The Government has been ordered to hand over documents examining how adult social care and the NHS would cope during a pandemic if it were overwhelmed – a move that is likely to raise questions about whether Britain was sufficiently prepared for Covid 19.

The Information Commissioner’s Office (ICO) has ordered the Department of Health and Social Care (DHSC) to provide “pandemic influenza briefing papers” which looked at how services, including elderly care homes and the NHS, would cope if resources became stretched. 

The briefing papers were prepared by NHS England following Operation Cygnus, an exercise carried out in 2016 to test the country’s resilience to responding to a pandemic.

Exercise Cygnus

One of the papers that will be released, created at the end of 2017 and entitled “NHS surge and triage”, looks at the rationing of care if services were overwhelmed and resources – such as ventilators – were scarce.

The idea that some patients may not have received the care they needed during the pandemic has been a contentious issue for the Government, with the health secretary saying everyone who needed treatment received it, despite reports indicating the contrary.

An NHS doctor submitted the requests under the Freedom of Information Act, and although his request was refused by the DHSC, the Information Commissioner – Elizabeth Denham – has decided that the documents should now be disclosed.

“In the Commissioner’s view, the balance of the public interest in this case favours disclosure of the information,” said the report, which was sent earlier this month.

The issue of “triage” was “literally life and death decisions”, and “there is a very strong public interest in understanding what considerations the Government has made about how a triage system would operate, when it would be triggered and by whom.

“This would inform the public and enable them to participate in the debate,” she said.

Pressure intensifies on Matt Hancock

The news that the Government will have to reveal their findings on these issues is likely to intensify pressure on Matt Hancock, the health secretary, who has faced heavy criticism about his handling of the crisis.

The documents are likely to raise questions about whether the Government could have been more prepared, and therefore saved lives.

Dr Moosa Qureshi is represented by Leigh Day Solicitors, and has organised the CygnusReports.org campaign for pandemic transparency against several government departments.  He said there “is a medical and legal imperative for pandemic triage guidance from the DHSC”.

“By refusing to provide a population triage protocol, the Department of Health is arguably transferring blame – and legal liability – from politicians to NHS healthcare workers, who are already risking their lives on the front line. It’s also failing to clearly define the rights of patients during the current pandemic. That has to be unacceptable.”

Dr Qureshi’s initial request and appeal to the DHSC was rejected. He then took it to the ICO for review.

The Commissioner rejected the Government’s argument that if documents about triage were released, the public may confuse ideas that were discussed with policy implemented.

Ms Denham also rejects the idea that the information could inhibit “free and frank discussion” saying that she was “sceptical” about this.

The documents about “triage” – which involves limiting care if resources are under pressure – and how adult social care would function are likely to increase scrutiny on the way the crisis was handled, because they may show potential weaknesses in the system.

A high number of Covid-related deaths occurred in elderly care homes, and it is generally accepted that mistakes were made in the way the sector was handled. It is likely the documents will shed light on policies that may have contributed to this.

“Population triage” has also been contentious, with doctors and legal experts calling for a centralised policy to be published to protect medics from being sued.

The Government also denied that care was withheld during the pandemic, despite reports that thousands of elderly people were denied potentially life-saving treatment to stop the health service being overrun, and “do not resuscitate” decisions being made about people with learning disabilities and mental illness.

The New York Times reported in April 2020 that the Government was on the verge of publishing a triage plan, but changed its mind because of “fear of public uproar”.

In the decision letter, the ICO said that the “Commissioner recognises that there is a very strong public interest in understanding how effectively the Government prepared for and has handled the pandemic”.

She said that “exercises like Cygnus were designed to test capability and to identify areas of weakness”.

“Therefore it is important to understand whether lessons from Cygnus were properly learned and where appropriate, developed or addressed.”

  • https://cygnusreports.org/blog/