Secret document drawn up during Covid-19 pandemic to 'decide who should live and die' if NHS overwhelmed

A secret document was drawn up during the Covid-19 pandemic outlining which patients should be prioritised for care if the was overwhelmed.

NHS England's national medical director told the Covid-19 Inquiry such a priority list should be drawn up now to prepare for the next pandemic. Professor Sir Stephen Powis also said the government had pushed for clinicians to draw up the guidelines which advised doctors how they should prioritise the fit and young. The document was never officially released as it became clear that the nation was reaching the peak of the crisis, he said.

Sir Stephen said: "At that point in March [2020] 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 come ahead. It was not clear whether the public would respond to lockdown - they did wonderfully, but that was not clear.

"Frankly, I was personally terrified, terrified that the NHS was going to be overwhelmed and doctors were going to be placed in a position, and other clinicians, where they would not be able to make the professional judgement that they usually make in terms of treatments and escalation. And in those circumstances, I and my clinical colleagues and CMOs (chief medical officers), felt that we should begin to explore a decision tool such as this."

The inquiry was shown the unpublished document, titled Covid-19 Decision Tool, which highlights three elements to consider when prioritising care: age; "clinical frailty" and "comorbidities". Patients were given "points" based on their age, with under 50s placed at zero and 80-year-olds starting at six points. It also ranked patients from one to nine, one being fit and well and nine being terminally ill, while comorbidities such as previous heart attacks, high and heart failure also scored with points. A point was taken off for women. The scores would then dictate what sort of care should be provided to the patient.

The inquiry heard that the "impetus" for the document came from the Department of Health and Social Care. It comes after evidence to the inquiry last year from former NHS England chief executive Sir Simon Stevens who said ex-Health Secretary wanted to decide "who should live and die" if the NHS was overwhelmed.

In his witness statement, he said Mr Hancock thought he, not doctors or the public, should decide who to prioritise. Sir Simon told the inquiry: "The secretary of state for health and social care took the position that in this situation he - rather than, say, the medical profession or the public - should ultimately decide who should live and who should die." He added: "I certainly wanted to discourage the idea that an individual secretary of state, other than in the most exceptional circumstances, should be deciding how care would be provided. I felt we were well-served by the medical profession, in consultation with patients to the greatest extent possible, in making those decisions."

The latest module of the inquiry chaired by Baroness Hallett was told on Thursday that 28 March 2020 a decision was made that the prioritisation plan should not go ahead.

Sir Stephen Powis said: “It became absolutely clear to me that this was going to be controversial, that it hadn't had the opportunity to be discussed more widely with patient groups, with public and so my recommendation to the inquiry is that we should absolutely, in future, not try and develop one of these tools in the midst of a pandemic. This is a discussion that has to occur 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. This is too hard a task to do at the height of the pandemic."