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.

We hear the bad stories but here is a good one with a happy ending.

In August FIL aged 82 collapsed while out shopping with my DH. DH drove him to A&E and within a week FIL had a triple heart bypass and a pacemaker fitted. Aftercare has been amazing with a nurse visiting him at home the day after he was discharged. Not all old people are being written off.

DM was contacted by her GP to discuss her preferences. She agreed DNR but said if she needed hospital care for something with a good chance of recovery she'd like to be admitted. She wasn't told she was waiving her right to any hospital care for anything. She was lied to (not the GP's fault, I don't imagine they were aware).

The picture is guidance for paramedics from 10 April. It also clearly shows that care home residents were not ordinarily to be admitted.

www.thetimes.co.uk/article/41f78db2-1601-11eb-8d4b-d807836d5e13?shareToken=e47354796320b884f500eda0a18dc72c

@notangelinajolie

We hear the bad stories but here is a good one with a happy ending. In August FIL aged 82 collapsed while out shopping with my DH. DH drove him to A&E and within a week FIL had a triple heart bypass and a pacemaker fitted. Aftercare has been amazing with a nurse visiting him at home the day after he was discharged. Not all old people are being written off.

Yes there was treatment in August. DM was in hospital for a week being treated for a tissue infection in her leg and has made a good recovery. Thank fuck that didn't happen in April.

@LangClegsInSpace
I meant to go to bed but saw your post.
That's shocking. Denying treatment by deception.

I assume younger disabled care home residents were also denied treatment?

If the NHS was routinely refusing to treat old people GP surgeries and hospitals would be practically empty.

What doesn't seem to be acknowledged though is that tens of thousands of elderly were admitted to hospital and survived.

My Ddad was intubated , and was in ICU for over a week after he became very unwell from flu in 2015. He was 79. I was shocked how much weight he lost, and when he was out of ICU he was too weak to even feed himself, let alone get out of bed or stand unaided. It took several months for him to fully recover, although I think even some of the medical professionals were surprised that he did.

I am really uncomfortable with people over 70 being described as elderly in this context as if they are about to die anyway. That’s about 8.8 million people, many of whom are as healthy and well as you and I.

@Redolent

I don’t get it. People seem to readily grasp that the older you are (mid-70s onwards) the less likely to be admitted for treatment. But then there’s a widespread denial - seen elsewhere - of the fact that ICU beds are largely occupied by those of working age population: people in their mid-50s and 60s. Presumably because they’re the ones who are seen as most likely to benefit.

I don't think I follow your logic here? You're right that if they're routinely not transferring patients over 70 to ICU then of course ICU is dominated by people in their 50s and 60s. What doesn't really follow is the implication, which is how 'ICU is full of people in their 50s!' is always used, that Covid is therefore very dangerous to people in their 50s and 60s as a group - I think that's what people are 'in denial' of, because it isn't really true.

Has this been common knowledge for months? I already knew this.

Watch the series "Hospital" and on any given day most hospitals had

1 critical cancer patients
1 embolisum patient bleeding to death
1 RTA

All after the same ICU bed. The only chance the cancer patients have is if the embolisum and RTA die on route to hospital or if it early enough in the day, in operating theatre.

That's every day. If the is a ICU bed for you you still need everything else free, like surgeons, theatre, icu staff etc.

There but for the grace of God goes everyone, every day here and even if you was loaded you will still be at mercy of the NHS if the shit really hit the fan and had a critical, time dependent condition.

I'm not surprised at all. Watch the series from this year and last year

It isn't just the elderly that were/are being denied treatment. Patients of any age who were considered unlikely to survive were/are overlooked as well.

@Hardbackwriter

I see what you’re getting at. There’s not necessarily a causal link. But studies (one published in The Lancent) have clearly indicated that you have an almost 9% chance of being hospitalised with covid if you’re in your 50s. Does that seem very low to you? I don’t know, but it seems - at a population level - to be a not insignificant chunk of people.

I personally don’t think people have really grasped the implication of that number, if we’re talking about the working age population who will be in hospital.

It's not the fact that elderly people are denied intensive care treatment that is shocking. Intensive care is not always appropriate.

It's the cynical hypocrisy and lying and spinning of the facts that is the shocking part, if you actually read the whole article.

Elderly people being cleared from hospitals, when it is known they are infected with covid, being sent to care homes, where the proper provision of PPE is refused. And then the refusal to treat many of these people, even to ensure their last hours are dignified and comfortable and they have someone with them.

This was a cynical move by the government to make it seem as though the underfunded mismanaged NHS was coping. It was merely to deflect criticism. No wonder places like the Royal Gwent Hospital saw "disproportionate" numbers of men in their 50s admitted to intensive care. Many many more were dying at home, on their own. Actually given the numbers which were infected the age and sex of the patients in intensive care in Newport were entirely proportionate.

As soon as overall numbers began to drop, the numbers of elderly allowed to have hospital treatment rose again, and because they were being seen sooner, their chances of survival increased.

It was that policy which led directly to so many elderly people dying of Covid and other causes. And yet now young people are being blamed and being told "Don't Kill Granny" by the likes of Hancock whose own actions and decisions led directly to so much death.

