The truth about resource allocation - Lord Sumption was only describing where we are.
The burden of Covid-19 on the NHS has been enormous, meaning that already stretched resources have had to be spread further
Lord Sumption has been criticised for suggesting that some lives are worth less than others, but he reveals the picture of a very real situation of decision making in the NHS - not of his making
Covid-19 has turned out to be worse than the worst fears of older people and those with dementia
Everyone working in the health and social care sector for the last year has been aware, more than ever before, of the issue of resource allocation. In the past, this has been seen in appeals for more resource overall, aspirations to do more, or complaints that there is not enough to do what has been promised by government. But it has been much different this past year.
Some lives have more value than others? Any person with a conscience would say no, but NHS resource allocation seems to paint that very picture
Not only workers, but families, patients and users of services over the last year have become aware of this issue. And it is not just about wanting to do more, or to do things faster. There have been real issues highlighted by the quote from Lord Sumption on BBC’s Big Questions at 07:00 minutes that some lives are “less valuable” than others.
Of course, the press ploughed into him, (e.g. here, here, here, and here) but he seems to be describing a situation that is borne out by the way resource allocation issues are being decided in real time, in real life, during this Covid-19 epidemic.
Call for national guidance for resource allocation
The Nuffield Council on Bioethics, which is the nearest thing the UK has to a national bioethics authority, has published a Statement on the need for national guidance. Reporting, for example from London hospitals shows that the NHS health care system is stretched to capacity and under these circumstances, who gets admitted to hospital, or access to intensive care, is a resource allocation question much more clinical and immediate than arguing over budgets. These decisions are made on the spot by professionals who are well aware of the risk of legal challenge for what they do under pressure. The handling of DNAR (do not resuscitate) decisions during this time is a good example of people trying to do the right thing but revealing ageism and a lack of understanding of both legal and human rights.
Elements of Covid-19 turned out to be worse than our worst fears for old frail people and people with dementia
I take issue with some elements of the Nuffield statement. It says that “the very worse fears of scarcity did not come to fruition…”. Actually, for old frail people and people with dementia, it was worse than our worst fears. Concern to clear hospital beds led to untested patients being discharged into care homes where large numbers subsequently were discovered to be infected with Covid-19 and many died. The underlying assumption of the statement is that because the NHS was saved, we had a bit of an escape. The key question for me is at what cost to the care homes? They have never been popular and now labour under unfair accusations that they caused the deaths of residents by being too big or using too many casual staff or by not following guidelines properly or from prioritising profits. Their staff bear the brunt of family distress and grief at the hideous separation of residents from their families with the aim of avoiding infection.
Back the call for guidance
Of course, the Nuffield Council is right to demand national guidance on how decisions should be approached. In the absence of that guidance, the personal risk to clinicians is unacceptable.
I strongly urge people to get behind and support this Statement from the Council and call for guidance. Join in the discussion so that we are ready for the following waves of this epidemic, and any more to come.
If you would like more information, you can buy my book Dementia, the One Stop Guide or Care Homes: When, Why and How to Choose a Care Home. I am available for consultancy for families or organisations. And if you have any further queries or questions, or suggestions for something you’d like to see me write on, please contact me via the Contact Page
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