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Government must firm up national advice on DNACPR orders, finds CQC review


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The CQC has made a range of recommendations to improve practices surrounding Do Not Attempt CPR (DNACPR) orders after its review found patients’ human rights may have been breached 500 times during the pandemic.

In response, the CQC called for a new Ministerial Oversight Group to be set up to look in depth at the issues identified and oversee the required changes. It also recommended that health and social care staff – including GPs – are given ‘clear and consistent’ training in line with a national, unified approach to DNACPR decision making.  

The Government commissioned the CQC to carry out a review of DNACPR decisions last October, in response to concerns they were being applied inappropriately during Covid, with the final report published today (18 March).

An information request to adult social care providers by the CQC found that 6% of 2,048  providers felt people in their care had been subject to inappropriate ‘blanket’ DNACPR decisions during the pandemic.

It also concluded that the number of patients with DNACPR orders in place increased in the pandemic, from 28% to 36%. In nursing homes, the figure increased from 74% to 92%.

Some DNACPR agreements had not been agreed in discussion with the person or considered as part of a personalised care plan, the CQC found.

It said this painted ‘a worrying picture’ of poor involvement of patients, poor record keeping, and a lack of oversight and scrutiny of the decisions being made.

And, while many decisions had been overturned amid national ‘messaging and support’, some were still in place in December 2020.

The regulator said the figures raised ‘serious concerns’ that individuals’ human rights – to be involved in DNACPR decisions about themselves or their families – were potentially being breached in more than 500 cases across the adult care services it surveyed.    

Looking at causes, the investigation, which also included a public survey and fieldwork in seven CCGs, listed pandemic staff pressures and rapidly changing guidance from commissioners.

However, the CQC added that the issues raised in the report ‘pre-date the pandemic’.

It concluded: ‘Clinicians, professionals and workers must have the knowledge, skills and confidence to speak with people about, and support them in, making DNACPR decisions. 

‘To do this, there needs to be clear and consistent training, standards, guidance and tools for the current and future workforce. 

‘This needs to be in line with a national, unified approach to DNACPR decision making. Providers also need to ensure that there is training and development available for all health and care professionals.’

Rosie Benneyworth, CQC’s chief inspector for primary care, said: ‘Covid-19 has brought this to the fore but these are not new issues. While this rapid review was not asked to make judgements 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.’