Swine flu- hospitals could turn away critical patients in a pandemic
A Department of Health document warns that the health service is already working close to its capacity, leaving little scope to meet the demands of a mass outbreak of swine flu, which could force doctors to turn away patients needing intensive care.
The document, seen by The Daily Telegraph, says cuts in the number of beds since Britain last underwent a pandemic in 1969 – combined with an ageing population and changes in the way patients are treated – mean intensive care units “could be rapidly overwhelmed”.
The disclosure of the document last week came as:
Nicola Sturgeon, the Scottish health minister, reported that there has probably been the first British case of swine flu in someone who has not travelled to Mexico, indicating that the virus has begun to pass between people here;
Three new cases were confirmed in Britain;
Countries around the globe continued to report new cases of H1N1, with new confirmed cases in Holland. the Republic of Ireland and Germany.
Authorities in Mexico, the source of the outbreak, asked for a five-day shutdown of non-essential business and travel in an attempt to slow the spread of the disease.
The world is now on the brink of the first flu pandemic in 40 years, with the World Health Organisation’s (WHO) alert status at five out of six.
The Department of Health is printing leaflets to put through every door urging people to find “flu friends” who can bring them groceries and supplies if they fall ill.
However, the Department of Health (DoH) document seen by The Daily Telegraph warns that, during the peak of a flu pandemic, complications such as pneumonia could mean there are 10 times as many people requiring ventilators as the NHS can supply.
If demand cannot be met, it recommends doctors deny treatment to the weakest patients so that resources can be shared among the greatest number.
The draft document, which was written in September before the outbreak of swine flu, acknowledges that its recommendations open “controversial ethical issues” and could cause anger and violence from relatives of those refused care.
Doctors taking decisions to deny care are urged to fully document their decisions to protect themselves from litigation, while hospitals are warned that “additional security decisions may be necessary because of the risks of violence directed at staff making triage decisions”.
The document, Pandemic Influenza: surge capacity and prioritisation in health services, sets out the criteria which doctors should use to determine which patients receive intensive care.
If there is competition for places in intensive care units, patients suffering from advanced cancer could be refused beds along with pensioners suffering from severe burns, those with multiple organ failure and children suffering from advanced cancer, severe burns or trauma.
If patients competing for life support are likely to have an equal benefit from treatment, decisions should be taken by lottery, the guidance concludes.
The document describes the pressures that the NHS suffered during the last two pandemics, in 1957 and 1969, which caused a total of 3 million deaths worldwide.
It states that the impact of the 1969 outbreak was lessened by a high number of spare hospital beds at the time. The document says cuts to spare bed capacity, so that the health service is now working “at or near capacity”, a 31 per cent increase in the number of over-65s, a more complicated out-of-hours system for GPs and more widespread use of critical care would all make it more likely that intensive care units could be “rapidly overwhelmed”.
Meanwhile, NHS Direct took a more than 10,000 calls in total on Wednesday and almost 3,000 of them related to swine flu – more than double the calls received on Monday about the virus, reflecting how public concern is growing.
A spokesman for the DoH said: “We have published this draft guidance to help clinicians to work within an ethical framework during a pandemic.”