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.

The published plan went far beyond very elderly (for whom ICU might be too brutal).
It excluded young older people - from 60, still working age. Fit and healthy enough. They would've been excluded purely because of age. Not because of medical contraindications.

In fact, I noticed one version - point scoring based, started to consider exclusion from 50. That is not elderly.

@cologne4711 I think they don't like replacing hips before 50 due to hiw long they last. I may be wrong.

How long they last and they wear out quicker when young and active.

Its called realistic medicine.

My GP tried to persuade me, years ago, to have a different diabetic drug, because it was basically 'more cost effective'. = cheaper.

I've had that with one of my drugs, the generic injection works out far cheaper and the muppet GP keeps prescribing it on a repeat, even though the consultant has told them specifically what must be prescribed. It just makes more work for the GP to generate another prescription, complete donkey.

Thank Christ they aren't allowed to prescribe my biologic!!

Agree though that the contradiction of not getting your pension till 68 but being ineligible for life saving treatment in your earlier 60s is a big problem. I'd like to see some interested legal bods pursue that one.

@0896756453314a

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.

I agree. The government could put more money into the NHS and then let qualified doctors/nurses decide where it should go. Nobody should just be left to die. There is no need for that.

I have no beef with realistic medicine and knowing when to quit. I don't agree with elderly very frail people being intubated or shocked back into life, or being given CPR.

However what angers me is the fact that this was a clear policy to make the government look less bad, even though I have suspect this was the case for months. It was deliberately designed to try and avoid bad publicity (the fact that the NHS had been so run down it could not cope with an influx ill people.) And if you read the reports into the psychological "warfare" used to scare the population into compliance it grows worse.

Leaving people to die with no one looking after them and deliberately withholding treatment is appalling, especially in areas where those beds weren't actually needed to younger fitter people after all.

No one in charge comes out of this with any credit at all. It has been shameful.

TBH I’m more horrified that the elderly are being left without contact from their loved ones in what is likely their final months.
Pure cruelty.

I’ve spoken to all my elderly relatives and they’re pretty pragmatic about death but not isolation.

@GooseberryJam

Agree though that the contradiction of not getting your pension till 68 but being ineligible for life saving treatment in your earlier 60s is a big problem. I'd like to see some interested legal bods pursue that one.

Yes. I think the issue raises very interesting legal questions.

I don't think it does raise legal questions. The State Pension is never guaranteed. It lasts from when you reach qualifying age, to when you die. Every year period die before pensionable age. It's a sad fact. The only difference is that you have heard about it.

In March I know of a few unwell elderly patients of mine and their families were asked by their GPS what they would prefer to happen if they caught Covid which they would have little chance of surviving. The choice was to be admitted to hospital and have treatment despite poor chance of survival but they will not be able to have visitors even if they were dying. The other option was to stay at home with palliative care from district nursing. All of them chose the latter

This report details that this palliative care at home was not forthcoming in many cases though.

My lovely dear father’n’law died from covid in march. His nursing home explained at the time that hospitals were refusing to admit nursing home residents and the gps were refusing to enter homes. We would have never had of ventilated him but we wanted his end of life to be comfortable with extra oxygen and given iv fluids. He was not able to get these. We would have been happy for him to be given these in the home but the home could not provide these without hospital or GP approval. Sometimes when the issue of the elderly entering hospital comes up there are people who state the poor outcome of ventilation for these people. But there is a middle ground - supplementary oxygen and iv drip for fluids so they can have a comfortable death and this does not have to be given in hospital.
My f’n’law had covid at the same time as Boris. We had to watch Boris receiving top care while we fought for basic care for my f’n’law. Boris was getting same day testing while my f’n’law initially didn’t meet the criteria as he was not in hospital. We eventually were able to get him tested but the results took 4 days to come back by which time he had died the day before. In this civilised society that we live in surely there is room for the very sick to be allowed to have comfortable deaths.

@ittakes2

My lovely dear father’n’law died from covid in march. His nursing home explained at the time that hospitals were refusing to admit nursing home residents and the gps were refusing to enter homes. We would have never had of ventilated him but we wanted his end of life to be comfortable with extra oxygen and given iv fluids. He was not able to get these. We would have been happy for him to be given these in the home but the home could not provide these without hospital or GP approval. Sometimes when the issue of the elderly entering hospital comes up there are people who state the poor outcome of ventilation for these people. But there is a middle ground - supplementary oxygen and iv drip for fluids so they can have a comfortable death and this does not have to be given in hospital. My f’n’law had covid at the same time as Boris. We had to watch Boris receiving top care while we fought for basic care for my f’n’law. Boris was getting same day testing while my f’n’law initially didn’t meet the criteria as he was not in hospital. We eventually were able to get him tested but the results took 4 days to come back by which time he had died the day before. In this civilised society that we live in surely there is room for the very sick to be allowed to have comfortable deaths.

This is awful. I'm really sorry

Ventilation is hugely invasive and has consequences. I think some people confuse it with CPAP. I will never forget seeing my friend in hospital who had been in an induced coma and ventilated and the consequences- she couldn't walk and couldn't swallow. Her muscles were wasted. She had to learn to do a lot of things from scratch again. This was someone who was extremely active and played a lot of sport. It was shocking seeing the after effects.

