West Yorks and Harrogate Integrated Care System Board meeting Tues 1 Sept 2pm

West Yorkshire and Harrogate Integrated Care System Board will meet in public, virtually, on Tuesday 1 September, at 2pm.

The agenda, papers and watching the meeting live can be accessed at: www.wyhpartnership.co.uk/partnershipboard

The meeting will focus on the Integrated Care System’s response to Covid-19 phase three.

NHS England has instructed all Sustainability and Transformation Partnerships and existing Integrated Care Systems to come up with development plans by 1st September, that embed and speed up “system” working methods used to respond to and recover from the Covid-19 pandemic. The plans have to be finalised and sent to the quango by 21st September.

This is part of the contentious move for all Sustainability and Transformation Partnerships to become Integrated Care Systems by April 2021.

This doc for the Board – ‘Planning for System Stabilisation and Reset’ – reports on the detailed planning work West Yorks and Harrogate Integrated Care System has been doing.

Utilitarian ethical framework for clinicians’ decisions on who gets critical care and community care

The Planning doc links to a rather chilling Ethical Framework prepared by West Yorkshire & Harrogate Clinical Forum, about how to prioritise scarce resources between patients. It concludes that this is going to need a “utilitarian” approach.

In contrast to the ethic of equality, this seems to mean clinicians will decide to limit treatments to patients deemed likely to benefit from them and the other patients will receive palliative or ameliorative care:

The healthcare system’s response to the COVID-19 pandemic presents us with a complex set of resource limitations. At present, community care is facing limited resource in the sense of inaccessibility of usual treatment pathways and consequent impact on wider population health due to the reconfiguration of hospital care to focus very heavily on providing capacity for treatment of COVID-19. There is also the potential for resource limitations if a surge of infections impacts on critical care availability. An ethical phraseology around resource prioritisation is thus proposed:

Prioritising resource: Every patient will be given access to the most appropriate treatment for them, given a reasonable chance of the treatment succeeding. However, in a situation of inaccessibility of a resource or overwhelming demand, decisions should be made through a utilitarian lens in order to maximise the benefit across the entire population whilst striving to maintain Equal Concern for our patients. If a resource is limited or inaccessible, a patient who will gain more benefit and is more likely to benefit from that resource should be prioritised to receive it; a patient who is less likely to benefit from the resource should be given the best care possible that is more readily available. These decisions should still encompass Equal Concern and not fall into a co-horting approach.

Resource prioritisation as a concept is important to highlight now, but there may come a point in future where there is a need to move beyond this into a utilitarian approach. We acknowledge the deep discomfort felt by many clinical staff around utilitarianism and thus encourage the thinking around utilitarian approaches to be undertaken in advance so that these challenging questions can be fully, calmly and rationally addressed. Then if a utilitarian approach is needed in the future we will be prepared and can be confident that we are making ethical, albeit extremely challenging, decisions.

Where does this ethical framework for Covid19 critical care sit with the NICE guidelines?

Is it in case even following the NICE guidelines still leads to more need for critical care than West Yorkshire and Harrogate NHS hospitals can provide?

And where does the Harrogate Nightingale Hospital fit in?

Wasn’t that set up in order to significantly increase the number of critical care beds?

The West Yorks and Harrogate ICS has told us:

The NHS Nightingale Hospital Yorkshire and the Humber is part of a wider national response to the Covid-19 pandemic and is an insurance policy for our region. The Nightingale Hospital remains on standby to provide additional critical care beds in our region should our existing hospital critical care provision reach capacity in the event of a second wave of covid-19 over the coming weeks and months.

So why does the Ethical Framework identify “the potential for resource limitations if a surge of infections impacts on critical care availability”? Isn’t the “insurance policy” Nightingale hospital enough?

Results of decade-long cuts to NHS funding, hospital beds and clinical staff

CK999 has already asked West Yorkshire and Harrogate Integrated Care System about the effects on WYH ICS’s ability to respond to the Covid-19 Pandemic, of decade-long cuts to NHS funding, hospital beds and clinical staff – including ICU beds and staff, and the government’s failure to promptly authorise and direct widespread testing and tracing, from the start of the pandemic. Their answers were evasive.

Surely it would be more ethical for the West Yorkshire & Harrogate Clinical Forum to demand adequate resources to meet patients’ needs, without recourse to utilitarian “ethics” of weighing up one patient’s claim on scarce resources againsts another’s?

And where does this Ethical Framework sit in relation to the proposed virtual elective care hub for West Yorkshire?

Ck 999 reported on this in July – in response to an invitation from NHS England/Improvement, the Integrated Care System have bid for £1.2m to pay for a virtual Elective Hub until March 2022. (The current pandemic planning period.)

If the funding is approved, this data crunching IT centre will trawl through planned operations waiting lists and determine who are priority patients and where in West Yorkshire NHS and private hospitals capacity exists for planned care operations at a given time. It will then direct patients accordingly.

Clinical prioritisation of patients

“would primarily include surgery for cancer, high priority non-cancer diagnoses, and those who are ‘long waiters’”.

“A clinical panel will be convened, if necessary, to support patient prioritisation at WY&H level.

Will the clinical panel be using the utilitarian ethical framework? And is this just a backup for computer algorithms that say yes or no to patients’ getting planned care? What ethical considerations have been programmed into the algorithms?

How to send in questions for the Board

Due to the Board meeting virtually, questions from members of the public will be limited to one per person being read out at the Board. All other questions submitted will receive a written response after the meeting and published on the Partnership’s website as usual.

If you want to ask questions, you need to email them to westyorkshire.stp@nhs.net before Monday 31 August at 5pm – highlight the one to be asked at the Board. You can also call 01924 317659 to submit questions.

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