Older coronavirus patients were denied intensive care treatment on the NHS during the height of the Covid-19 pandemic, it has been claimed.
Those aged over 80, and some in younger groups such as the over 60s, were not given potentially life-saving treatment because health chiefs were concerned the NHS would be overrun, according to reports.
It is claimed documents called a ‘triage tool’, drawn up at the request of England’s chief medical officer Chris Whitty, were used in preventing elderly Covid-19 patients from receiving ventilation in intensive care.
As part of an investigation, the Sunday Times says the tool was used to create a ‘score’ for patients based on their age, frailty, and illness. Under the original system, over 80s were automatically excluded from intensive care treatment due to their age. Even those in the over 60s who were considered frail and with pre-existing health conditions could have been over the intensive care threshold.
The tool was never formally published, nor was it official NHS policy. But the paper, which carries claims by doctors who say the tool was used in their hospitals, said the documents were widely circulated among health care professionals.
NHS chiefs have today hit back at the reports, saying that while early work on an intensive care national ‘triage tool’ did take place, it was ‘not completed’ and never issued.
They also denied critical care units were ever at capacity, saying that even at the height of the pandemic, only 42 per cent of NHS’ ventilator beds were being used.
Meanwhile, an NHS spokesperson added that more than 110,000 hospital patients with Covid-19 have been treated so far, two thirds whom were aged over 65.
A graph showing the percentage of intensive care hospital admissions versus the the number of hospital deaths in different age categories
A graph showing the number of intensive care admissions of patients over the age of 60. The graph shows that while the admissions soared, the percentage of elderly admissions declined
A graph from a report by the Cabinet Office Briefing Rooms (COBR), showing the percentage of critical care beds being taken up by Covid-19 patients in the UK between March and April
At the peak of the crisis in Britain, only a quarter of all beds were occupied by virus patients. On April 7, 26.5 per cent of the 67,206 people in England’s hospitals were being treated for coronavirus — the highest proportion on record
Office for National Statistics figures show hundreds fewer people are dying from all causes in hospitals
The claims come following a three-month investigation by the Sunday Times, who have spoken to more than 50 witnesses, including doctors, bereaved families, care home workers, politicians and government advisers.
As part of the investigation, the paper claims some GPs were asked to identify frail and elderly patients who would be left at home, even if they needed hospital treatment due to complications from Covid-19.
It also claims NHS England issued guidance about groups of patients who should not ordinarily be taken to hospital without the green light from a senior doctor. These groups include all care home residents.
Meanwhile, paramedics were told to be more selective about who they take into hospital, the paper adds.
The paper also claims the controversial triage tool, which was first discussed by the UK’s Moral and Ethical Advisory Group (MEAG) at the start of the pandemic in March, was used in hospitals in Manchester, Liverpool, London, the Midlands and the southeast.
The tool was to be used to give a score to patients using their age, frailty and pre-existing health conditions. That score would then be used work out if a patient should be selected for critical care, should they need it, with ‘eight’ being the cut-off point.
Under the tool, those over the age of 80 would score nine on their age alone, meaning they would automatically be excluded, while over 75s were marked close to eight to begin with. Even those aged over 60 could be at risk of missing out on treatment on the triage tool, if they had an underlying health condition and were considered frail.
According to the Sunday Times, a second version was later produced, lowering the score for age, but still advising those over 80 who were not in peak physical health should be denied treatment.
NHS chiefs say the service has never adopted, published or relied on any such tool and its logo has not be authorised for use on any such tool.
However, the paper claims that it was distributed to the some doctors during the consultation period, while NHS Highland in Scotland also is said to have posted a version on its website – before later saying it was published ‘in error’.
Dr Chaand Nagpaul, chairman of the British Medical Association, told the Sunday Times ‘large numbers of patients’ did ‘not receive the care they needed’ and this was down to the health service’ not having the resources’.
Meanwhile, Conservative MP David Davis told the paper: ‘The policy appears to have given the least care to those who needed it most.
‘It is profoundly wrong that the government did not come clean to the public about this tragedy.’
