Before Covid, four types of pneumonia added together were the highest cause of death in the UK. In a newly implemented Medical Examiner System to certify deaths, the Medical Examiner was certifying all types of pneumonia deaths as covid-19 deaths, a former Director of End-of-Life Care has said.
On Saturday, Sai, a former NHS Director of End-of-Life Care, wrote a Twitter thread which, amongst other things, gave a personal account of the changes to the system of reporting deaths implemented in the NHS:
“When four different diseases [are] grouped and now being called covid-19, you will inevitably see covid-19 with a huge death rate. The mainstream media was reporting on this huge increase in covid-19 deaths due to the Medical Examiner System being in place.
“Patients being admitted and dying with very common conditions such as old age, myocardial infarctions, end-stage kidney failure, haemorrhages, strokes, COPD and cancer etc. were all now being certified as covid-19 via the Medical Examiner System.
“Hospitals were switching to and from the Medical Examiner System and the pre-pandemic system as [and] when they pleased. When covid-19 deaths needed to be increased, the hospital would switch to the Medical Examiner System.”
In addition, “hospitals were incentivised to report covid-19 deaths over normal deaths, as the government was paying hospitals additional money for every covid-19 death that was being reported,” Sai said. “I have no doubt in my mind, that the Government has planned the entire pandemic since 2016 when they first proposed the change to medical death certification.”
You can read Sai’s thread on Twitter HERE or Thread Reader App HERE. In the event it is removed from Twitter we have copied the thread below and attached a pdf copy at the end of this article. In the following, the number at the beginning of a paragraph relates to the number of the tweet within the thread.
1. The truth about the covid-19 pandemic from within the NHS (ex-Director of End-of-Life Care at one of the largest hospital trusts in the UK)
2. In 2016, the British government proposed and piloted a change to the process of how deaths were certified across all hospitals in the UK. I have attached a link to this Department of Health (“DoH”) document below:
Reforming death certification: Introducing scrutiny by Medical Examiners, Department of Health, May 2016
3 & 4. The DoH document proposed a switch to the “Medical Examiner” (“ME”) System and was sent to a number of different audiences for feedback and consultation. The ME System was already being piloted at two hospitals up north. The results of the consultation are below:
Introduction of Medical Examiners and Reforms to Death Certification in England and Wales: Government response to consultation, Department of Health & Social Care, June 2018
5. Prior to the covid-19 pandemic, the death certification process involved treating doctors of a patient to attend Bereavement Services/Patient Affairs to discuss the death and either: a) refer the death to the Coroner or b) write a Medical Certificate of Cause of Death (“MCCD”).
6. The MCCD states the cause of death. Whereby a direct cause (1a) or contributing causes (1b) (1c) (1d) are stated along with co-morbidities (not directly causing the death) being written in (2) on the MCCD. The MCCD is only ever a probable cause of death, it is not definitive.
7. The only definitive way of determining an accurate and plausible cause of death is to refer the deceased patient to HM Coroner (if certain criteria are met), for HM Coroner to accept and take on the case, resulting in a Post Mortem (“PM”) being conducted by a Histopathologist.
8. When a death is seen as natural and there is nothing untoward, the MCCD is written by the treating doctor of a deceased patient. Usually, this is an F1, F2, SHO or Registrar that attends. It is rare for a treating Consultant to attend, but they will finalise the cause of death.
9. A strict hospital hierarchy exists within the NHS for doctors. It is as follows – from lowest to highest rank: Foundation Year 1 (FY1), Foundation Year 2 (FY2), Senior House Officer (SHO), Registrar (Reg), Consultant, Clinical Lead, Medical Director.
10. Junior doctors will very rarely speak up or challenge their seniors. A senior decision is seen as final and it will be carried out and executed without any hesitance or questioning.
11. In my 5.5 years of experience in End-of-Life Care, I have only ever seen one junior doctor disagree with a proposed cause of death and challenge their consultant.
12. With the number of deaths that occur in a hospital, as you can imagine, there is a great deal of variation with regards to causes of death, as we have numerous different doctors writing an MCCD and coming up with various different potential diseases in different orders.
13. The proposed ME system would change this, as the government would now hire and pay one Medical Examiner, to sit in every hospital and write all MCCDs for all deceased patients. This would effectively eliminate any variation in causes of death.
14. In 2016, when I heard of this proposal, I worked as a Bereavement Officer at a hospital in Central London. My mentor/line manager at the time was a former Chief Nurse who managed Bereavement Services and all hospital deaths would be controlled by her and the department.
15. We essentially carried a huge amount of power with regard to decision-making, as we would go through all patient notes following the death of a patient, and essentially guide and advise doctors on what would need to be written with regards to an MCCD or Coroners Referral.
16. In my personal opinion, our role was to sit on the fence and act in the best interests of a deceased patient (and their families), but also protect the hospital and our doctors from any potential negligence.
17. As you can imagine many battles were fought over decisions about a cause of death of a patient or a referral to the coroner with a vast [number] of doctors over the years.
18. F2s and SHOs were particularly the worst with regards to carrying an arrogance of knowing what should be written on an MCCD or stating that a patient didn’t need to be referred to the Coroner (often stating that their Consultant had given them instructions).
19. It is worth noting that Consultants are also only human and can be incorrect at times too. We have to remember that they are succeeded in hierarchy by a Clinical Lead and beyond that a Medical Director. Who have far more experience and knowledge.
20. When I asked my mentor in 2016, how the ME system would change things, I was told that Bereavement Services/Patient Affairs would become purely administrative and that the clinical judgement would fall to the Medical Examiner.
21. The power and decision-making with regards to MCCD/Coroners Referrals was being taken away not only from treating doctors but also from Bereavement Services/Patient Affairs/Bereavement Officers/Bereavement Service Managers/Directors of End-of-Life Care.
22. This decision-making power was being handed solely to the Medical Examiner, who has not been involved in the treatment of a patient during an admission.
I took all this information in at the time and acquired as much knowledge as I could from my mentor/line manager.
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