Pandemic NHS triage and social care briefing papers

It has taken us over a year to win disclosure of these secret documents prepared by NHS England for the Department of Health & Social Care in 2017/18. They address a pandemic influenza but they are clearly relevant for UK pandemic management during COVID-19. Both documents will be published and downloadable here from 9am on 31st July 2021.

NHS Surge Triage document
Social Care document

Brief analysis

The Telegraph’s Investigations Team have published a front page exclusive story on the two pandemic documents.

NHS England have issued a statement to the Telegraph: “The NHS was asked to produced 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.”

If these documents did not form the basis of the NHS response to coronavirus, then what triage plan did NHS England prepare for coronavirus and why have they consistently refused to share it with frontline NHS staff who have had to make very challenging decisions on the ground?

We encourage everybody to read the documents and make your own minds up. 

NHS Surge and Triage document

  • The UK’s relatively modest intensive care capacity is recognised, and short-term emergency measures are considered to increase this, but NHS England makes no mention about a long-term plan to build pandemic resilience.
  • The decision to move to triage would happen when 6,500 out of a projected emergency 7,000 ICU beds were occupied.
  • Patients to be assessed on probability of survival rather than clinical need.
  • Age and “life years saved” would be important in allocating care, for instance the document says “perinatal/maternal care plus childhood care being protected would have the greatest benefit”.
  • The document has an Annex which provides extremely useful guidance and specific clinical examples for healthcare professionals on the ground in a severe pandemic.
  • The document was discussed with the British Medical Association and Academy of Royal Sciences, and was planned for discussion with the Presidents of the Royal Societies, regulators and professional bodies. It was never discussed with the frontline NHS staff who would have to make these difficult decisions on the ground.

Adult Social Care document

  • The “vast majority” of UK adult social care is provided by independent private providers, and 91% of the workforce work in the independent sector.
  • There are 90,000 vacancies in the care sector, with high tunrnover rates of registered nurses and care workers.
  • There are significant gaps in the Government’s data on social care. They do not know how many beds are occupied. There is no national data which breaks down domiciliary care provided at home. Regarding the lack of data on community health services, the report says “this data set is not suitable to model how a reasonable worst-case scenario pandemic will impact community healthcare demand”.
  • The document plans to use social care for “rapid discharge from hospital to maximise hospital capacity”, which we know happened during the first wave of COVID-19 with disastrous consequences. The social care document also plans to increase capacity in residential / care homes by installing extra beds in rooms. The document seems to make no allowance for risks of increased infectivity within care homes.

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9 thoughts on “Pandemic NHS triage and social care briefing papers”

  1. in the last 16 months there have been more avoidable civilian deaths (avoidable deaths and “groupthink” words used by jeremy hunt summer 2020) than in the last thousand years,-the simple reason being clinicians , with thousands of years of experience with infection and contagion where left out of the equation-the decision makers CMO, CSO and SAGE did nothing -groupthink-rabbits staring at headlights. This is clinical negligence manslaughter in public office-plain and simple.
    As an old semi retired clinician i saw last face to face Feb 27 2020 and quarantined/lockdown patient care to remote Mar 2 – a 90% reduction in deaths was easily achievable , but the experts sat and did nothing –neither are they trained like proper doctors to react.none have resigned. The CSO went to Wimbledon maskless whilst numbers and deaths went up-poor judgement and no respect.
    I am MAC chair of small day case hospital/ private mainly doing NHS work 7/7-we have had not a single transmission patient/ staff, charles davis clinical prof neurosurgery and neurooncology preston

    1. Groupthink is definitely a problem, and I share your concerns about manslaughter, and although ministers may enjoy Crown immunity, it may be possible to argue a case for corporate manslaughter against NHS England’s executive board. I’m not commenting on specific individuals, but in general the Chief Medical Officer isn’t the best clinician or even public health expert in the UK, and the Chief Scientific Officer definitely isn’t the nation’s most gifted scientist – these offices are political offices, they form part of the Government. This means that the types of individuals drawn to these roles can find it difficult to remain independent, even though they’re supposed to offer objective advice.

  2. I think the big questions are why both Labour and the Lib Dems are actively complicit in this dismantling of the bedrock of the Welfare State, does Labour believe that saving the NHS is ‘too lefty’ to win votes? Do the Lib Dems believe it is ‘too expensive’ to viably save? And why are the Media derelict in their duty to better publicise and explain what is being done? They are not acing as the fourth estate, perhaps because the head honchos pretty much all outlets went to same schools and sup at the same tables as those in power… at the risk of being called a Conspiracy Theorist, how else could this be accomplished without public outcry? Not even Channel 4 News have taken up this baton – is there a Super Injuction preventing them from doing so? If so, we need a whistleblower!

    1. You raise some important questions, I suspect the answers are complex. The most important thing is to escape from the simplistic and outdated “Tories versus the NHS” narrative. Political parties are arguably less important than large transnational corporations in what’s happening in the NHS. What’s interesting for me is that there’s really authoritative economic guidance from people like Kenneth Arrow and Amartya Sen (both Nobel prizewinners in economics) that privatisation specifically in healthcare is very tricky, and leads to inefficiency (read Kenneth Arrow’s work on ‘asymmetric information’). These economists aren’t communists, by the way – they held or hold eminent academic positions in the United States. So the question is why UK politicians and some healthcare leaders are saying “we don’t have enough money for the NHS” but then we’re moving towards a more economically inefficient model of healthcare?

      1. “why UK politicians and some healthcare leaders are saying “we don’t have enough money for the NHS”- The fact is, of course, that the UK, with its own sovereign currency., and central bank, NEVER has purely financial constraints. When a UK government spends, it issues new £sterling through the Bank of England marking up relevant accounts, and can do so to any extent it chooses. It cannot “run out” or “be short of” of £sterling, any more than a stadium can run out of goals. There are, indeed, constraints of actual resources, eg staff, buildings, medicines etc, but never money. The false macroeconomic narrative of governments being dependent on tax receipts, or the smoke and mirrors of “borrowing”, allows a governing party to deceive the public about its political choices in funding. https://thepoundinyourpocket.org/2021/05/16/11-where-does-uk-government-money-really-come-from/

    1. Hi Sean – I understand your concerns. “The NHS” is a complex organisation and changing rapidly, I’d encourage you to read our blog here about the worrying direction it’s taking in the current Health and Care Bill: https://cygnusreports.org/nhs-white-paper-doublespeak/

      Regarding your specific point, I think the content of the Telegraph article makes a clear distinction between the corporate executives who run the NHS from their offices and the frontline NHS workers who are battling against COVID-19 on the ground. For instance, it quotes me as follows: “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?”

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