Senior NHS Doctor Feared Hospital Overload During Pandemic’s Initial Phase

The most senior physician in NHS England has stated he was “personally terrified” that hospitals could have been overwhelmed during the initial stages of the pandemic. Professor Sir Stephen Powis informed the Covid inquiry that officials had prepared a preliminary document outlining how patient care should be prioritized if the NHS became unable to manage the influx of patients. This ‘Covid-19 decision tool’ assigned scores based on a patient’s age, frailty, and existing medical conditions. A high score indicated that they might not be admitted to intensive care if services were at capacity. The tool was never publicly released, as it became apparent that infection rates might have already reached their peak in March 2020. Sir Stephen, who continues to serve as national medical director at NHS England, remarked that the senior clinicians asked to develop these plans on short notice “did a magnificent job” that “nobody ever wants to do”. “But it became absolutely clear to me that this was going to be controversial, [and] that it hadn’t had the opportunity to be discussed more widely with patient groups, [or] with the public,” he added. The draft document instructed doctors to score Covid patients using a frailty scale based on three criteria. It specified that individuals with a total score exceeding eight points should not be admitted to intensive care if services became overwhelmed. Patients aged 70 to 75 were to be automatically assigned four points, while those over 80 would receive six. Additional points would be added for chronic conditions, such as heart disease or diabetes. People who were terminally ill, with a life expectancy of less than six months, would automatically be given nine points. Sir Stephen noted that work on the guidance document began early in the pandemic, at a time when the number of patients in intensive care in England was doubling every 5-7 days. “It was not clear that the public would respond to lockdown – they did wonderfully – but that wasn’t clear [at that point],” he said. “Frankly, I was personally terrified that the NHS was going to be overwhelmed.” The project was discontinued on 28 March 2020, after it became clear that the peak of the first Covid wave was approaching and the health service would not “breach capacity”. Sir Stephen also indicated a risk that the point-scoring system could have been “used inappropriately,” potentially replacing the individual clinical judgment of doctors. “My recommendation to the inquiry is that we should absolutely, in the future, not try and develop one of these tools in the midst of a pandemic,” he added. He stated that such work needed to be carried out in consultation with the public “in normal times.” “In my view, it’s a discussion that shouldn’t be government-led, it shouldn’t even be led by the profession, it needs to be located within society.”