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Updated guidance is to be rolled out in England for patients and staff on the use of do not attempt cardiopulmonary resuscitation (DNACPR) orders, following reports of poor practice during the coronavirus pandemic.
NHS England and NHS Improvement are putting together “system and patient-facing guides” on DNACPR decisions including how they can be challenged if required, the government has confirmed.
“Both scenarios completely undermine person-centred care at the end of life”
The work is being carried out in collaboration with representatives from the learning disability and autism sector.
The announcement comes after health and social care secretary Matt Hancock was threatened with legal action in May this year over an apparent lack of clear and accessible national guidance on DNACPR orders.
The challenge came from campaigner Kate Masters, who was supported in her bid by law firm Leigh Day and charity Compassion in Dying.
The Department of Health and Social Care has today promised new guidance but insisted work on it was “already underway and is not a result of legal action”, noting that the application for a judicial review had already been withdrawn.
Since the outbreak of Covid-19, concerns have been raised about blanket applications of DNACPR orders to groups of people, including people with learning disabilities and autism.
In response, Mr Hancock, NHS England, the Nursing and Midwifery Council and General Medical Council have all previously spoken out to condemn the use of DNACPR orders in this way.
Compassion in Dying said around 7% of all queries to its nurse-led information line between 2017 and 2019 related to DNACPR decisions.
These calls came not only from concerned families, but also health and care professionals, who were “confused by the lack of clarity” around DNACPR, according to the charity.
Responding to the government’s pledge for new guidance, Davina Hehir, director of policy and legal strategy at Compassion in Dying, said it was a “victory for common sense”.
“Coronavirus has highlighted and exacerbated ongoing problems concerning accurate and accessible national guidance regarding CPR, the lack of which has contributed to a proliferation of poor and unlawful practice during the pandemic,” she said.
“We know that many patients who express a wish to protect themselves from potentially harmful or futile CPR are not supported to do so, and equal distress is caused when a DNAR decision is not thoroughly and sensitively explained to a patient and their family.
“Both scenarios completely undermine person-centred care at the end of life, and risk jeopardising sensible efforts to demystify CPR decisions and improve communication between doctors, patients and families around end-of-life decisions,” she added.
Ms Hehir said the guidance for health professionals should include advice on “proper protocol and how to have sensitive, honest conversations with patients and families, so that they can provide lawful and compassionate care”.
“The publication of national guidance has the potential to ensure that all patients only have DNR decisions made following a lawful process”
Ms Masters was motivated to pursue the case because her late father, David Tracey, was behind a landmark Court of Appeal hearing in 2014 that had established that NHS trusts had a legal duty to consult with and inform patients with mental capacity if a DNACPR is placed on their records.
The court found that doctors at Addenbrooke’s Hospital had acted unlawfully when they placed two DNACPR orders on the medical records of Ms Masters’ mother, Janet Tracey, a care home manager, without telling her.
Ms Tracey had advanced lung cancer when she was taken to the hospital following a serious car crash and later died.
Merry Varney, from the human rights team at Leigh Day, representing Ms Masters, said the firm had been “inundated” with requests for help from patients and families in regard to DNACPR decisions since the start of the pandemic.
“Many appear to have had their right to respect for private life infringed, just as Kate’s mother had, with evidence of DNRs being implemented without consultation, without families being told, and without any clear explanation of the process for making these decisions,” she added.
“The publication of national patient-facing guidance and guidance directed at all NHS bodies, for all NHS staff involved in DNR decisions, has the potential to ensure that all patients only have DNR decisions made following a lawful process and that no others have to endure what our client and others have had to.”
A Department of Health and Social Care spokesperson said: “We have made clear that it is completely unacceptable for DNACPR orders to be applied in a blanket fashion to any group of people.
“The government has taken consistent action on a number of fronts to prevent this from happening and NHS England is currently creating patient-facing guidelines on how to challenge a DNACPR and access support.
“This work was already underway and is not a result of legal action,” they added.