This graph shows the number of Covid-19 patients in UK hospitals in critical care as the coronavirus pandemic took hold, between March and the start of April
This graph shows the number of UK hospital admissions in different parts of the UK as the coronavirus pandemic began to take hold, from March to the beginning of April
A graph from a report by the Cabinet Office Briefing Rooms (COBR), showing the percentage of critical care beds being taken up by Covid-19 patients in the UK between March and May
Conservative MP David Davis (left) told the Sunday Times: ‘The policy appears to have given the least care to those who needed it most.’ Dr Chaand Nagpaul (right), chairman of the British Medical Association, told the paper: ‘It is manifestly the case that large numbers of patients did not receive the care that they needed
What NHS chiefs say to the Sunday Times article today
• The NHS hospitals did not run out of intensive care beds, so there was never a need to refuse anyone treatment on the basis of NHS capacity.
• Clinicians make decisions about the best course of treatment for their individual patient, based on that person’s specific needs, and wherever possible with relatives, carers or next of kin. That is what happened throughout this pandemic; there was categorically NO blanket national decision to refuse care to any group of people, including on the basis of their age.
• The optimal therapy for most hospitalised Covid-19 patients has turned out to be oxygen therapy, which can be given in a general ward, rather than the patient being sedated on a mechanical ventilator in intensive care, and latest data show that of all Covid-19 patients receiving any form of oxygen therapy, the majority of them were indeed aged 65 or older.
• Older people were not denied admission to ICU during the first wave; actually they comprised the majority of patients admitted to ICU with Covid-19, throughout. This has remained true irrespective of the overall number of patients of any age in England’s ICUs being treated for Covid-19.
However, the decision to review a triage tool has been defended by health chiefs, who said the process was talked about at the start of the pandemic, when it was estimated around two-million people could be put in hospital by Covid-19.
An NHS spokesperson said: ‘No intensive care national triage tool was issued by the NHS.
‘Early work on a triage tool was commissioned when modelling suggested two million people here could require hospital treatment and hospitals in northern Italy and Spain were being overwhelmed.
‘This was not completed let alone issued because it became clear that, thanks to the efforts of the public in following Government guidance, the number of patients would be kept within NHS capacity.’
Co-chair of MEAG, Professor Sir Jonathan Montgomery, said: ‘We were asked to look at the issue of a Covid-19 triage tool, however, it wasn’t needed.
‘Clinicians have been focused throughout the pandemic on assessing the individual needs of their patients and then providing the care that will benefit them best.
‘The rapid expansion of critical care capacity ensured that our initial concern that the NHS might be unable to meet all its patients’ needs proved unfounded.’
Meanwhile, Dr Alison Pittard, Dean of the Faculty of Intensive Care Medicine, said: ‘Throughout the first wave of Covid-19 the NHS did not run out of critical care capacity, which remained available to everybody who would benefit from it.
‘As we learned more about Covid-19 treatment changed as it became clear that oxygen therapy, that can be delivered on general wards, is often more beneficial than being on a ventilator.
‘The Faculty of Intensive Care Medicine has been clear throughout that doctors should make decisions about patients’ treatment just as they normally would.’
At last! NHS workers are ‘set to get a vaccine in weeks’ as the Government accelerates timetable for a mass roll-out before Christmas – while ministers introduce new laws to bypass EU approval for jab
By Michael Powell and Glen Owen for the Mail on Sunday
Plans are being drawn up for frontline NHS staff to receive a coronavirus vaccine within weeks, as the Government moves to accelerate the timetable for a mass roll-out.
An email sent by an NHS Trust chief to his staff, seen by The Mail on Sunday, reveals the Health Service is preparing for a national vaccination programme before Christmas.
It can also be disclosed that the Government has introduced new laws that would allow the UK to bypass the EU approval process if a safe and effective jab is ready before the end of the post-Brexit transition period on December 31.
The move will boost optimism that a ‘game-changing’ vaccine will soon allow Boris Johnson to relax the social restrictions which have crippled the country since March.
In his memo to staff earlier this month, Glen Burley, chief executive of George Eliot Hospital NHS Trust in Warwickshire, wrote: ‘Our Trust, alongside NHS organisations nationally, has been told to be prepared to start a Covid-19 staff vaccine programme in early December.
‘The latest intelligence states a coronavirus vaccine should be available this year with NHS staff prioritised prior to Christmas.’
Plans are being drawn up for frontline NHS staff to receive a coronavirus vaccine within weeks, as the Government moves to accelerate the timetable for a mass roll-out. An email sent by an NHS Trust chief to his staff, seen by The Mail on Sunday, reveals the Health Service is preparing for a national vaccination programme before Christmas. (Above, the memo, sent by Glen Burley, chief executive of George Eliot Hospital NHS Trust in Warwickshire)
It can also be disclosed that the Government has introduced new laws that would allow the UK to bypass the EU approval process if a safe and effective jab is ready before the end of the post-Brexit transition period on December 31
Despite facing continued criticism, Mr Hancock has pushed through new laws to strip the European Medicines Agency of the power to approve the vaccine if it is ready before the end of December. Instead, British watchdogs will be able to fast-track its production. (File image of an experimental Covid medicine being tested)
Mr Burley added that the vaccine was ‘expected to be given in two doses, 28 days apart’ and urged his colleagues to have had their flu shot by the end of November so they can qualify for a Covid-19 jab.
