No blanket do-not-resuscitate order during Covid, Swann tells inquiry

There was no blanket “do-not-resuscitate” order for sick patients in Northern Ireland during the Covid pandemic, former health minister Robin Swann has said.

Mr Swann told the UK Covid-19 Inquiry that he believed it would have been “unethical and unnecessary” to deploy the orders based on age or disability.

The inquiry is examining the impact the pandemic had on healthcare systems – including the use of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders.

It wasn’t that we had to stop cancer treatments in regards to supply the additional critical care beds, it was the fact that some of those treatments and supports were displaced elsewhere

During his evidence, Mr Swann told counsel to the inquiry Nick Scott that it was “ill-founded that there was a blanket response”.

Asked how he knew this, Mr Swann said it was based on feedback from officials.

He added: “They were being applied appropriately and there wasn’t a blanket response.”

However, Mr Swann accepted he had been aware of concerns from families about an increase in the number of DNACPR orders applied to patients being admitted to hospital.

During his earlier evidence, Mr Swann was questioned about his decision to site Northern Ireland’s Covid Nightingale hospital in the tower block at Belfast City Hospital (BCH).

Mr Swann, who was Northern Ireland’s health minister during the pandemic, told the inquiry the hospital was not the preferred site for the Nightingale unit, but logistics prevented the facility being placed at a non-hospital site.

Mr Scott asked the former minister about the creation of the Nightingale facility to deal specifically with critically ill Covid patients in April 2020.

Mr Scott showed a Department of Health briefing paper which said a number of non-hospital sites had been explored, including the Eikon Exhibition Centre near Lisburn, the Titanic Exhibition Centre and Belfast Harbour Studios.

The document said the Eikon centre was considered the most suitable option, but it was not progressed due to the amount of work which would have been required to transform it into a medical facility.

The barrister asked: “That is the reason why the Nightingale ended up in the Belfast City Hospital tower, fundamentally because the preferred option could not be made ready in time?”

Mr Swann replied: “That is correct.”

Mr Scott said: “Is that a reflection of the fact that there had been a lack of planning for a Nightingale at an earlier stage?”

Mr Swann said: “The work that would have had to be done to make oxygen available, to make all the proper medical necessities available for critical care beds, the Eikon centre would have taken an inordinate amount of work to bring it up to status because it is a large exhibition centre, a warehouse, rather than the facilities which would become available by the adaptations of the tower block in the City Hospital.”

Mr Scott asked if the Eikon centre could have been used if planning had begun earlier.

Mr Swann said: “In a roundabout way I could agree, but there’s a difference between planning to make those changes and actually putting physical site works in place that would have allowed us to put ICU beds into that facility.”

The barrister said: “Effectively the Belfast City Hospital tower was not the preferred option, you would have preferred it to be elsewhere?”

Mr Swann said the Eikon would have been the preferred site “if we’d had time to do that”.

Mr Scott pointed out that siting the Nightingale at the BCH meant “you were putting it in the middle of the Regional Cancer Centre”.

I think it was something that was more impacted in Northern Ireland due to the status and the state that the health service actually went into prior to Covid

He added: “What were the consequences for infection prevention for those people who were suffering from cancer who were visiting the BCH while having the Nightingale in the middle of the tower?”

Mr Swann said: “It was on different floors so there was that segregation between the provision of additional services that were within the tower as well as being able to adapt those floors that were being used for the Nightingale.”

Mr Scott asked if there had been an impact on the ability to provide cancer care because facilities were being used for the Nightingale.

The former minister replied: “It wasn’t that those staff were being simply redeployed to the tower block; we had to step down certain specialities, certain provisions, that we wish we hadn’t had to have done so.

“But in regards to be able to complement the additionality in regards to critical care, referring back to the point of the availability and the services of staff, that was something we did not have in Northern Ireland at that point.”

Mr Scott continued: “If you hadn’t put the Nightingale in the middle of the BCH tower, you could, had you chosen to do so, have continued to use those facilities to provide cancer care, is that not right?”

Mr Swann said: “It wasn’t that we had to stop cancer treatments in regards to supply the additional critical care beds, it was the fact that some of those treatments and supports were displaced elsewhere.

“Going back to the operational decision of the trusts, we had to step down services that we didn’t wish we had to in regards to what we had to do to support the Covid delivery of supporting patients.

“I think it was something that was more impacted in Northern Ireland due to the status and the state that the health service actually went into prior to Covid.”