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30 October 2020

Public weigh up how to allocate NHS resources during second Covid wave

Deliberative online workshops encourage the public to think deeply about a pressing issue


Resource allocation, age and Covid-19

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Members of the public have deliberated on how to allocate scarce NHS resources during the second wave of Covid-19 infections, as part of a study aimed at helping medical professionals gauge what would be considered acceptable.


Researchers from King’s College London and Ipsos MORI held a series of deliberative online workshops for 22 participants that were designed to encourage deep consideration and help them learn about a complex and controversial subject that they had not previously considered.


Participants were asked to discuss and analyse different principles by which intensive care resources should be allocated during the second phase of the coronavirus pandemic.


One principle, of considering whether patients have had a “fair innings”, argues that once a certain age is reached, resources should be directed toward those who are younger. But age was largely rejected by participants, who felt uncomfortable with the prospect of prioritising younger patients over older ones.


At the end of the process, many voiced support for a principle of “maximising life years” – prioritising patients with the longest life expectancy, to save the most years of life.


They agreed this would avoid allocating resources to someone who won’t survive, support getting people into intensive care units who are likely to recover more quickly, and free up beds for other patients.


However, concerns were raised that it is too difficult to accurately estimate someone’s life expectancy, and that medical survival chances should be the main consideration, with a focus on saving the most amount of lives rather than the most life years.


And while survival chances were seen as important, at the same time participants had a strong sense that those most vulnerable to Covid-19 should be prioritised, not discriminated against.


To avoid subjective judgements about who is most in need of scare resources, some study participants preferred a principle of “first come, first served” for its fairness and simplicity. The role of unconscious bias in decision-making was a concern, with some worried that certain groups might receive unfair treatment.


There are currently no specific government guidelines about how to prioritise intensive care resources among coronavirus patients, if it becomes necessary. Participants stressed that, while national recommendations, with ongoing review, would be important, they should not be mandatory, preferring that doctors have room to exercise discretion.


Participants also felt that doctors should make decisions about resource allocation as a group, not as individuals, as this could reduce burden and bias.

This study gives an indication of where the public are on the issue of how to allocate NHS resources in this second wave of Covid-19 infections. It required discussions about incredibly complex and sensitive issues, and yet people were not only willing to give up their time to do so, they proved highly capable of analysing the principles at stake. Public debate can often be characterised as divisive, but these deliberative approaches can be a way to find consensus.

Suzanne Hall, Research Director at Ipsos MORI

The members of the public who took part in this study recognised the importance of directing scarce intensive care resources to those most likely to benefit from them. But they sought to reconcile this with a belief that older people and those who are most vulnerable to coronavirus should not lose out. They wanted proportion. Participants were, overall, quite unified in their trust of medical professionals, with a clear message emerging that doctors should be making these kinds of decisions in ICUs, though not by themselves.

Dr Gareth Owen, study lead at King’s College London

The deliberative workshops were carried out across August and September 2020, with participants made up of residents of the London boroughs of Lambeth and Southwark, in the catchment area of King’s College hospital. To ensure participants reflected the demographic composition of the KCH catchment area, quotas were set on gender, age, socio-economic status, ethnicity, and education level.

Read the full report, Resource allocation, age and Covid-19: Deliberative study.