Do Not Resuscitate - Do You Agree With The CQC Report?

Do Not Resuscitate - Do You Agree With The CQC Report?

In October 2020, the government commissioned the Care Quality Commission (CQC) to conduct a review of how Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made during the coronavirus pandemic.

It followed concerns raised about blanket DNACPR orders being applied to groups of people, such as those with learning disabilities, rather than such decisions being based on individual circumstances.

Do you think the pressure of the pandemic forced a more general policy, and was this an acceptable compromise on standards of care?

DNACPRs are also known as DNRs and DNARs. The report uses DNACPR for consistency, so this article will do the same.

The CQC had also received reports that elderly and vulnerable people may have been subjected to DNACPR decisions without their consent or without being given enough information to make an informed decision.

In May 2020, Health and Social Care Secretary Matt Hancock had been threatened with legal action over an apparent lack of clear and accessible national guidance on DNACPR orders.

Should the CQC review report highlight systemic deficiencies, do you think criminal proceedings are likely to be instigated?

Within the review’s remit are hospitals, community health services, ambulances, primary care (excluding dental care), and adult social care including supported living schemes.

An interim report published in December 2020 found that pressure on care providers as a result of COVID-19, combined with rapidly changing guidance about all aspects of providing care may have led to DNACPR decisions being incorrectly conflated with other clinical assessments.

Given the unclear and often contradictory advice coming from government to care providers, should government carry some of the responsibility for the report’s conclusions? The final report from the CQC stated they had recorded ‘worrying’ levels of variation in people’s experiences of DNACPR decisions during the pandemic.

While there were examples of good practice, CQC also heard from people who were not properly involved in the decision-making process or who were unaware that such an important decision had been made about their care.

Could the banning of visitors from care settings and hospitals have been a contributory factor, if indeed a significant number of DNACPR decisions were made without the involvement or consent of a patient’s family or Carers?

The pressure of responding to COVID-19 was also found to have impacted on the time that staff had to hold meaningful conversations. A lack of training was also highlighted as having been a contributing factor.

The review also found that the training and support that staff had received to hold these conversations was a key factor in whether they were held in a person-centred way, that met people’s needs and protected their human rights.

Do you think the level of absenteeism due to self-isolation or COVID diagnoses meant there was a lack of staff with sufficient experience to ensure that all the appropriate protocols were being explained and followed? Before COVID-19, it must be noted that there had been widespread concerns about whether DNACPR decisions were always personalised, as they should be.

Most providers the CQC spoke with were unaware of DNACPR decisions being applied to groups of people, but they did find evidence from people, their families, and carers that there had been ‘blanket’ DNACPR decisions in place in some situations.

Are the provisions for DNACPR decisions something the government should include in their forthcoming Social Care reforms? And would closer ties between the NHS and Social Care be beneficial in providing consistent guidance on this issue?

A judgement by the Court of Appeal in 2014 confirmed that DNACPR notifications are to be based on clinical judgement, but that the decision should be made with the person whom the decision affects included wherever possible.

During early lockdown, the charity Healthwatch reportedly received information about care providers seeking to apply DNACPR forms to patients without sufficient discussion or explanation with the individuals and their families.

The Equality and Human Rights Commission and Amnesty have both highlighted that inappropriately applied DNACPR notices may still be on patients’ files and should be reviewed and removed.

Should the reassessment or removal of any remaining DNACPR notices deemed inappropriate be the priority for health and care providers now the pressure from COVID cases has diminished markedly?

Please let us know what you think in the comments and Like the article if you found it of interest.

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