A damning report released by the Care Quality Commission (CQC) has found that thirty-four-percent of people working in health and social care were pressured into placing ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) orders on Covid patients who suffered from disabilities and learning difficulties, without involving the patient or their families in the decision.
The CQC was commissioned by the Department for Health and Social Care, under section 48 of the Health and Social Care Act 2008, to conduct a special review of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions taken during the COVID-19 pandemic (full report can be found here).
The investigation was carried out due to concerns around the blanket application of DNACPR decisions, including applying them to groups of people rather than on an assessment of each individual, and due to reports of these decisions being made without involving the person concerned.
The CQC looked at all key sectors including care homes, primary care and hospitals and investigated the implementation of the DNACPR guidance.
After conducting their investigation the CQC found evidence of unacceptable and inappropriate DNACPR’s being made throughout the pandemic and said it was possible that cases of inappropriate DNACPR’s remain in place.
A DNACPR decision is an instruction not to attempt cardiopulmonary resuscitation. DNACPR’s are designed to protect people from unnecessary suffering by receiving CPR that they don’t want, that won’t work or where the harm outweighs the benefits.
Every decision about CPR must be made on the basis of a careful assessment of each individual’s situation and should never be dictated by ‘blanket’ policies. Decisions about CPR must be free from any discrimination, for example in respect of
a disability, and not made on a professional’s subjective view of a person’s quality of life. A best interests decision about CPR is unique to each person and is to be guided by the quality of future life that the person themselves would regard as acceptable.
However the CQC investigation found that throughout the “pandemic” this guidance was not being followed as they had received deeply troubling evidence from numerous sources that during the COVID19 pandemic DNACPR notices have been applied in a blanket fashion to some categories of person by some care providers, without any involvement of the
individuals or their families.
Almost 10% of people using services or families who responded to their call for evidence told the British Institute of Human Rights that they had experienced pressure or use of DNACPR orders. Thirty-four per cent of people working in health
and/or social care said they were under pressure to put DNACPR’s in place without involving the person. In addition, 71% of advocacy organisations and campaigners said they experienced DNACPR orders put in place or pressure to make them
without being involved in the decision.
The CQC found examples of inappropriate and unlawful use of DNACPR forms – including blanket DNACPR. They also found that staff incorrectly interpreting DNACPR prevented people getting access to hospital care and treatment. Reports were also received of Care providers seeking to apply DNACPR forms to patients without sufficient discussion or explanation with the individuals and their families.
These are some examples of the reports that the CQC received –
‘The doctor on call had advised care home staff that if the older people in their care contracted COVID-19, they would have a DNACPR put in place. Another said doctors were refusing to visit a care home because they had had two residents die from COVID-19. Care staff were asked to take observations that they were not trained for, and all residents had a DNACPR in place.’
‘The individual feedback we received showed experiences of people and their families who were unaware that they had a DNACPR order, often not finding out until the person was quite unwell. Sometimes this decision had been made by a medical
professional without the involvement of the person or family. Sometimes the family were told that the person had agreed to the DNACPR, but there were questions’ raised about whether this was informed consent due to reasons such as deafness or
not speaking English, or from conversations that the family had with the person.’
‘There were also examples from the feedback where care had not been provided to the person with a DNACPR in place – for example, a care home not calling an ambulance straight away, a delay in calling doctors, or someone who felt pressured to agree to an advance COVID-19 care plan that stated that they would stay at home without treatment if they contracted COVID-19.’
Most alleged Covid deaths have occurred in people aged 90+. The next age group with the most deaths being 85 – 89, then 80 – 84 and so on and so on. With ‘Do Not Resuscitate’ orders being placed on the elderly and disabled resulting in a complete lack of care is there any wonder?