Diane Wake, chief executive of the Dudley Group NHS Trust, told a recent hospital board meeting: ‘I’m hoping for a Covid-19 vaccine to be available to healthcare providers some time in December. It has not been confirmed yet but I’m hoping to be able to offer a Covid-19 vaccine to our staff.’
Despite facing continued criticism, Mr Hancock has pushed through new laws to strip the European Medicines Agency of the power to approve the vaccine if it is ready before the end of December. Instead, British watchdogs will be able to fast-track its production.
A health official said: ‘Although we still think it most likely that the vaccine will be ready early next year, Matt wants the freedom to operate if it all moves more quickly.’
The official added that under changes to the Human Medicines Regulations 2012, which took effect on October 16, the UK was ‘no longer beholden to the EU process if a vaccine is developed before 2021 and has strong evidence proving it is safe, high quality and effective’.
The memo outlines a programme of vaccinations which frontline NHS staff, such as this surgeon, will be first to get
They added: ‘Should a vaccine be available before the end of the year, we have put in place robust measures to allow the Medicines and Healthcare products Regulatory Agency to authorise the vaccine for UK patients. This will only happen if there is a strong public health justification and the EU process is taking too long.’
The regulator will have autonomy to approve vaccines for the UK from 2021 in any case.
A senior Government source said: ‘We have made sure that if a vaccine is proven safe and effective we won’t be held back from deploying it by the need for approval from Brussels.’
NHS staff are most likely to receive the vaccine being developed by Oxford University and pharmaceutical giant AstraZeneca, which is in the final stages of trials.
The Government has already bought 100 million doses of the drug, which is administered in two doses. Under Government plans, frontline NHS staff and care home workers will be vaccinated first, followed by those aged over 80.
Human trials of the Oxford vaccine have been under way since April, involving about 20,000 volunteers worldwide. Scientists have reported a ‘robust immune response’ and no serious side-effects.
Last night, David Eltringham, managing director at George Eliot Hospital NHS Trust, said: ‘We don’t have a definite date for delivery of the vaccine, but we are making ready to deploy the vaccine from the beginning of December.’
Oxford’s Covid jab ‘has only been tested on 500 over-70s’
By STEPHEN ADAMS for the Mail On Sunday
Britain’s front-running Covid vaccine has only been tested on about 500 elderly people in this country, raising questions about how effective it might be for a vital section of the population.
There are high hopes for Oxford University’s ‘ChAdOx’ jab but only 1,000 or so of the 10,000 people recruited to the UK arm of Oxford’s trial are aged 70 or over. Half of them have been given the vaccine and half have had a placebo.
Last night, former immunisation ‘tsar’ Professor David Salisbury said the relatively small numbers might not be enough to generate a meaningful result.
‘Clearly, if you’ve just got 500 vaccinated and you’ve given 500 the placebo and you are looking to see a significant difference in protection between the two… you may not get much out, in terms of data,’ he said.
However, he added that early results appeared to show that older people given Covid vaccines developed good immune responses, so he was hopeful they would work well in the elderly.
The issue is critical because the virus is much more deadly in older people. An 80-year-old is about 1,000 times more likely to die of the virus than a 20-year-old, while five out of every six Covid-related deaths have been in the over-70s.
Earlier this month, Kate Bingham, head of the UK’s Vaccine Taskforce, gave a clear signal that Covid vaccination is to be aimed at older people, even though vaccines are often less effective in that group as their immune systems tend to respond less strongly.
For example, the flu vaccine given in 2016-17 was completely ineffective in the over-65s, according to data from Public Health England. It did, however, work well in younger people.
As Oxford’s Covid vaccine works in a different way, there is no specific reason to believe it will be a dud in the elderly but all the leading jab contenders are acutely aware of the issue.
Oxford has launched parallel trials in Brazil, South Africa and the US – but only the American ‘arm’ is enrolling over-65s. AstraZeneca, which is handling the US trial enquiries, refused to say how many over-65s have been recruited there so far.
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