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COVID pressures led to blanket Do Not Attempt CPR orders, CQC finds

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A new report from the CQC has found a worrying variation in people’s experiences of ‘Do Not Attempt’ CPR (DNACPR) decisions during the pandemic.

Protect, respect, connect – decisions about living and dying well during COVID-19  found COVID pressures had an impact on practices with service users reporting blanket DNACPR decisions being proposed.

While 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.

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The report calls for a 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.

Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care at the Care Quality Commission, said: “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.”

Matthew McClelland, Executive Director of Strategy & Insight at the Nursing and Midwifery Council (NMC), said: “COVID-19 has meant health and care professionals have been under incredible pressure to make urgent, complex decisions in challenging situations.

“But as today’s report rightly highlights, there’s simply no excuse for do not attempt cardiopulmonary resuscitation (DNACPR) decisions to be made without people’s involvement and their individual needs considered. The report amply demonstrates the impact on people and their families of getting this wrong – and that should concern all of us.”

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.”

Caroline Abrahams, Charity Director at Age UK, said a “complete overhaul” was needed in the approach to advance care planning in order to restore public confidence.

A DHSC spokesperson said: “It is totally unacceptable for ‘Do Not Attempt CPR’ orders to be applied in any kind of blanket fashion – this has never been policy and we have taken decisive action to prevent it from happening, working closely with the health and care sector to make this clear and asking the CQC to undertake this review.

“We support the recommendations in this report and we are determined to ensure everyone receives the compassionate care they deserve in all settings.”

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The author Lee Peart

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