Strategy drawn up by NHS England following 2016 pandemic planning exercise was designed to stop hospitals being overwhelmed
30 July 2021 •
The NHS drew up secret plans to withdraw hospital care from people in nursing homes in the event of a pandemic, The Telegraph can disclose.
Confidential Whitehall documents show that the NHS plans refused treatment to those in their 70s and that “support” would instead be offered to use so-called “end of life pathways”.
The strategy was drawn up by NHS England following a pandemic planning exercise in 2016 and was designed to stop hospitals being overwhelmed.
It suggests that in a “severe” flu pandemic, the Health Secretary could authorise medics to prioritise some patients over others and even stop providing critical care altogether.
Ministers have repeatedly insisted that care homes were not abandoned by the NHS during the coronavirus crisis, despite mounting evidence to the contrary. More than 42,000 residents in England and Wales died during the pandemic and hospitals released thousands of patients into care homes without testing.
The Telegraph disclosed earlier this year that care homes were asked by NHS managers and GPs to place “do not resuscitate” orders on all residents at the height of the pandemic to keep hospital beds free – in breach of guidelines.
Dominic Cummings, Boris Johnson’s former chief adviser, has said it was a “lie” that everyone received care, and that in fact “many people were left to die in horrific circumstances”.
The documents reveal that the Government proposed triaging patients based on their “probability of survival” rather than “clinical need” if resources were exhausted.
The documents on “NHS surge and triage” and adult social care – labelled “confidential” and “official sensitive” – were created in 2017 and 2018 and sent to government advisers. Both looked at how services would respond to a serious flu outbreak.
The reports were obtained by an NHS doctor, working with lawyers Leigh Day, who was concerned about pandemic preparedness. The Government initially rejected his request under the Freedom of Information Act, but the Information Commissioner said their disclosure was in the public interest.
Barbara Keeley MP, who sits on the health and social care select committee, said: “It’s time the Government came clean about its policies on care homes.”
Dr Moosa Qureshi, who passed the reports to The Telegraph, said it was “unprofessional” that plans were not given to medics.
“The Information Commissioner held that clinicians must be supported by a clear framework when allocating care during a severe pandemic, and that the framework needs public debate,” he said.
“The NHS triage paper provides real guidance for frontline staff if NHS services are overwhelmed. Why did the Department of Health, NHS England and BMA keep it secret from healthcare professionals?”
An NHS spokesman said: “The NHS was asked to produce this discussion document based on a specific and extreme hypothetical scenario to inform the Government’s pandemic flu preparedness programme rather than for operational use and it did not form the basis of the NHS response to coronavirus.”
A government spokesman said the reports were “historical draft briefing papers that include hypothetical scenarios which do not and have never represented agreed government policy”.
‘Purely because my father was living in a care home, he was left to die’
When Andrew Ward received a phone call from the care home in April last year, it was the news he and his siblings had been dreading.
Their father, Geoffrey Ward, had developed a cough and, although at 74 he had previously been as “fit as a fiddle”, he had been diagnosed with Covid.
He had gone to live in the home after an accident made him prone to wandering off unsafely, Andrew Ward recalled. But “from the moment that he displayed the first symptom, it was as though everyone had decided that the Covid would kill him”.
Staff at the Cumbria nursing home told Andrew that they had already contacted the GP who had assessed his father over video rather than carrying out a face-to-face visit and determined that he should not be admitted to hospital.
Despite Andrew’s protestations to the GP and other medics, this remained the position and three days later his father, a former printer, collapsed and an ambulance was called to help hoist him back to bed. According to his son, the paramedics told the care home staff they would not return to help him again.
A couple of days later, Geoffrey Ward was dead – an apparent victim of Covid, with his family feeling he had been denied care.
His story could be dismissed as an isolated incident given the stress the NHS was under. The Government has also repeatedly offered assurances that everyone who needed care during the pandemic received it.
That line had already started to unravel when Mr Cummings revealed how members of the Government were told by senior advisers that some “people did not get the treatment they deserved, many people were left to die in horrific circumstances”.
But now, documents obtained by The Telegraph show that three years before Covid, the Government raised the matter of withholding care from the elderly in the event of a pandemic, leading to questions about whether individual tragedies could have been part of a wider strategy.
The documents raised scenarios in which, if there was a severe influenza pandemic and extreme pressure on resources, doctors would need to put some elderly patients on an “end of life pathway” and deny them hospital care.
When the Covid pandemic hit, The Telegraph found that restricting care turned out to be one of several ways in which care homes were apparently abandoned.
Guided by its mantra to “protect the NHS”, the Government effectively loaded the Covid problem on to the care sector by telling them early in April last year that hospital patients could be discharged into care homes, regardless of whether they were Covid-positive or had even been tested.
Pressures on the sector meant care staff were forced to cut corners, according to the manager of a Nottinghamshire care home, who admitted that they would sometimes nurse residents in bed all day because they were so short-staffed.
The documents obtained by The Telegraph show that, for vulnerable people cared for at home, this was one of the approaches examined. “Service users being cared for in their own homes will have to remain in bed during the day, with much-reduced hygiene support,” a document states.
A table in the social care report says that in a “moderate” pandemic, care workers would “stop” assisting patients with “getting in and out of bed” or “having a bath/shower” in order that they could provide other basic services.
In a “severe” pandemic, they would even stop “managing toilet needs” – something which it states could be mitigated “by the provision of aids, eg commodes”.
When shown the documents, Lucy Easthope, a disaster recovery professor at Durham University and government adviser, said that pandemic flu briefing papers appeared to show that social care was likely to be sacrificed in the event of a severe pandemic, and that this Government’s “plan” for the sector was so ill-considered that it would inevitably have led to unnecessary deaths.
The documents also show that there was seemingly a complete lack of awareness from government officials about the dangers of an infectious virus spreading in care homes populated with vulnerable elderly people, with officials suggesting extra beds be added to homes so that more hospital patients could be discharged to them.
This blinkered thinking remained in evidence when the Covid pandemic took hold, with early Public Health England guidance confidently stating that the virus was “very unlikely” to spread in care homes. The guidance remained in place until mid-March last year, at which point there were around 800 Covid cases recorded across the UK.
Peter Kyle, the Labour MP for Hove, said that during the first wave, a care home had called him for help because when it had contacted a GP to assist a dying patient, the doctor had not come inside.
Instead of administering morphine, the doctor had walked halfway up the drive to deposit a kit to make the patient’s final hours more comfortable and gave directions over the phone.
“It was inhuman and meant that untrained staff were delivering end-of-life care,” said Mr Kyle. “For the elderly, it’s not just a question of a right to life, but also a good death.”
A care home owner based in the north of England, who asked to remain anonymous, said that at the beginning of the pandemic his staff found it “very difficult” to get medical treatment for residents, particularly if they were suspected of having Covid.
“GP practices wouldn’t visit, some of the patients we had discharged from hospital had ‘not for readmission’ written on discharge letters, so if they became more poorly they weren’t allowed to go back into hospital,” he said.
“Sometimes we couldn’t always get the oxygen we wanted for residents who returned from hospital after being diagnosed with Covid. Staff felt helpless and guilty. Oxygen may have improved their quality of life before they died.”
Looking back, Andrew Ward still wonders if his father might have lived if he had been at home.
“If my father had been living … in any other setting than a care home, then an ambulance would have picked him up when he was ill and taken him to hospital. But purely down to the fact that he was living in a care home, he was left to die.”
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