Secret proposals to ration care by age in pandemic branded ‘unacceptable’

UK came ‘perilously close’ to triage approach during Covid outbreak, warns charity boss

Andrew Woodcock
Political Editor
Saturday 31 July 2021 14:34 BST

Secret plans to withdraw hospital care from over-70s in the case of a catastrophic pandemic have been branded “totally unacceptable” by charities representing older people.

Confident documents produced following a pandemic planning exercise in 2016 proposed a “triaging” system to be put into operation if healthcare resources were exhausted, under which people in nursing homes could be offered “end of life pathways” instead of medical assistance.

The government said the proposals related to “hypothetical scenarios” and had never been adopted as official policy.

But Age UK charity director Caroline Abrahams told The Independent that Britain had come “perilously close” to an approach of this sort at the height of the Covid-19 pandemic last year.

And she said that the government and NHS should be clear that treatment decisions must always be based on clinical need.

The documents on “NHS surge and triage” and adult social care in the case of a pandemic, labelled “confidential” and “official sensitive”, were obtained by an NHS doctor under freedom of information legislation and published on Saturday by the Daily Telegraph.

Written in 2017 and 2018, they suggested that in the case of a serious flu outbreak which overwhelmed the NHS’s ability to respond, patients could be “triaged” - or prioritised for treatment - based on their “probability of survival” rather than “clinical need”.

In a severe pandemic, the health secretary could authorise medics to prioritise some patients over others and even stop providing critical care altogether, the documents suggested.

Ms Abrahams expressed deep concern that the approach had even been considered.

“Whatever the status of this planning document may be, we know from other reports that during the early part of this pandemic we got perilously close to triage approaches being introduced in hospitals that took age heavily into account,”she said.

“If they had been put into practice the result would have been that a relatively healthy 70-year-old would not have got access to the intensive treatment they needed - they would effectively have been written off.

“At that time there was huge uncertainty and fear, as doctors struggled to cope with a virus that was threatening to overwhelm the NHS.

“However, we said at the time and repeat now that there is no place for treatment decisions based on age in a civilised society. Whatever the pressures, these decisions should always be based on clinical need.

“To do otherwise is blatantly ageist and totally unacceptable.”

Prof Martin Green, chief executive of Care England, which represents independent providers of adult social care, told The Independent: “The NHS should not have blanket policies and every single person should be assessed on the basis of need.

“The NHS should be available to all citizens and any scenario planning for a pandemic should focus on the needs of citizens, not the needs of organisations.”

Dr Moosa Qureshi, who obtained the plans, said it was “unprofessional” that they were not given to medics.

“The Information Commissioner held that clinicians must be supported by a clear framework when allocating care during a severe pandemic, and that the framework needs public debate,” he said. “The NHS triage paper provides real guidance for front-line staff if NHS services are overwhelmed. Why did the Department of Health, NHS England and BMA keep it secret from healthcare professionals?”

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 coronavirus.”

A government spokesman said the reports were “historical draft briefing papers that include hypothetical scenarios which do not and have never represented agreed government policy”.

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