Individuals’ human rights were potentially breached in more than 500 cases where ‘do not resuscitate’ decisions were made during the Covid pandemic, England’s care regulator has said.
The Department of Health and Social Care (DHSC) asked the Care Quality Commission (CQC) to conduct a rapid review of how ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions were used during the Covid pandemic, “building on concerns that they were being inappropriately applied to groups of people without their knowledge.”
Some 2,048 adult social care providers responded to the CQC and said that 508 DNACPR decisions made since 17 March 2020 had not been agreed in discussion with the person, their relative or their carer.
‘Unaware that such an important decision about their care had been made’
The new report from the CQC found a “worrying variation” in people’s experiences of DNACPR decisions during the pandemic.
The CQC said: “While there were some examples of good practice, CQC also heard from people who were not properly involved in decisions, or were unaware that such an important decision about their care had been made.”
An interim report which was published in December 2020 found that a combination of “unprecedented pressure on care providers and rapidly developing guidance” may have led to decisions regarding DNACPR being incorrectly “conflated with other clinical assessments around critical care.”
The latest report also drew on fieldwork from seven Clinical Commissioning Groups (CCGs), alongside 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 said that although most providers of adult social care, primary care and secondary care that it spoke to reported that they were not aware of inappropriate decisions regarding DNACPR - or DNACPR decisions being applied to groups of people - the CQC also received “feedback from stakeholders, people who use services and their families and carers, that ‘blanket’ DNACPR decisions had been proposed at a local level.”
The regulator also heard examples of these then being quickly challenged and retracted.
Although inspectors found some examples of good practice, they also found “a worrying picture of poor involvement of people using services, poor record keeping, and a lack of oversight and scrutiny of the decisions being made.”
The Care Quality Commission (CQC) has said these shortfalls in governance must now be addressed if providers “are to assure themselves that decisions were, and are, being made on an individual basis, and in line with the person’s wishes and human rights.”
‘It is vital we get this right and ensure better end of life care’
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 loved 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.”