UK Covid-19 Inquiry Module 3 report: Scottish Government response

Recommendation 7 - A framework to guide the allocation of intensive care resources in the extreme event of saturation

Chair’s recommendation:

The UK Government and devolved administrations should publish a UK-wide framework setting out ethical and operational principles to guide the allocation of adult intensive care resources in the extreme event that they are saturated during a pandemic. That framework must:

• be informed by comprehensive engagement with the public and developed in conjunction with professionals across healthcare, law and ethics, as well as with regulators of healthcare professionals
• set out clearly established triggers for its use, based at least in part on a UK-wide system that measures critical care capacity strain and facilitates mutual aid (such as the CRITCON tool used in England)
• establish clinicians’ legal and professional duties in applying the framework, which should be clearly explained to clinicians through guidance; and
• be regularly reviewed with reference to contemporary patient data during a pandemic, and any future use of it must be evaluated and reported on publicly

A plan and timeline for completing this work should be published within six months of this Report.

Application of the framework should be tested as part of the pandemic response exercises recommended in the Inquiry’s Module 1 Report (Recommendation 6).

Scottish Government response:

The Scottish Government accepts this recommendation in principle and is now working with the other three UK nations to agree a plan to meet this recommendation. This will involve developing an ethical framework of principles that will help guide clinical decision making in intensive care in extreme circumstances beyond usual ‘surge’ levels. It is important to note that this is intended to be used only as a last resort, and that the actions under Recommendations 5 and 6, if effective, should prevent the need for these principles to be put into practice.

We are clear that these principles should be founded in the basis of ensuring as much as possible the welfare of those affected by decisions as well as the welfare of those making them.

The Scottish Government believes a four nations approach will promote transparency, understanding (for patients, their families and staff), accountability and consistency, recognising the different NHS systems in operation across the four nations of the UK.

As discussed with CIREG, the intention is that this process would include wide stakeholder engagement, including human rights organisations and workforce and patient representatives.

Actions and implementation timescale(s):

The four nation plan is still in development but an indicative timeline for the work is:

• A project plan would be agreed in autumn 2026
• The scope of the framework would be agreed by the end of 2026
• There would be engagement on the principles from the first half of 2027
• Draft principles would be prepared by autumn 2027, with final stages of engagement through to the end of 2027
• The final draft would be agreed in the early months of 2028 and signed off by the middle of the year (2028)

The Scottish Government would seek to widely promote the framework to ensure awareness and understanding across all relevant stakeholders.

We have identified a group of clinical experts to participate in the working group including the following:

• The Deputy Chief Medical Officer
• The CMO’s Special Advisor on Anaesthesia and Intensive Care
• A specialist from the Centre for Sustainable Delivery
• The President of the Scottish Intensive Care Society
• A representative from the College of Intensive Care Medicine

These clinical experts will be supported throughout the process by Scottish Government officials, and we will ensure that key stakeholders in Scotland are part of the engagement work and that any feedback and input shapes the draft principles. CIREG feedback on other potential members is being considered.

Accountable Officer:

The Director General for Health and Social Care, working with the Directorate for the Chief Operating Officer, NHS Scotland within the Scottish Government, will be accountable for the implementation of the Scottish elements of this recommendation.