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.
On 17 November 2020, CQC published an update on its website relating to the DNACPR review and stated that, “The review will take a national view of how these decisions were made in and across different types of services – including hospitals, GPs and care homes – using all the information available to us. By doing this it will inform national learning and support good practice development as the nation continues to respond to the pandemic. It will include examples of best practice in this complex area, as well as times when procedures may not have always been followed so that any mistakes are learnt from.”
How will the review be carried out?
CQC stated that it is in the process of, “analysing what we know so far from initial conversations with people who have been affected by this issue and other stakeholders, concerns raised…, and the existing literature and guidance on this sensitive topic.”
Interim findings from CQC’s review of DNACPR decisions will be reported on later this year and the findings will “provide a base for fieldwork” that CQC will carry out in seven local Clinical Commissioning Groups across the country. This will focus (but not exclusively) on the experience of older people and people with a learning disability or autism. CQC state that doing this will allow it to explore how primary, secondary, social care and system partners have worked together in an area – including the impact of commissioning arrangements. Fieldwork is expected to be started in late November 2020, with a final report being published in early 2021.
To look at a range of ways of working and experiences, the seven areas CQC will be looking at are:
- NHS Birmingham and Solihull CCG
- NHS Bristol and North Somerset CCG
- NHS Cambridge and Peterborough CCG
- NHS Morecombe Bay
- NHS Sheffield
- NHS South East London CCG with a focus on Greenwich
- NHS Surrey Heartlands CCG with a focus on East Surrey
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 (https://ridout-law.com/coronavirus-and-dnar/) 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 fully recognised in the review into DNACPR decisions.