We all have been disturbed to notice that the COVIDー19 Rapid Guideline for Critical Care from The National Institute of Health and Care Excellence, requires that all patients tested positive for COVID-19 will be assessed on a ‘Clinical Frailty Scale’ by healthcare professionals when admitted to hospital to determine if they will be likely to receive critical care. 

For many people with Learning Disabilities, Autism and any disability - this means that receiving critical care may be unlikely, if the Clinical Frailty Scale is applied as it is written now.

The frailty scale is a measure used by The Specialised Clinical Network,

“to identify patients who are at increased risk of poor outcomes and who may not benefit from critical care interventions”.

It is not just based on physical ability, but also cognitive ability.

All links to the Guidelines and Clinical Frailty Scale are linked at the bottom.

The National Institute of Health and Care Excellence states in their Rapid Guideline for Critical Care some concerning clauses which mean people with learning disabilities, autism, and any disability may be unlikely  to receive critical care, meaning no equal access to critical care throughout COVID-19:

1.1

On admission to hospital, assess all adults for frailty, irrespective of age and COVID‑19 status. Consider comorbidities and underlying health conditions.

This means that all people could be labelled and scored immediately on the Clinical Frailty Score.

2.2

Involve critical care teams in discussions about admission to critical care for a patient where:

the CFS score suggests the person is less frail (for example the score is less than 5), they are likely to benefit from critical care organ support and they want critical care treatment or

the CFS score suggests the person is more frail (for example the score is 5 or more), there is uncertainty regarding the likely benefit of critical care organ support, and critical care advice is needed to help the decision about treatment.

This means that if a person’s Clinical Frailty score is 5 or more, it is unlikely they will receive critical care.

2.4

Sensitively discuss a possible 'do not attempt cardiopulmonary resuscitation' decision with all adults with capacity and a CFS score suggestive of increased frailty (for example of 5 or more). Include in the discussion:

the possible benefits of any critical care treatment options

the possible risks of critical care treatment options

the possible likely outcomes.

This means that cardiopulmonary resuscitation, (CPR or saving of life) may not be attempted at all if you have a Clinical Frailty Score of 5 or more.

The lives of people with disabilities, the hard work of many parents, carers and organisations, through these new guidelines, are belittled. For many years we fight and campaign for society to see people with a learning disability, autism or any disability, AS EQUAL. These guidelines show us that there will not be equal access to critical care for those who may most need it.

By signing this petition, these are the changes we want to make:

1. We want these guidelines to be reviewed and to be changed urgently.

2. We want Members of Parliament and The National Institute of Health and Care Excellence to reconsider the wording and outcomes of these clauses. 

3. We want NICE to make guidelines for people with learning disabilities and/or autism, so that they would not be judged on cognitive ability during COVID-19, to prevent totally unjust decisions over whether they live or die.

4. We want people with learning disabilities and other disabilities to have the same rights as everyone else during COVID-19. 

Please join Talkback UK, parents, carers, organisations to fight for our voices to be heard and for people’s lives to be valued shown by the commitment of our NHS staff and their decisions to do the right thing.

The full Rapid Guideline for Critical Care can be read HERE

The Critical Frailty scale can been read about HERE

The Critical Frailty scale can be seen HERE