Struggling medical staff may be forced to ration care, fears top GP
Surge could have been prevented by stronger, earlier lockdown, he claims
MEDICS in Northern Ireland may be forced to make traumatic life or death decisions during this pandemic “crunch point” due to a delay in implementing an effective lockdown, it has been claimed.
Dr Tom Black, chair of the British Medical Association’s (BMA) Council in Northern Ireland, has warned doctors here will suffer “moral injury” if they are forced to ration care as the health service struggles to cope with demand in the coming weeks.
A spike in patients seriously ill with Covid-19 has already resulted in health trusts cancelling surgeries, with some cancer patients caught up in the emerging crisis, while a senior official has warned the coming fortnight will be “the worst of the worst” for the buckling health service.
According to most recent official figures, there were 776 inpatients with Covid-19 yesterday, with 65 in an intensive care unit. A further 640 new cases were announced, while 19 further deaths were reported.
Dr Black said: “We would be very worried about decision making if services are overwhelmed and there is a mismatch between the needs of the patients and capacity to deliver care. That would be one of the main concerns we have, particularly about Covid wards and access to intensive care units. The critical care network is very worried because their capacity to deliver care is limited.
“Staff are struggling for a number of reasons — because of concerns around the delay in the second dose of the vaccinations and worry about immunity, the physical exhaustion they’re experiencing, and now worry about potential legal cases and accusations of unlawful killing being taken against doctors and nurses for decisions they may have to make.
“People just feel put upon. They know this surge could have been prevented if a stronger lockdown had been put in place earlier, they feel they are suffering as a consequence of a failure to put in place a proper lockdown. This is going to be the worst phase of the whole pandemic so far, it’s going to be worse than anything than has gone before and hopefully worse than anything that is yet to come. This is the crunch point in the pandemic.”
Dr Black was commenting after the BMA reissued ethical guidance to members in the event they are forced to ration treatment to patients.
The document explains that, in the event of there being insufficient capacity in the system, doctors will be forced to make decisions on treatment that may not depend on the clinical situation.
As a result, it states that doctors may have to consider whether the patient will be able to contribute to the pandemic response if they survive as a factor on who should receive treatment. This means people who work in healthcare, security and utilities are among those who may receive treatment ahead of other patients.
Dr Black continued: “These would be very difficult choices and doctors would suffer moral injury, they would have to live with their own conscience and the consequence on their mental health could be grave. People have already stretched themselves to the limit and they’re being asked to step forward again.
“Doctors were trained to do their best for their patients, not to prioritise or ration or withdraw treatment.”
Yesterday, David Robinson, director of hospitals at the South Eastern Trust, said work is ongoing to ensure there is adequate capacity in the coming weeks.
But he warned: “It is going to be the worst of the worst this week and next. As of 9am, we had 107 Covid positive patients, which has increased from 77 the previous week and I wouldn’t be shocked if it rose to 150.”
An Executive Office spokesman said “priorities are to protect the health service and save lives”. He added: “Ministers have taken difficult but necessary decisions to implement strict measures to stop the spread of coronavirus and alleviate pressure on our hospitals.”