Question to the Department of Health and Social Care:

To ask Her Majesty's Government what assessment they have made of reports that letters have been circulated by GP surgeries to residents in care homes in the East of England stating that residents are “unlikely to benefit from mechanical ventilation” and will not be offered the treatment in hospital if admitted with COVID-19; whether any such letters have been circulated elsewhere; and on what authority and basis such guidance was issued. [T]

We are aware of reports of people in care homes being told by general practitioner (GP) surgeries that they are unlikely to be prioritised for mechanical ventilation if they contract COVID-19, because they could be too ‘frail’. This stemmed from recent National Institute for Health and Care Excellence (NICE) guidance on prioritising critical care. NICE was forced to revise the guidance, which included use of the clinical frailty scale (CFS), following allegations it discriminated against people with learning and other disabilities. The guidance was revised on 25 March 2020 and now states: “The Clinical Frailty Score should not be used in younger people, people with stable long-term disabilities (for example, cerebral palsy), learning disability or autism. An individualised assessment is recommended in all cases where the CFS is not appropriate.”

A letter was sent on 3 April 2020 to primary care, acute trusts and community trusts from the National Director of Mental Health, National Clinical Director (for Learning Disability and Autism) and the Medical Director for Primary Care to the NHS on the appropriate use of Do not Resuscitate forms and clinical frailty assessments (which can be used to assess whether critical care is appropriate for a patient) following recent reports on inappropriate use. A copy of the letter is attached.

Furthermore, a letter to the system from Ruth May, Chief Nursing Officer, and Steve Powis, National Medical Director at NHS England and NHS Improvement was sent out on 7 April 2020, addressing concerns recently raised regarding the use of DNR forms and supporting best practice in the application of advance care plans. A copy of the letter is attached.

Finally, NHS England and NHS Improvement have produced a GP Standard Operating Procedure (SOP) for managing COVID-19 in general practice, published on 6 April. This includes a COVID-19 advance care plan template, guidance notes for completing an advance care plan and states that “Advance care plans should be made on an individual basis. It is not acceptable for advance care plans, with or without Do Not Attempt Resuscitation forms, to be applied to groups of patients”. A copy of the SOP is attached.