Clinical Frailty Scale in this country :(

[marlboroughlemon]

Been reading in the Sunday papers about NICE (national institute for health and care Excellence) rapid COVID-19 critical care guidelines of 21 March that all adults on admission to hospital should be assessed according to Clinical Frailty Scale (CFS).

I am beyond shocked that I am really reading about the UK. This is really true?
If any mumsnetters works at this NICE centre of excellence, or similar, please can they explain this Fragility Scale ? because to a ordinary member of public like me it makes me feel sick and horrified. Does it really mean a handicapped or elderly person would be turned away from hospital because on the scale they are not worth saving? Maybe I have misunderstood it.

If it is true, I feel we have really, really let down those people we were supposedly celebrating for VE day.

You should read this update OP as it explains things and clarifies that the frailty should not be used in isolation for people who may have learning difficulties etc (handicapped has negative connotations by the way so it's probably best to avoid that word):
www.nice.org.uk/news/article/nice-updates-rapid-covid-19-guideline-on-critical-care

It's not that the more frail people are not worth saving, it's that ventilation is a brutal process where air is pumped into your lungs and your body fights against it so much they have to use anaesthetic to make you unconscious.

If you're frail then you probably won't survive with ventilation and then they would have just put you through something really brutal for no benefit to you.

They can still make people comfortable and give oxygen, but not all treatments are appropriate for all people. Ventilation is only a good idea if there is a reasonable chance that you will survive it and have a decent quality of life afterwards.

Is it the CFS that you don't approve of or the use of it on admission to hospital ?

It's the use of it for admission to hospital.

They're using it on admission to hospital not for admission to hospital

Sad but true. That's why care home and residential home residents have not been taken to hospital. There are no ventialtors in care homes.they don't have the facilities of ICU. Of course there will be deaths. It's sickening what has happened to our elderly and vulnerable

There are no ventilators in care homes.they don't have the facilities of ICU

It is absolutely inappropriate and cruel to put people on a ventilator if they are unlikely to ever come off. They are even struggling to get younger fitter people off ventilator with Covid. It is much kinder to offer supportive care.

I work in a community care team. We complete this form on our first visit to patients and allocate a number as appropriate. It’s just a quick way of gauging any change in people between periods of treatment.
Nothing sinister to it, just for monitoring purposes.

We have used the clinical frailty score for a long time for all patients on admission to hospital. It is just one of many many assessments, I have NEVER seen this used in isolation to make decisions on care or treatment. Clinical frailty is something that needs to be considered for all patients, to determine a level of appropriate care that does not cause unnecessary suffering but gives a good quality of life. I don't believe we have needed to implement this in regards to rationing care, that is however just my own clinical experience. If I witnessed this in practice I would speak up.

As @MereDintofPandiculation has said, it's not for admission to hospital, it's on admission, to help direct what treatment choices (including whether ITU admission is appropriate) may become appropriate. It's not a statement of worthiness to be saved, but a recognition that some treatment options are inappropriate and would be cruel, particularly if someone is too frail to survive them.

There's a scale that they do use for hospital admissions and also the paramedics take into account other conditions.

It is around 4 usually, on the 11th March is was put up to 6/7. It's now been put back down. They knew that people don't feel as though they are struggling to breathe, but that was still being used as a marker for admission, or even to send a paramedic. Most people wouldn't survive once they turn blue. It's a national disgrace. Top doctors and chief medical officers have known that they are giving us advice that could kill us.

That's why we had so many deaths of younger people at home.

it's that ventilation is a brutal process where air is pumped into your lungs and your body fights against it so much they have to use anaesthetic to make you unconscious

To add to this it also leaves you open to other infections which would also do more harm obliterating whatever slim chance someone may have left for recovery.

If this virus caused appendicitis instead of respiratory distress/failure the same assessments would be being made about fitness to undergo general anaesthetic and surgery. Medicine is advanced but it can’t solve everything and sometimes the treatment is just too much for an individual to handle.

I understand why it’s upsetting to see reports but the truth is that we’re very sheltered from death and the limits of medical help in this country until we’re in a situation where it has to be discussed.

I think my biggest issue, especially with care homes, is the lack of palliative care. It’s one thing to judge someone as not fit for invasive medical help but I can’t help but feel that some HCP’s could have been deployed to the community to assist caring for those judged too frail for interventions and to prevent admittance to an environment that would have been distressing in a lot of cases. Of course that’s with the luxury of hindsight and no knowledge of what therapies could have been moved to a community setting but they have been very much left to their own devices. The impact on residents and staff is awful.

Seriously, understand before you start frothing.

@cornettoninja There's been no lack of Palliative Care in the community in my area that I'm aware of. The whole service has been reconfigured to prepare to manage people dying of Covid in care homes or at home whilst continuing to care for those who are dying of other conditions who are usually managed in the Community. The Palliative Care service is advising GPs and hospital doctors too and whole new guidelines and resources have been found and applied. I'm not contradicting your experience just saying that is not the case local to me. A lot of Palliative Care is based in the community usually including for those in care homes. Unless there was a complete collapse of the whole PC and GP service I don't understand how those in Care Homes etc aren't being provided with it.

You have misunderstood

It is used on admission, which means the patient is already being admitted to hospital.

Someone who is very frail is not going to survive ventilation, it is used, in combination with other factors as a way of making future treatment choices and discussing these with a patient and their families before it gets to that point.

It is also used as a general guide for how frail a patient is, to build up a picture of a patients general condition I guess. Theres lots of information that you record when you admit a patient

Seriously, understand before you start frothing.

Unlikely.

OP what do you think about this now that you know that it's the usual way of assessing patients? Will it change the way you view the 'crisis'?

@Eachpeachpearbum that’s really good to hear thank you.

Admittedly I have been following the media narrative which gives the impression care home residents are being waved off home with a covid diagnosis and nothing more is done. Off the back of reports from Spain and Canada it feels like the normal narrative is to think people are being completely abandoned to their fate. I am more than happy to be corrected on this!

There have been some issues with palliative care because of the Shipman rules. I'm hoping they've sorted it out by now but it required Priti Patel to do something so who knows.

www.ft.com/content/eedbe1cc-5773-4e07-b9a3-76177f9ad7f1

These measures aren't there as a way to 'ration' healthcare, but as a guide to assess who can survive treatment or be left with some quality of life. Having lost a very active and healthy Grandparent last year with age there are some things the body just can't recover from sadly - falls, breaks, infections.

Thanks for all your answers. No need for some of you to be so nasty. This is an anonymous chat forum for mums, so why is it so "frothing" to ask a question?
But despite reading the pps (many thanks) am still v concerned, for example in today's Daily Telegraph from a covid Dr (cardiologist) in London "We discharged known, suspected, and unknown cases into care homes which were unprepared, with no formal warning that the patients were infected, no testing available, and no PPE to prevent transmission. We actively seeded this into the very population that was most vulnerable.

“We let these people die without palliation. The official policy was not to visit care homes – and they didn’t (and still don’t). So, after infecting them with a disease that causes an unpleasant ending, we denied our elders access to a doctor – denied GP visits – and denied admission to hospital. Simple things like fluids, withheld. Effective palliation like syringe drivers, withheld"

The community nursing teams have still been visiting residential settings and patients own homes and providing palliative care, including using syringe drivers where appropriate to deliver symptom relief. The Doctor may not be aware of the role or scope of provision provided by the community care teams though.