National bodies ‘failed to help staff with rationing care during covid’
Six in 10 healthcare professionals said they lacked support from national bodies like NHS England and the Department of Health and Social Care when making decisions about which patients to prioritise for higher-intensity care during the pandemic, according to research.
A similar proportion of staff said they were unable to escalate some patients to a higher level of care, when they otherwise would have, a survey carried out for the covid-19 inquiry found.
The most common reasons given for not escalating were a lack of staff and not enough beds, including for high dependency care and for invasive mechanical ventilation.
It comes as NHS England’s representative, Eleanor Grey KC, urged the inquiry to “bear in mind the resources that were available” and “external constraints… such as the ageing NHS estate”.
Ms Grey also argued the exercise should consider what alternative decisions could have been taken by NHSE, arguing: “Evidence of the harm caused by a measure that was adopted has to be balanced by an equally serious assessment of the anticipated harms of alternatives.”
The research was commissioned by the covid inquiry for third module, which over the next two months will look at the healthcare system’s response to the virus. It was carried out by IFF Research and surveyed nearly 2,000 staff, including doctors, nurses and paramedics.
During the peaks of the pandemic, officials downplayed the prospect of intensive care being rationed, and little official guidance was issued on making such decisions. But in the survey, four fifths (81 per cent) of clinicians “agreed that more patients were unable to be escalated… compared to before and over two thirds (71 per cent) agreed that patients who were unable to be escalated were more severely ill”.
The survey report said: “The primary reasons for the inability to escalate care were a lack of available beds at all levels, including high dependency units, and a lack of staff (overall or at the right level), followed by a lack of equipment or technology and lack of access to an ambulance.”
The research said: “There was room for improvement in terms of how supported HCPs felt by many organisations, particularly national authorities and regulators.”
Results were better for employers, where more than half felt supported in making decisions about care.
One paramedic quoted in the report said: “It was very difficult and upsetting to leave some sick patients at home due to tightening of criteria for conveyance to A&E. Some of these patients would have deteriorated and died. I understand why it had to happen, but it went against my paramedic values.”
A critical care doctor elsewhere said most people who needed care received but the “quality of care was being diluted from [the] pre-pandemic standard. This was reflected in a significantly higher mortality [rate].”
Ms Grey added: “We ask the inquiry to recognise the serious purpose for which all measures were adopted, ultimately, to preserve life.
“This is not a tale of carelessness or improper motives, nor one of accepting a… disproportionate impact on different people, but one in which difficult choices have weighed very heavily on staff whose overriding concern and priority was always to save lives.”