@SheepandCow

The NHS is buggered for sure if the narrative of its only the Tories continues. It's been a mess for more than a decade. The Blair and Brown governments are equally responsible.

As % of GDP spending on health is the lowest since the first decade of the NHS, its highest was in the last years of the labour government.

Blairs Labour inherited years of under investment after 2 decades of tory rule, it tooks years for them to make a difference.

...and who took away nursing bursaries? we've over 40k nursing vacancies and 110k overal in the NHS.
Lowest per capita beds compared to other major EU economies, same with doc's and nurses.

Like it or not the Tories, cut NHS spending as a % of GDP and always have, they have been the predominant govt since 1945.

How come NHS not overrun yet Sweden Italy were? despite UK having higher per capita deaths? withholding of treatments, fewer hospital admissions is why.

@thecatsatonthewall
I'm not disagreeing about the lack of funding. Your last paragraph is spot on.

I've long wanted higher taxes - and in return a German or Scandinavian healthcare system. Well funded - with more emphasis on early and therefore preventative care.

I was simply pointing out that the Blair and Brown governments share responsibility with Conservative (and the Lib Dem coalition) governments for the mess our NHS is in. Remember PFI?
It's irrelevant in a way since looking back won't solve the current issues but I like to acknowledge all guilty parties. It's just a thing of mine regardless of the issue.

@ittakes2 I'm so sorry. That's terrible. Your FIL deserved decent care. Nobody should be denied it, nor should they or their families have go fight to get it.

@HesterShaw1

This report details that this palliative care at home was not forthcoming in many cases though.

Under the circumstances - if a second wave sees a repeat of patients denied care such as ICU, I really hope that this time round their GPs will be able to easily and quickly prescribe them morphine or diamorphine (including enough to overdose). Even if (as with the London Ambulance Service's changed admissions criteria in April) it's just a temporary thing.

How come NHS not overrun yet Sweden Italy were? despite UK having higher per capita deaths? withholding of treatments, fewer hospital admissions is why.
Absolutely. How else do people think we have higher deaths than those countries and yet we didn’t see the scenes here that we saw over there? Anyone who thinks it’s because our NHS did better is deluded.

@ittakes2 I’m so sorry about your FIL.
I too had to watch Boris taken into hospital having been chatting away on TV a couple of days beforehand, whilst I lay at home struggling to breathe and unable to walk to the bathroom unaided. I was one of the many (I suspect thousands upon thousands) who was triaged away from the NHS by 111 who merrily announced I was talking to them so must be fine. Luckily I’m still here, but it’s been a crazy long recovery and it was just luck and no thanks to the NHS. I’m positive I’d at least have had oxygen in most other developed countries.
I’m really really sorry your FIL was not so fortunate as to still be here. It’s a disgrace.

I just read the whole thing. I knew some of this was happening but not all of it. It's absolutely harrowing.

This goes FAR beyond the usual clinical decisions around ICU and ventilation.

Well I can certainly be shocked and disgusted by what they did in Sweden . They kiilled patients with mophine cocktails rather than give them basic oxygen treatment ,( and I am not talking about ventilation, just nasal oxygen being denied to care homes)

@bumblingbovine49

Well I can certainly be shocked and disgusted by what they did in Sweden . They kiilled patients with mophine cocktails rather than give them basic oxygen treatment ,( and I am not talking about ventilation, just nasal oxygen being denied to care homes)

That's terrible if true. And people keep on citing Sweden as an example to follow!

That said, it's better than what we did. No oxygen OR morphine. At least the Swedish deaths were quick and painless. Lesser of two evils although still utterly disgraceful to deny treatment.

@AndromedaPerseus

In March I know of a few unwell elderly patients of mine and their families were asked by their GPS what they would prefer to happen if they caught Covid which they would have little chance of surviving. The choice was to be admitted to hospital and have treatment despite poor chance of survival but they will not be able to have visitors even if they were dying. The other option was to stay at home with palliative care from district nursing. All of them chose the latter

Bully for them. I know my dad would have chosen hospital care in his 80s but he wouldn't have been given the choice.

Also everyone keeps saying that even those aged 80+ have a 80,%chance of surviving Covid . I imagine that becomes lower if you deny them oxygen and intravenous fluids which would give their body help in fighting off the infection. No-one is saying they should necessarily have an ICU bed, bit putting them straight in palliative care without giving some support so that their bodies have the best chance of resisting the infection itself, is appalling

There are a lot of people here jumping in to counter the argument that "all elderly people should be ventilated if they're very ill". That's a straw man though - what people were worried about in the spring, and what this article seems to be saying did happen to some extent, is the idea of entire groups of people being triaged away from even quite basic hospital care for covid based purely on their age.

It's the difference between saying "it's not appropriate for most people over 70 to get a particular type of care" and saying "it's not appropriate for any people over 70 to get that type of care".

I don't know anyone who'd really argue with the first one. It can be seen as just an observation of what actually happens when lots of patients of different ages are assessed for the most brutal and intensive kinds of care. The more elderly people are, the less likely they are to survive or benefit from that type of care.

The second one is different though. It's not an observation, it's an instruction. It takes individual health right out of the decision. It's writing people off completely based purely on their date of birth, and when it's not just saying "don't ventilate people of this age", but is actually saying "don't even bring them in for oxygen or a drip", it needs some pretty serious justification that I haven't seen yet.