CQC to review use of DNACPR during pandemic

On 12 October 2020, CQC reported that the Department of Health and Social Care (‘DHSC’) asked the regulator to review how Do Not Attempt Cardiopulmonary Resuscitation (‘DNACPR’) decisions were used during the coronavirus pandemic. CQC stated that the scope and methodology of this review are being developed at pace and the review is expected to look at people’s experiences in care homes, primary care and hospitals.

In CQC’s statement published on its website on 12 October 2020, it stated the following:

“Anticipatory care planning allows people to make informed decisions about what treatment they would like to receive and how they would like to be supported. DNACPR orders can be part of this anticipatory care plan to allow individuals to make a shared decision about what intervention they would like if they suffer cardiac or respiratory arrest, including refusing resuscitation. Any advance care plan and decision should always be made with the individual or, if they lack the capacity to engage, family members or other appropriate individuals.

Earlier in the year concerns were widely reported that elderly and vulnerable people may be being subjected to DNACPR decisions without their consent or with little information to allow them to make an informed decision. In April, we published a joint statement with the British Medical Association (BMA) Care Provider Alliance (CPA) and Royal College of General Practitioners (RCGP), reminding all providers that it is unacceptable for advance care plans, with or without DNAR form completion to be applied to groups of people of any description. Interim findings are expected to be reported later this year with a final report in early 2021.”

When commenting on the review into DNACPR decisions, Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care at CQC said, “… This builds on the concerns we reported earlier in the year and we are pleased that they are being given closer attention. Health and social care providers have faced extraordinary pressures this year. Both staff, and people using services and their loved ones, have at times raised concerns with us about care. It is vital that we take this opportunity to learn from what has happened – challenging poor care and sharing the ways that providers have put people’s needs at the heart of their care so that others can learn from them.”

Dr Rosie Benneyworth also stated, “Along with partners we have been clear that it is unacceptable for advance care plans, with or without Do Not Attempt Resuscitation (DNAR) form completion, to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need. Through this review we will look to identify and share best practice in this complex area, as well as identifying where decisions may not have been patient-centred and ensuring mistakes are not repeated.”

What are the implications of CQC’s review for providers?

The issue of DNACPR decisions is a difficult and sensitive area. In an article written on 9 April 2020 Paul Ridout, explained that care providers and their staff should exercise extreme caution when being pressured by GP practices to complete DNAR forms.

As acknowledged by CQC, care providers have faced extraordinary pressures during the pandemic and at Ridouts, we hope that this is fully recognised in the review into DNACPR decisions.