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CQC calls for ministerial oversight as pandemic ‘shines light’ on unlawful DNR decisions

End-of-Life-Care

Individuals’ human rights may have been breached in more than 500 cases across adult social care services where ‘do not resuscitate’ decisions were made during the COVID-19 pandemic, the Care Quality Commission has said.

Care providers told the regulator that 508 of DNACPR decisions put in place since March 17 had not been agreed with a person, relative or carer.

And while many of these decisions made during the COVID-19 pandemic had been reviewed in response to national messaging and support, an information request showed that around a third (180) were still in place in December.

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In a new report, the CQC has called for a Ministerial Oversight Group to be created to take responsibility for delivering improvements in this area.

The findings come after the CQC was asked by the Department of Health and Social Care to conduct a rapid review of how DNR decisions were used at the start of the coronavirus pandemic.

It followed concerns that elderly and vulnerable people were being subjected to these decisions without their consent or with little information to allow them to make an informed decision.

An interim report published in December 2020 found that a combination of “unprecedented pressure” on care providers and “rapidly developing guidance” may have led to decisions concerning DNACPR being incorrectly conflated with other clinical assessments around critical care.

This latest report also drew on fieldwork in seven Clinical Commissioning Groups (CCGs), responses to a national information request to providers of adult social care, a national public survey and ongoing engagement with voluntary sector organisations working in the area.

The CQC noted that while most care providers were not aware of inappropriate DNACPR decisions, or DNACPR decisions being applied to groups of people, it received feedback from other stakeholders, people who use services and their families and carers, that ‘blanket’ DNACPR decisions had been proposed at a local level.

Some 119 providers said people in their care had been subject to blanket DNAR decisions since March 2020.

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.”

Commenting on the report, Kathy Roberts, chair of the Care Provider Alliance (CPA) said: “It is essential that meaningful conversations to aid decision-making is had with people at the end of their life and with their families. Good training and support can help us learn from this feedback and ensure everyone has access to personalised advanced care plans appropriate to their needs. 

“For older people and people with other serious mental health or long-term conditions, it has never been more important for decisions to continue to be made on an individual basis according to the person’s wishes. Where the person lacks the capacity to engage with the process then it is essential that best interest guidelines are followed, with the involvement of family members or other appropriate individuals.”

Tags : CQCDNRdo not resuscitate
Sarah Clarke

The author Sarah Clarke

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