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1/5: Medical triage (rationing) in a crisis is a difficult issue but it needs to be confronted directly to prevent things getting much worse. We are now at alert "Level 5", meaning there is a *material risk* of NHS services being overrun, so I looked at it for today's paper...
2/ First, the news story. In the absence of national guidelines (more on that shortly), clinicians in Bath have drafted and circulated a detailed protocol for debate among doctors. The story is free to read here: https://www.telegraph.co.uk/global-health/science-and-disease/covid-lottery-doctors-draw-triage-protocol-event-treatment-has/
3/ A news story can never do justice to such a complex subject but can spark debate. You can read the full draft protocol and accompanying background here. Note, the authors wrote it when deaths were low to encourage calm debate ... https://jme.bmj.com/content/medethics/early/2020/11/20/medethics-2020-106771.full.pdf?with-ds=yes
4/ Why is there no national policy on triage? @DrMQureshi regards it as an "abdication of responsibility" by ministers. It's brave for local clinicians to have devised a protocol but it's not optimal. There should be national guidance. I explain why here: https://www.telegraph.co.uk/global-health/science-and-disease/crisis-triage-protocol-brave-attempt-ensure-happened-italy-not/
5/ The Dept of Health's behaviour has been appalling. Exercise Cygnus in 2016 flagged the need for a national triage protocol and the report that followed ordered one be drafted. Yet the DH claims to have fulfilled the Cygnus recommendations *and* not to have a protocol (magic!)
6/ You can read more about Cygnus here. It will be at the heart of any future public inquiry into the Covid-19 pandemic in the UK https://www.telegraph.co.uk/global-health/science-and-disease/six-crucial-pandemic-lessons-government-ignored/
7/ Note too, that when hospitals were overrun in Cygnus, the then health sec @Jeremy_Hunt was asked to turn off ventilators but refused to do so as detailed here: https://www.telegraph.co.uk/global-health/science-and-disease/jeremy-hunt-downed-tools-refused-play-asked-turn-ventilators/
8/ For that story (in nice quiet October) his office gave me the quote below, which makes good sense in many ways. The trouble is where is that "rethinking" today?? We are perhaps 21 days from parts of the NHS being overwhelmed and clinicians are being told nada
9/ Last, it is important to note the NHS is not yet overwhelmed and may never be so. There are more in hospital now than in April but fewer Covid cases being admitted to ICU. There is still time for the DH to issue national guidance. The rest of us should remain indoors #COVID19
