Analysis comment

The NHS chart that will decide whether you receive ventilation if you need it

Points-based system means even relatively young people with moderate health issues – or almost anyone with significant physical or mental disability – can be ruled out of life-saving intervention

An chart first published by the Financial Times reveals the decision-making system that the government’s failure to plan ahead and build up the availability of ventilators and a decade of cuts and fragmentation have forced on the NHS in its treatment of coronavirus patients – and how shockingly easy it is to end up with a ‘score’ that may deprive someone of intensive medical intervention if they become seriously ill.

The NHS ‘Decision Support Tool’ allocates points to each patient based on their age, condition and ‘co-morbidities’ – other existing medical conditions – and unlike in most sports, the people with the most points lose.

The chart also reveals the chilling reality that patients with physical or mental disability – even if not otherwise life-limiting – are almost certain to fall foul of the system and miss out on ventilation.

And even not taking regular exercise will put you almost halfway there:

Enlarge image for detail

More points, worse result

Under this system, anyone with eight points or more is essentially ruled out – subject to ‘clinical discretion’ – from intubation on a ventilator. As the bottom right table makes clear, only those in the green category will have ‘rapid access to intubation’.

Those with 8 points or more might receive ‘CPAP’ – ‘continuous positive airway pressure’ via a mask.

But patients with high scores who are not helped by a ‘trial’ of CPAP receive at best an ordinary oxygen mask – and face palliative care if they are lucky, or else being sent home or back to a care home where they are likely to die, as well as to infect others.

Scoring is easy

The document reveals a scoring system that many would consider discriminatory or even Darwinist.

A person in a wheelchair, in a stable condition and not dying from their disability but requiring help with personal care, scores 7 points – only one from the eight-point boundary. A person needing help because of an impaired mind also receives 7 points, whether or not they have a deteriorating condition.

A person with even mild limitations to their mobility scores 4 – and someone with no significant limitations but who simply does not exercise regularly scores 3. Any kind of ‘frailty’ quickly moves up the points scale.

Ageism is also intrinsic to the system. The older you are, the more points you ‘score’ – regardless of your fitness level:

And co-morbidities also rack up points, even having high blood pressure – and note that there is no mention of whether it’s controlled by medication, while diabetes expressly scores a point even if it is controlled by medication:

Nobody outside the green 0-8 point zone will even be considered for ‘extra-corporeal membrane oxygenation‘ (ECMO) – a machine that will oxygenate a patient’s blood outside the body – and even those in the green zone will only be considered if they are under 60 years of age:

And note that this ‘Support Tool’ is not in accordance with the usual guidelines for the treatment of ‘ARDS’ – acute respiratory distress syndrome:

The only glimmer of good news – for half the population at least – is that women have a point taken off their score before it is considered, presumably in reference to the fact that female coronavirus sufferers appear to have a higher survival rate than men.

The UK media made much of the stark choice facing Italian and Spanish medics when their health systems were overloaded by the pandemic. But in this country, our hospitals are already using points to deny intervention to older or disabled people and even those with intellectual impairment – to barely a murmur from the ‘MSM’.

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  1. ‘Decision support tool’ my arse. It’s a tool for dealing with the results of an underfunded and under resourced NHS!

  2. Behind the curve again in the rush to find devils. The dangers of intubation are causing considerable increasing concern and raising quaestions of appropriateness.

    Once again – it’s not so simple.

  3. Meanwhile, ken dodd’s ‘happiness’ has been released by a series of has-beens and others (Ricky Tomlinson excluded) in tribute to the NHS.

    The last line is: ”We’ve got more than our share of NHS”

    It’s very good of them to do so, and show such sentiment, but I think they’d be better off rewriting that last line, meself…😕

  4. Shocking not shoving! First time on S’box I’ve been moderated; a new system or what? Or have I been speaking out ot turn?

  5. Do S’box tell you if you have been moderated? My last comment has disappeared after a note said it awaited moderation. It was about the use of oxygen. Odd!

    1. I been having the same problem occasionally when posting from my phone then from laptop.

      It also invariably happens if you post more than one link per post.

      1. I’m not sure what was objectionable to my comment which was moderated and then disappeared on this thread. It’s true I was cheekily asking that people who would have difficulties on a ventilator get as effective oxygenation as Johnson had. I also questioned the use of ventilators generally which is a very contentious issue but it’s hard to believe anything I wrote was against S’box policies (whatever they are). If it was an error then wouldn’t it be re-posted?

  6. A USA company was commissioned costing £100,000,000 to Investigate and Isolate out those who were the most EXPENSIVE or was it EXPENDABLE PATIENTS. This just after GE2019 and before a Pandemic was declared.
    The Ideology of removing UNPRODUCTIVE HUMANS from EARTHLY EXISTENCE is nothing new.
    This HERD IMMUNITY IDEA is still prevalent and explains the LACK OF ACTION AND EQUIPMENT for NHS staff

  7. There has since been a backtrack by the top brass at NHS England over the “frailty test”. This letter (copied and pasted) makes some relaxation for the disabled and those with Learning Disability or Autism

    To: Primary Care Distribution Lists, Acute Trust CEOs Community Trust CEOs

    Dear Colleagues,

    We are writing to ensure that there is clarity in relation to the use of the Clinical Frailty Scale (CFS) and the use of do not attempt cardiopulmonary resuscitation (DNACPR) with younger patients, those with a stable long term physical need, learning disability or autism.

    In May 2019 the National Medical Director, Professor Stephen Powis, wrote with regard to Learning disability, death certification and DNACPR orders, emphasising that: “The terms “learning disability” and “Down’s syndrome” should never be a reason for issuing a DNACPR order or be used to describe the underlying, or only, cause of death … Learning disabilities are not fatal conditions.”

    Earlier this week NICE issued rapid guidance on admission to hospital and to critical care: COVID-19 rapid guideline: critical care in adults NICE guideline [NG159]. The guidance made reference to assessments using the Clinical Frailty Scale (CFS).

    The guidelines have now been amended on the 25th March to make it clear that: “The CFS should not be used in younger people, people with stable long-term disabilities (for example, cerebral palsy), learning disability or autism. An individualised assessment is recommended in all cases where the CFS is not appropriate.”

    NHS England / Improvement has published specialty guides for the active management of patients with suspected and confirmed COVID-19 which include specific guidance on the management of people with learning disabilities and autism to which clinicians are strongly recommended to refer:
    The health of some people who have a learning disability and / or a diagnosis of autism may be at risk from the presence of co-existing physical conditions and also from inequities in access to and delivery of appropriate and timely assessment and treatment for physical health conditions.

    It is imperative that decisions regarding appropriateness of admission to hospital and for assessment and treatment for people with learning disabilities and / or autism are made on an individual basis and in consultation with their family and /or paid carers, taking into account the person’s usual physical health, the severity of any co-existing
    conditions and their frailty at the time of examination. Treatment decisions should not be made on the basis of the presence of learning disability and / or autism alone.

    Claire Murdoch
    National Director NHS England and NHS Improvement

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