Top NHS doctor: I was terrified the service would be overwhelmed during Covid

The country’s top doctor has described how he was “terrified” that the NHS would be overwhelmed when officials prepared an unpublished document detailing who should be prioritized for care if the service exceeded capacity in the early stages of the Covid-19 pandemic.

The document was never officially released as it became clear the country was reaching the height of the crisis, NHS England’s national medical director said.

Professor Sir Stephen Powis told the UK Covid-19 Public Inquiry that the work was something “no one ever wants to do”.

The ‘prioritization document’ was written in March 2020 for consideration if the NHS became overwhelmed by Covid-19 cases.

The study was shown the unpublished document, titled Covid-19 Decision Tool, which highlights three elements to consider when prioritizing care: age; “clinical vulnerability” and “comorbidities”.

Patients were given “points” based on their age, with children under 50 placed at zero and 80-year-olds at six points.

It also ranked patients from one to nine, with one fit and healthy and nine terminally ill, while co-morbidities such as previous heart attacks, high blood pressure and heart failure also scored points.

One point was deducted for women.

The scores then determine what care should be provided to the patient.

Sir Stephen said: “As for this decision instrument, which was never approved, it has never been officially released.

“It did not progress beyond this stage, except that the group that developed it subsequently published a version of it in a set of principles around decision-making in an Intensive Care Society.”

The investigation found that the “initiation” for the document came from the Department of Health and Social Care, but on March 28 it was decided that it should not go ahead.

Sir Stephen continued: “This was at a point in March when Covid cases were rising rapidly.

“The strategy that the NHS and the government had adopted was on the one hand to introduce social distancing, in other words lockdown, to reduce the rate of transmission, and within the NHS our job was to increase capacity.

“But at that point in March, the number of patients with Covid in ITU (intensive care) beds was doubling every five to seven days.

“We couldn’t see – because there was no community testing at the time – what was likely to happen.

“It wasn’t clear whether the public would respond to the lockdown – they did wonderfully, but it wasn’t clear.

“To be honest, I was personally terrified, terrified that the NHS would be overwhelmed and doctors would be put in a position, and other doctors, where they would not be able to make the professional judgments that they normally make in terms of treatments and escalation.

“And in those circumstances, I, my clinical colleagues and CMOs (Chief Medical Officers) felt that we should explore a decision tool like this.”

He added: “It was stopped, I think because a number of us, the Chief Medical Officer, myself, with input from the (then) CEO of NHS England, came to the conclusion that it should not be released.

“For me the main reason was that at this point it was becoming increasingly clear that the peak of the pandemic was approaching and therefore this would not be necessary because we would not be breaking capacity.

“It became very clear to me that it would not be necessary, and I was concerned that if it were released, it could be used when it was not necessary.”

There was also a “danger” that the tool would take away some of doctors’ professional judgment and could be considered “too simplistic”.

“I think it was right to stop it because we didn’t need it and it could have been used inappropriately,” he said.

Sir Stephen also said he shared concerns that the document would be controversial and risk a bad reaction from the public.

“This is not a criticism of the group of clinicians who worked on this, they did a fantastic job,” he told the Pandemic Inquiry.

“They were asked to do something no one ever wants to do: develop these kinds of tools, and they had to do it quickly.

“But it became absolutely clear to me that this was going to be controversial, that it had not had the opportunity to be discussed more broadly with patient groups, with the public, and so my recommendation for the study is that in the future we absolutely must, don’t try to develop one of these instruments in the middle of a pandemic.

“This is a discussion that should take place in normal times.

“In my opinion, it is a discussion that should not be led by the government, which should not even be led by the profession, but which should take place within society.

“This is too difficult a task to undertake at the height of the pandemic.”

It comes as the survey’s Every Story Matters campaign reached the milestone of 50,000 entries.

The public engagement exercise aims to better understand the public’s pandemic experiences and will shape the surveys’ recommendations.

Ben Connah, Covid-19 Inquiry Secretary, said: “I would like to thank every member of the public who took the time to come and visit our team, or contribute in some other way, throughout 2024. it was a privilege to hear what you have to say.

“We have heard of terrible hardship and loneliness, but also of true dedication and sometimes even courage.”