Elderly people were denied treatment to stop the NHS being overrun

[Redolent]

This is being reported in The Times today:

“How the elderly paid the price of protecting the NHS from Covid-19”. .

Full article here:

archive.fo/anmfT

Parts of it make for difficult reading.

“The chief medical officer, Chris Whitty, commissioned an age-based frailty score system that was circulated for consultation in the health service as a potential “triage tool” at the beginning of the crisis. It was never formally published.
It gave instructions that in the event of the NHS being overwhelmed, patients over the age of 80 should be denied access to intensive care and in effect excluded many people over the age of 60 from life-saving treatment.

Testimony by doctors has confirmed that the tool was used by medics to prevent elderly patients blocking up intensive care beds.”

Triage tool that was circulating online from April, attached.

Are we going to see a return to this over winter? There has to be full transparency if so.

Elderly people placed on ventilators have terrible outcomes and often spend many days and weeks on artificial life support and then die anyway

That is true with Covid and without

Covid is a multi system disease. Simply supporting breathing is not the solution. People with ageing organs and/or with co morbidities that will not withstand the brutal attacks on the body that ventilation instils should not be offered it

Artificial ventilation of itself is hugely damaging and quite often people die from the secondary effects of it. It is certainly not a miracle cure and the medical profession are increasingly realising that it should be used more selectively, not less

Not entirely true
The plans were drawn up but never put in place as nhs wasn’t overrun

It was based on the info they had from Italy

Plus those instructions were all over the media in April so we have known that that was the potential plan for months so old news really

Clinicians make decisions like this in the NHS every day, they always have to decide which patient to prioritise and sometimes the consequences can be severe.

Transparency wouldn't change this. On a lower level this is why some couples aren't entitled to IVF and some are, why some cancer treatments can be funded and others cannot. It's based on cost benefit because we can't supply endless capacity for all kinds of treatment.

I don't want to sound very doom and gloom, the NHS will always do it's upmost for every single person. But there has always been a point where resources run low and difficult decisions need to be made.

I read this article yesterday. I think in most cases those who were "left to die" were going to die anyway. The tragedy will be there were a few elderly people who were otherwise healthy and almost certainly would have survived to live another decade, but were written off purely because of age. I doubt it was many, but it's very sad.

But the NHS has been rationing treatment on grounds of age for years. I know a lady who had to get treatment for a bad hip privately and she was barely 50 - GP refused to refer her because it was to improve her lifestyle. Similarly another guy I know who's about 60 had the same problem with a knee injury. He ended up paying for treatment himself and getting back to running. Both were considered too old to warrant quality of life treatment. At 50 and 60. In a well funded area.

As pp's have said, this is nothing new, and is not specific to Covid. Decisions are taken all the time as to the "appropriate" treatment to offer to elderly patients. Ventilation in particular is not effective, and only prolongs death. CPR would fall in the same category, hence why so many elderly now have "no aggressive" treatment directives. It doesn't mean you can't ANY treatment, it just means "appropriate`" treatment. After all, many, many elderly have hips and knees, and heart bypasses, and cancer treatment, etc etc every year, that's why the NHS is on it's knees, we have a huge elderly population with very high medical needs. You can't discriminate on age, but you can make a balanced decision on suitability for treatment, and best outcomes.

The 'Three Wise Men' approach was definitely talked about in the early days - having small panels of experienced doctors deciding which of the people needing treatments got what - a kind of reverse triage.

And UK wasn't alone in this- according to this article, Sweden was doing it too:

"Even more worrying, evidence has emerged that many sick elderly patients were effectively automatically denied access to treatment, to avoid hospitals being overwhelmed. One March 17 FHM directive to Stockholm hospitals stated any patients over 80 or with a body mass index above 40 should not be admitted to intensive care, because they were less likely to recover. Other reports describe sick care home residents being administered a palliative cocktail of morphine and midazolam, because the homes were not equipped to administer oxygen, something some doctors have described as ‘active euthanasia.’

“The government didn’t protect the most vulnerable members of society,” says Ewing. “People were triaged out of healthcare and given ‘No Hospital’ notes on their journals, before they got sick. And this was not only for patients who were suspected of having Covid-19. A person who got a urinary tract infection and required hospitalisation, for example for IV antibiotics or fluids, would not get that care either. They received palliative medicine instead.”

www.wired.co.uk/article/sweden-coronavirus-response-experiment

We never reached quite that point, but it's what overwhelming the NHS would look like if it were allowed to happen. We're storing up enough problems by a planned reduction of services and screening programmes, but it couid be so much worse if it just fell apart

I think this was widely talked about in March.

I look at my relatives in their 80's and 90's and there is no way I would want any of them on ventilators. I'd definitely not want them resuscitated either. Both are traumatic. They are both highly likely to keep someone alive in any case. Death is natural when you're old. No, it's not fair if a pandemic cuts short someone's life, it's not fair that this virus hit us. But it is wholly reasonable to focus on treating younger patients if you have limited resources and few options in terms of keeping the sickest, oldest people alive. I still feel for the doctors making these kinds of decisions because it must be gut-wrenching. They make these kinds of decisions for other illnesses too, though.

