Intensive care for coronavirus patients now limited to those ‘reasonably certain’ to survive, London NHS trust concedes

Intensive care for coronavirus patients is now being limited to those “reasonably certain” to survive, a major NHS London trust has conceded.

A department head at Imperial College Healthcare revealed on Sunday that fewer and fewer marginal patients are being selected for ventilator treatment because so many serious cases require a fortnight on the machines.

It comes as the NHS faces the toughest week in its history, with the Deputy Chief Medical Officer, Dr Jenny Harries, warning the number of deaths will increase.

Imperial College Healthcare acknowledged that “very poorly patients with coronavirus may need to be on a ventilator for extended periods,” adding that “for some patients this would not be in their best interests”, but denied people are being denied care due to capacity problems.

The statement amounts to the first admission that NHS doctors have significantly tightened their intensive care admission criteria since the start of the outbreak.

It follows a new study by the Intensive Care National Audit and Research Centre (ICNARC) which found that the death rate for Covid-19 patients admitted to ICU is nearly 50 per cent.

Comprising two large acute hospitals in west London, Imperial is so far coping with the flow of coronavirus patients, unlike several others in the capital.

However, the senior consultant told The Telegraph: “As we learn more about the disease, we are being much more careful about which patients are being considered for critical care.

“In normal times we will give most people the benefit of the doubt. That has changed.”

“With this infection you need a couple of weeks on a ventilator, so with resources being used for such a long time, you have to be reasonably certain the person is going to get better.

“Delaying their death for two or three weeks is not the right thing for them or for society.”

The disclosure follows advice from palliative care doctors in recent days that family members should ask elderly loved-ones if they want hospital treatment in the event they deteriorate with coronavirus.

Rachel Clarke, a specialist in Oxford, warned that Covid-19 patients were spending their final hours and days alone in busy intensive care units, despite having no hope of survival.

On Saturday’s edition of Any Answers on BBC Radio 4, the presenter, Anita Anand, described the calls she received to discuss quality of death with coronavirus as “breaking my heart”.

The ICNARC study involved 165 patients treated in critical care in England, Wales and Northern Ireland since the end of February.

Seventy-nine died, while 86 survived and were discharged.

The sample was taken from a wider audit 775 people who have been or are in critical care with the disease, 610 of whom continue to receive intensive care.

Although Imperial College Healthcare, which includes two acute hospital, denies that it has or will need to ration critical care due to capacity issues, frontline staff at other London trusts have told The Daily Telegraph that this is already happening at their hospitals.

The NHS says it has access to around 8,000 ventilators, and the government is desperately trying to source another 30,000 to cope with the expected spike of patients.

Last week the National Institute of Health and Care Excellence, which sets clinical guidelines, issued a new framework instructing doctors to prioritise those most likely to survive.

Health officials have so far refused to directly address in public the issue of rationing, preferring to talk instead about guidelines enabling doctors to have “difficult conversations” with families.

However, Nice director for the Centre for Guidelines, Dr Paul Chrisp, told The Sunday Telegraph last week that the framework enables doctors to ration scarce ventilators to patients with the best chance.

Professor Julian Redhead, medical director at Imperial College Healthcare NHS Trust, said: “Clinicians at our trust are not making decisions about ventilating patients based on capacity considerations.

“Our trust currently has good capacity for patients requiring ventilation and already has plans in place to increase that capacity as needed.

“We know that very poorly patients with coronavirus may need to be on a ventilator for extended periods – for some patients this would not be in their best interests.

“Clinicians have to make difficult judgements on the balance of risk and benefit for patients all of the time and will also endeavour to discuss decisions with patients and families.”

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