A damning new report from the Care Quality Commission (CQC) shows that some elderly and disabled people have been pressurised into signing “do not attempt cardiopulmonary resuscitation (DNACPR)” requests during the Covid pandemic – more commonly known as ‘Do Not Resuscitate’ orders.
The Commission also found examples of where people “were not properly involved in decisions, or were unaware that such an important decision about their care had been made.”
The Department of Health and Social Care requested CQC to do a fast analysis of how DNACPR conclusions were used in the coronavirus crisis, based on previous claims that were found to be misused on vulnerable populations without awareness.
The CQC states that no DNPR decisions can be taken without having sufficient communication with the patient, or with an appropriate party or delegate.
During the winter months of 2020, due to unusual provider and medical testing stresses, judgement on DNACPR treatment may have been confused with critical care decisions.
This new study was also based on the feedback from seven Clinical Commissioning Groups (CCGs), which also responded to a nationwide call for adult social care information and on national surveys that were conducted over the preceding years.
The research showed that while most adult nursing, principal, and secondary care services were unaware of the practise of blanket DNP or DNP decisions being made to specific classes of individuals, CQC discovered blanket DNP practises being proposed at the local level.
Additionally, the regulator has heard several cases of these being questioned and retracted.
Among its many recommendations, the CQC calls for the establishing of a “Ministerial Oversight Group” to “take responsibility for delivering improvements in this vital and sensitive area”.
Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care at the Care Quality Commission said: “Personalised and compassionate advance care planning, including DNACPR decisions, is a vital part of good quality care. Done properly, it can offer reassurance and comfort for people and their loves ones – before and during difficult times.
“It is vital we get this right and ensure better end of life care as a whole health and social care system, with health and social care providers, local government and the voluntary sector working together.
“COVID-19 has brought this to the fore but these are not new issues. While this rapid review was not asked to make judgments on how decisions might have impacted individual cases, we have to take this opportunity to address these problems.
“We need to make sure that people have the opportunity to discuss their wishes about care and treatment in a compassionate and person-centred way.”