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P05 Frailty goes viral: using critical discourse analysis to explore the justification and operationalisation of care rationing during COVID-19 in the United Kingdom
  1. Louise Tomkow1,
  2. Paul Pascall-Jones2,
  3. Daniel Carter3
  1. 1Population health and primary care, University of Manchester, Manchester, UK
  2. 2University of Manchester, Manchester, UK
  3. 3London School of Hygiene and Tropical Medicine, London, UK


Background Policymakers anticipated COVID-19 would overwhelm the National Health Service (NHS) in the UK with particular concern about critical care capacity. In March 2020, the National Institute for Health and Care Excellence (NICE) published guidance for clinicians treating people with COVID-19, which used the concept of frailty in its decision-making matrix for the care of people over the age of 65.

Methods This research paper uses a Foucauldian theoretical approach to explore how the rationing of medical care for older people by frailty score was justified and operationalised in the UK during the COVID-19 pandemic. We present a Critical Discourse Analysis of this guidance and the supporting online resources.

Results Analysis shows in the guidance, the Clinical Frailty Score is merchandised as a quick and easy-to-use technology which reduces social and physical complexity into a clinical score. This process makes older people knowable within the biomedical sphere and allows them to be stratified based on frailty score. This is justified through epidemiological discourses of risk, merged with the language of individual mortality prediction. This facilitates the allocation of resources along the lines of CFS score. We discuss this proceduralisation of CFS alongside a growing body of research that problematises its application in resource allocation and frailty studies.

Discussion We argue that the continuing dominance of frailty effectively obfuscates the concept’s limitations and ambiguities, the ageism implicit in the response to COVID-19 in the UK, and the relative resource scarcity facing the UK’s NHS.

  • Frailty
  • COVID-19
  • Foucault

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