Answers from Government today on letters 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; a reply on the protection of public health in Gypsy, Roma and Traveller Communities during the COVID-19 pandemic. And further Questions to Government about the scale of deaths in care homes and under reporting.
Health and Social Care, has provided the following answer to your written parliamentary question (HL3292):
Question by Lord Alton of Liverpool :
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] (HL3292)
Tabled on: 21 April 2020
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.
The following documents were submitted as part of the answer and are appended to this email:
- File name: C0133-COVID-19-Primary-Care-SOP-GP-practice_V2.1_6-April(1).pdf
- File name: C0166-Letter-LD AUTISM DNACPR.pdf
- File name: CNO Covid letter maintaining-standards-quality-of-care-pressurised-circumstances-7-april-2020.pdf
Description: Letter_ maintaining_standards_quality
Date and time of answer: 18 May 2020 at 16:17.
Links to these documents are:
May 18 CNO Covid letter maintaining-standards-quality-of-care-pressurised-circumstances-7-april-2020May 18 C0166-Letter-LD AUTISM DNACPRMay 18 C0133-COVID-19-Primary-Care-SOP-GP-practice_V2.1_6-April(1)Lord Bethell,
Lord Bethell, the Department of Health and Social Care, has provided the following answer to your written parliamentary question (HL3918):
Question by Lord Alton of Liverpool:
To ask Her Majesty’s Government what steps they are taking to protect public health in Gypsy, Roma and Traveller Communities during the COVID-19 pandemic. (HL3918)
Tabled on: 05 May 2020
The Government takes the welfare of all citizens seriously and we are working hard to ensure people get the support they need to look after themselves and their families during the COVID-19 outbreak. This includes enabling all communities to take the necessary measures to reduce the spread of the virus.
The Minister of State for Home Affairs and Housing, Communities and Local Government (Lord Greenhalgh) wrote to councils outlining their responsibility to support all communities, including Gypsy and Traveller communities, and to ensure they have access to water, sanitation and waste collections.
COVID-19 health guidance for members of Gypsy, Traveller and Boater communities is currently in development for dissemination in a range of formats.
NHS England and NHS Improvement have written to general practice reminding them of the importance of continuing to deliver appropriate care to their local population and the requirements on registration of patients, including those with no fixed address.
Date and time of answer: 18 May 2020 at 16:03.
Lord Alton to ask Her Majesty’s Government what assessment they have made of the report by Adelina Comas-Herrera and Jose-Luis Fernandez at the London School of Economics England: Estimates of mortality of care home residents linked to the COVID-19 pandemic, published on 12 May, which found that “data on deaths in care homes directly attributed to COVID-19 underestimate the impact of the pandemic on care home residents” and that such data accounted for “an estimate 41.6 per cent of all excess deaths in care homes”; what assessment they have made of the accuracy of the data provided by the Office for National Statistics that 8,314 people had died from COVID-19 in care homes from 13 March to 8 May; what were the causes of the additional 10,000 recorded deaths in care homes during that period between 13 March and 1 May as set out in the report; and whether the total number of deaths over that period represents 18,000 more than the average estimate in previous years.
Lord Alton to ask Her Majesty’s Government what assessment they have made of the comments by the UN Human Rights Commissioner about the operation of care homes during the COVID-19 pandemic; what assessment they have made of reports of care home staff (1) abandoning care homes, (2) leaving residents to die alone, (3) failing to make adequate preparations, and (4) failing to provide guidance and personal protection equipment; what assessment they have made, in assessing such reports, of the human rights of patients and staff in care homes; and what plans they have to support the call for a UN convention on the rights of the elderly.