, the Telegraph revealed how the documents revealed plans to withdraw hospital care from people in nursing homes in the event of a pandemic.

The Government has argued that population triage was never implemented during the coronavirus pandemic, but responding to the reports that have now been disclosed, doctors have said that such guidance should have been published and open to debate.

‘Cowardly politicians passed the buck to doctors’

Dr Moosa Qureshi, who obtained the papers under the Freedom of Information Act with lawyers from Leigh Day, said that “by refusing to disclose secret triage guidance to healthcare professionals on the ground during Covid-19, politicians put patients’ lives at risk”.

“They passed the buck to the NHS staff, exposing us to potential civil and criminal liability for their political cowardice,” he said

Catriona Ogilvy, chairman of The Smallest Things, a premature baby charity, said: “If parents of premature babies knew triage plans like this had been written up and discussed at government level, they would be horrified.

“If in 2018 you are making decisions around which babies you are going to ventilate, let’s look at more nursing staff, more ventilators and more support.”

The NHS document said that “population triage” was “effectively an extension of the usual routine and daily clinical decision made by clinicians … however, rather than decisions being made on the basis of triage by clinical outcome, triage by resource availability will also inform the decision”.

Officials examined “life year lost” if services were “ceased” and said that “perinatal / maternity care plus childhood care being protected would have the greatest benefit and should be maintained as much as is practicable”.

The Department of Health has spent months refusing to release the secret plans to Dr Qureshi, who has campaigned for greater transparency around the government’s pandemic preparations.

Younger patients more likely to be treated

In the report, officials also examined the availability of ventilators, and warned that critical care provision might be suspended altogether in a severe influenza pandemic in order to “support the wards” “if the number of patients are overwhelming” - a move which the document predicted would lead to an extra 28,000 excess deaths over a six week period.

A table setting out different “triage scenarios” illustrated how medics would evaluate “routine cases … in a period of severe influenza pandemic surge”.

A teenager with acute appendicitis is described as “highly likely to be admitted”, but older patients might not, officials wrote.

It would also mean that otherwise healthy younger patients would be likely be prioritised over “younger patients with life-limiting conditions (eg. cerebral palsy)”.

An NHS spokesman said: “The NHS was asked to produce this discussion document based on a specific and extreme hypothetical scenario to inform the Government’s pandemic flu preparedness programme rather than for operational use and it did not form the basis of the NHS response to the coronavirus pandemic.

“Every patient who could benefit from Covid treatment during the pandemic received it”.

A government spokesman said that the reports were "historical draft briefing papers that include hypothetical scenarios which do not and have never represented agreed government policy" and were part of a wide-ranging discussion.

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