I'm sure I've seen those charts before earlier in year? And it was discussed alot on here? Also it never actually happened did it?

Didn’t we all already know this? People had their cancer treatment postponed ffs, of course other treatments were denied.

Those sort of decisions are taken every day in hospitals, Covid is irrelevant to that. ITU beds are very precious and as pp pointed out very elderly people do not do well on ventilators.

My dad is 89 with dementia, heart failure, incipient kidney failure and high blood pressure. We will do our damnedest to ensure he doesn't catch COVID- but if he does I wouldn't want him put on a ventilator, even if there were plenty to spare. He deserves a more peaceful end than that. In the same vein, I wouldnt put his through chemo if he develops cancer. We might try dialysis if/when his kidneys fail but if it upsets him too much we will discontinue it.

I do not think the elderly are disposable, as some do on here, but I do believe in quality of life and knowing when to quit.

I think in most cases those who were "left to die" were going to die anyway

Chilling.

We're a developed, privileged nation with resources to help people recover but also die well.

I am beyond disgusted.

My mum was for non ventilation treatment before the age of 60 due to lung conditions. Ventilation isn’t an option for some. It’s brutal. It’s not just covid related.

You won’t see lots of elderly people in critical care but you will see them being actively treated according to their health needs on medical wards. Not just left in a corner to die because they are old

I think people on "both" sides of the debate can't fail to be shocked and horrified by the contents of this article.

The elderly have been failed at every single step of the way in the UK during this pandemic.

And the narrative continues to be spun that by shutting down society we are protecting them, when the opposite is true. All we are doing is protecting the government in their desire to hide the fact that the NHS is in such a shit state it cannot cope with acutely ill people without sacrificing a large number of other people.

Hiding away in repeated lockdowns is NOT the answer. All that does is maintain the government's façade.

As Anyfucker mentions this doesn't just happen for covid - we had a relative with a perforated bowel not given surgery due to age and co-morbidities - many elderly people have these. They just said it would postpone death not help in the longer term.

This isn’t news.

@HesterShaw1

I think people on "both" sides of the debate can't fail to be shocked and horrified by the contents of this article.

The elderly have been failed at every single step of the way in the UK during this pandemic.

And the narrative continues to be spun that by shutting down society we are protecting them, when the opposite is true. All we are doing is protecting the government in their desire to hide the fact that the NHS is in such a shit state it cannot cope with acutely ill people without sacrificing a large number of other people.

Hiding away in repeated lockdowns is NOT the answer. All that does is maintain the government's façade.

I agree.

Why are they recycling this?

The issue isn't that those guidelines were drawn up it's that, like many other 1st world countries, they needed to be drawn up.

Long term we either agree to pay higher taxes or we accept that health rationing is a real thing in emergency situations.

But taking this up again at the beginning of flu season is just bloody scaremongering. There's bound to be something similar being considered, but with 6 months more knowledge behind it. The reality of the current situation demands such things are considered.

It raises questions about the pension age. Looks like it should be lowered to 60.

Shows up the anti smoking brigade too.
You can't castigate somebody for smoking because 'it shortens your life' but then tell them they can't access potential lifesaving treatment because they're too old.

Smoking's the way forward. Stress relief (stress is terrible for the immune system), brings in billions for the NHS, and saves on pensions and social care costs.

I've just said this on another thread but I think it's worth repeating here.

I wonder if there's grounds for a legal challenge wrt pensions.

HMRC/DWP says 60-67 year olds are fit and well. The medical profession disagrees.

I think people on "both" sides of the debate can't fail to be shocked and horrified by the contents of this article.

Not at all shocked and horrified by this at all. All this "save lives" bollocks touted by Johnson and Co. is just that, bollocks and always has been.

I think we (society) knew this back in March. I can actually remember a phone in ( maybe 5 live) where older people were saying if they would want icu care or not if push comes to shove. In the end, I don’t think we got there but I don’t remember a massive out cry at the time. Presumably we (society) were ok with this triaging system back in March when it looked like we ( younger people) might be denied a ventilator because of eighty year olds do it seems hugely hypocritical to me of us all to cry crocodile tears and profess outrage about it now

@CuriousaboutSamphire

Why are they recycling this?

The issue isn't that those guidelines were drawn up it's that, like many other 1st world countries, they needed to be drawn up.

Long term we either agree to pay higher taxes or we accept that health rationing is a real thing in emergency situations.

But taking this up again at the beginning of flu season is just bloody scaremongering. There's bound to be something similar being considered, but with 6 months more knowledge behind it. The reality of the current situation demands such things are considered.

Yep.

I don't actually think refraining from ventilating octagenarians is the outrage that some seem to, but health rationing per se is part of a whole systemic issue with roots from long before covid. We as a society entered this pandemic in a much worse position than we needed to be, because the NHS hasn't been properly funded for years and we refuse to have the necessary societal conversation about how we manage a free at the point of use system combined with an ageing population.

And the narrative continues to be spun that by shutting down society we are protecting them, when the opposite is true. All we are doing is protecting the government in their desire to hide the fact that the NHS is in such a shit state it cannot cope with acutely ill people without sacrificing a large number of other people.

This.

I’m staggered that this hasn’t yet sunk in for so many.