Procedural changes to the NHS clinical frailty scale during Covid-19 pandemic: FOI release

Information requested

Can you confirm that the CMO was responsible for any procedural changes to the NHS clinical frailty scale and or DNACPR notices put in place during the pandemic?

Response

By way of background you may find it of interest to note the history of the Chief Medical Officer (CMO). The CMO role as it currently stands is a role created by virtue of the Scottish Administration (Offices) Order 1999 (made under section 126(8)(b) of the Scotland Act 1998 “the 1998 Act”). That order makes clear that the office of the CMO is a non-ministerial office in the Scottish Administration (in addition to holders of non-ministerial offices, members of the Scottish Government, junior Scottish Ministers and members of staff of the Scottish Administration fall within the scope of the umbrella term “the Scottish Administration”).

Legally the office of the CMO is not a Scottish Government department but is a separate office which forms part of the Scottish Administration in its own right. Therefore, while Professor Sir Gregor Smith is based in the Scottish Government and is supported by Scottish Government civil servants, ‘The Chief Medical Officer of the Scottish Administration’ is designated (at Part 2 of Schedule 1 of FOISA) as a wholly separate public authority from the Scottish Government. ‘The Scottish Ministers’ are designated at Part 1 of Schedule 1.

It should also be noted that requests for information submitted under FOISA cannot be transferred from one authority to another, therefore we cannot ask the Scottish Government, on your behalf, to respond. Only information held by the CMO has been considered within scope of this request.

With regards to your request, I can confirm that the Chief Medical Officer made no changes to the NHS clinical frailty scale. A letter was written to Chief Executives and Medical Directors of Health Boards for distribution to all clinical teams by Dr John Mitchell, Interim Principal Medical Officer within the Scottish Government on 05 May 2020. This letter reinforced that the evidence for the frailty scale tool was derived in over 65s and not in patients with disabilities, or younger patients, so should therefore not be used in these populations. This was not a change to the scale, just a reinforcement of the parameters of the scale.

In relation to the DNRCPR element of your request, I can advise that Scotland has had a consistent national DNACPR policy which is based on the principles set out in the Human Rights Act (1998), the Adults with Incapacity Act (Scotland) (2000) and the UN Convention on the Rights of Persons with Disabilities (CRPD). This guidance did not change during the pandemic and can be accessed at:

https://www.gov.scot/publications/decisions-cardiopulmonary-resuscitation-integrated-adult-policy/

With information for the people and their families at Decisions about CPR | NHS inform.

This guidance makes it very clear that a stable long-term physical need, learning disability or autism should never be the sole reason for considering whether a person would benefit from CPR.

Additionally, the Ethical Advice and Support Framework, published on 29 July 2020, emphasises this point and makes clear that health conditions or disabilities that are unrelated to a person’s chance of benefiting from treatment must not be a part of clinicians’ decision making regarding accessing treatment.

I can therefore confirm that the Chief Medical Officer for Scotland was not involved in changes to either the NHS clinical frailty scale or the DNRCPR policies in place during the Covid-19 pandemic as none were made.

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