More than 500 do not attempt cardiopulmonary resuscitation (DNACPR) orders were imposed on care home residents without their consent during the Covid pandemic, according to the Care Quality Commission (CQC).
The CQC’s Protect, respect, connect – decisions about living and dying well during Covid-19 report found that 5.2 per cent of 2,048 adult social care providers who responded to a CQC survey on the issue have since March 2020 made DNACPR decisions that were not agreed in discussion with the person or their family.
The 508 DNAR decisions made without consent were "potentially unlawful" and due to "poor record-keeping" and a "lack of oversight" could still be occurring, the CQC said.
“While most providers of adult social care, primary care and secondary care that we spoke to reported they were not aware of inappropriate DNACPR decisions, or DNACPR decisions being applied to groups of people, CQC received feedback from stakeholders, people who use services and their families and carers, that ‘blanket’ DNACPR decisions had been proposed at a local level,” it said in a statement.
“These shortfalls in governance must 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 added.
The CQC called for a new ‘Ministerial Oversight Group’ – working with partners in health and social care, local government and the voluntary sector – to take responsibility for delivering improvements in this "vital and sensitive area".
The regulator also wants to see a consistent national approach to advance care planning, with staff training, accessible information for families and records of conversations and decisions agreed.
CQC chief inspector of primary medical services and integrated care Rosie Benneyworth (pictured) said concerns relating to DNACPR and end of life care are not “new issues” but had been brought to the fore by the pandemic.
“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,” she added.
“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.”