Does no one else see it like that? The hypocrisy is absolutely sickening.

That's a good summary HesterShaw.

As soon as overall numbers began to drop, the numbers of elderly allowed to have hospital treatment rose again, and because they were being seen sooner, their chances of survival increased.

Actually scrap the phrase "allowed to have hospital treatment" and insert "allowed to have medical treatment".

Lots of these people were denied basic medical care, because doctors would not/could not go into care homes. This also led to Covid being put on the death certificate as having contributed to their death, even though they had not had even seen a doctor, much less been tested.

And to think we were constantly being told that lockdown was to protect the vulnerable. Absolute bullshit. It was to protect the government. It's an absolutely shitstorm of incompetence and inhumanity.

I hope Hancock etc see their day in court.

Really interesting (and disturbing) points @HesterShaw1

Agree with Hester

There is a world of difference between deciding that a patient is beyond effective treatment and allowing life to draw peacefully to its close. Based on the actual clinical condition of the patient.

And denying someone treatment they might otherwise have benefitted from, because they have been triaged out. Or having to delay or modify treatment because the covid risk means Plan A cannot be delivered safely.

It's why we need to keep transmission low, so that there are beds, and decisions can be made on potential benefit, not who is judged expendable. And so that non-covid services stand a chance of functioning

@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.

You don't 'die well' on ventilation. It's invasive and leaves many people who recover with PTSD. From a medical perspective it also is an aerosol emitting procedure that carries risk for medical staff and then requires heavy resourcing to manage.

It is worth it if the person is likely to recover and live many more years of healthy life. It is not something to put someone through if they are already frail, my grandfather was a surgeon and is now in a care home, he is extremely clear that he no longer would want any ICU treatment if he were to become ill, even if it was an option.

This is not about ventilation @OverTheRubicon. I wish people would stop with this straw man.

This is not about ventilation @OverTheRubicon. I wish people would stop with this straw man.

No it's damn well not.

I do wish people would try and see the nuance. I'm pretty anti lockdown, but it really isn't because I am an evil eugenicist who wants the virus to sweep through the elderly and vulnerable so the rest of us can "get on with it"

It's because as a long term strategy, they won't work. Lockdowns are a last resort and an admission of failure. It's fairly clear that even though our two countries are similar, the difference between our numbers and Germany's is down to management and better health provision.

From the start I have been horrified at the damage this was doing to older people, and I am so glad my dad died in his care home 3 years ago and is not living through this hell.

@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.

The NHS makes difficult life and death decisions every single day and - by necessity - prioritises some areas over others. Surely you are aware of that?

tox

Surely you cannot think that the NHS would characterise what you have described as "leaving people to die"?

Or would you?

I hope you're nothing to do with best practice or standards of care.

The NHS makes difficult life and death decisions every single day and - by necessity - prioritises some areas over others. Surely you are aware of that?

Yes, and that is how it should be, an individual clinical decision.

Not whole categories of people being triaged out, when they would have otherwise been treated

@HesterShaw1

It's not the fact that elderly people are denied intensive care treatment that is shocking. Intensive care is not always appropriate.

It's the cynical hypocrisy and lying and spinning of the facts that is the shocking part, if you actually read the whole article.

Elderly people being cleared from hospitals, when it is known they are infected with covid, being sent to care homes, where the proper provision of PPE is refused. And then the refusal to treat many of these people, even to ensure their last hours are dignified and comfortable and they have someone with them.

This was a cynical move by the government to make it seem as though the underfunded mismanaged NHS was coping. It was merely to deflect criticism. No wonder places like the Royal Gwent Hospital saw "disproportionate" numbers of men in their 50s admitted to intensive care. Many many more were dying at home, on their own. Actually given the numbers which were infected the age and sex of the patients in intensive care in Newport were entirely proportionate.

As soon as overall numbers began to drop, the numbers of elderly allowed to have hospital treatment rose again, and because they were being seen sooner, their chances of survival increased.

It was that policy which led directly to so many elderly people dying of Covid and other causes. And yet now young people are being blamed and being told "Don't Kill Granny" by the likes of Hancock whose own actions and decisions led directly to so much death.

Does no one else see it like that? The hypocrisy is absolutely sickening.

Excellent summary.

@pmdfoster did an interesting thread on this yesterday.

The story was covered by the FT in April but the story wasn't elderly patients 'being denied' treatment. The reality is (and this seems to hold water on statistics on this) that the over 80s simply dont survive ventilation anyway. So they weren't being denied treatment, they were being treated appropriately and with dignity.

The problem was actually to do with delays in results from tests.

So an elderly patient went into hospital was tested and came back with a negative and was sent back to their care home. The issue was at the time of testing they probably were negative but they were on a ward with other people also with unknown covid status who were also being tested. It was taking up to seven days to get results back so in the time between being tested (and getting an accurate negative) these elderly patients were exposed to someone who was positive and so by the time they were released back to their care home their covid negative status on paper didn't match their actual now infected status.

And this was one way that covid was getting into care homes unwittingly.

I do think that the scandal is in this issue and not in the potential triaging of patients who almost all wouldn't have benefitted from ventilation anyway.