The country’s top doctor described how he was “terrified” that the NHS would be overwhelmed as officials drafted an unpublished document outlining who should be prioritized for care if the service exceeded capacity in the early stages of the pandemic. of Covid-19.

The document was never officially published because it became clear the nation was reaching the peak of the crisis, the national medical director of NHS England said.

Professor Sir Stephen Powis told the UK Covid-19 public inquiry that the job was something “no one ever wants to do”.

The “prioritization” document was drawn up in March 2020 to be considered in the event the NHS was overwhelmed by Covid-19 cases.

The consultation was shown the unpublished document, titled Covid-19 Decision Tool, which highlights three elements to consider when prioritizing care: age; “clinical frailty” and “comorbidities”.

Patients received “points” based on their age: those under 50 years old started at zero and those over 80 years old started at six points.

It also ranked patients from one to nine, one fit and well and nine terminally ill, while co-morbidities such as previous heart attacks, high blood pressure and heart failure also scored points.

Women were deducted one point.

The scores would then dictate what type of care should be provided to the patient.

Sir Stephen said: “In terms of this decision tool, which was never authorised, it was never officially launched.

“It did not progress beyond this stage, except that the group that developed it later published a version in a set of principles related to the decision making of the Intensive Care Society.”

The inquiry heard that the “push” for the document came from the Department of Health and Social Care, but on March 28 the decision was made that it should not go ahead.

Sir Stephen continued: “This was at a time in March when Covid cases were rising rapidly.

“The strategy that the NHS and the government had adopted was on the one hand to impose social distancing, in other words lockdown, to reduce the rate of transmission, and within the NHS our job was to increase capacity.

“But at that time in March, the number of Covid patients in ITU (intensive care) beds was doubling every five or seven days.

“We couldn’t see, because there was no community testing at the time, what was likely to happen.

“It was unclear whether the public would respond to the lockdown; They did it wonderfully, but that was not clear.

“Frankly, I was personally terrified, terrified that the NHS would be overwhelmed and doctors and other doctors would be put in a position where they would not be able to make the professional judgment that they normally do in terms of treatments and escalation.

“And in those circumstances, I and my clinical colleagues and CMOs (chief medical officers) felt that we should start exploring a decision tool like this.”

He added: “I think it was stopped because a number of us, the chief medical officer and myself, with input from the (then) chief executive of NHS England, came to the conclusion that it should not be published.

“For me, the main reason was that, at this point, it was becoming increasingly clear that the peak of the pandemic was approaching and therefore it would not be necessary, because we would not exceed capacity.

“It was very obvious to me that it wasn’t going to be necessary and I was afraid that if it was published it might be used when it wasn’t necessary.”

There was also a “danger” that the tool would have removed some of doctors’ professional judgment and might have been seen as “too simplistic”.

“I think it was right to remove it because we didn’t need it and it could have been used inappropriately,” he said.

Sir Stephen also said he shared concerns that the document was controversial and risked a bad public reaction.

“This is not a criticism of the group of doctors who worked on this, they did a magnificent job,” he told the pandemic inquiry.

“They were asked to do something no one ever wants to do: develop this type of tool, and they had to do it quickly.

“But it was absolutely clear to me that this was going to be controversial, that it had not had the opportunity to be discussed more widely with patient groups, with the public, so my recommendation to the research is that, going forward, we should absolutely, not trying to develop one of these tools in the middle of a pandemic.

“This is a discussion that has to happen in normal times.

“In my opinion, it is a discussion that should not be led by the government, it should not even be led by the profession, but should be located within society.

“This is too difficult a task to undertake at the height of the pandemic.”

It comes as the inquiry’s Every Story Matters campaign reached the milestone of 50,000 submissions.

The public engagement exercise aims to better understand the public’s pandemic experiences and will shape the investigations’ recommendations.

Ben Connah, Covid-19 inquiry secretary, said: “I would like to thank every member of the public who took the time to come visit our team or contribute in any other way throughout 2024. It has been a privilege. to hear what you have to say.

“We have heard of terrible hardship and loneliness, but also of true commitment and sometimes even courage.”