Charity urges ambulance trusts ensure end-of-life care plans are met

Nearly a quarter of ambulance trusts have no systems for holding advance care plans for patients, a charity has warned.

Compassion in Dying, which helps people prepare for the end of life, said this could result in paramedics not being aware of, and therefore failing to respect, a patient’s stated preferences for medical treatment and care.

The charity said it was prompted to conduct the research after receiving frequent inquiries from people concerned about whether their advance care plans would be respected in an emergency situation or when being transported between care settings.

Such plans can include an advance decision (sometimes known as an advance decision to refuse treatment, an ADRT, or a living will), a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form, and/or a Lasting Power of Attorney (LPA) for Health and Welfare.

The charity said findings from a Freedom of Information (FoI) request show that trusts vary significantly in their policies and practices regarding advance care planning documentation.

A lack of a unified system for recording and implementing advance care plans, and a widespread absence of systems for monitoring and analysing adherence to advance care plans was apparent, it added.

While 23% (3 of 13) have no systems at all for holding advance care plans for patients in their areas, the remaining trusts varied over whether they simply record the existence of plans, keep physical or electronic copies of them, or have access to systems used by GPs which include the information.

It also found a varying approach regarding who trusts will accept advance care plans from, and in what form.

Nearly half (46% or 6 out of 13) accept them from individuals, whereas just under a third (31% or 4 out of 13) will only do so from healthcare professionals.

Meanwhile the majority (85% or 11 of 13 trusts) were unable to report on the number of advance care plans adhered to in 2017.

The charity said confusion over policy can cause distress not only to individuals and their loved ones, but also to the paramedics treating them.

Compassion in Dying said it is appealing to trusts and paramedics to implement its recommendations to ensure that the end-of-life wishes of people in their area are known and followed.

One member of the public, Christine Erskine, told the charity: “At the age of 96, my mother had a severe aneurysm and the paramedics wanted to take her to hospital to have a stent fitted.

“She was adamant she was not going into hospital and I respected these wishes… I explained about her advance decision, which they knew nothing about.

“Halfway to hospital, having finally read the relevant document they had subsequently been given, they changed their minds and palliative care was put in place.”

Davina Hehir, director of policy at Compassion in Dying, said: “We recognise that ambulance crews work in time-pressured and stressful environments.

“However, if person-centred care is to become a reality, it is crucial that ambulance trusts consider how systems for respecting end-of-life wishes can be strengthened and improved – for the benefit of patients, their loved ones and paramedics alike.

“We propose a number of recommendations on improving policies, systems and training strategies.

“Most importantly, we want to open up conversations with ambulance trusts and paramedics about what support they feel they need in order to achieve these objectives and what initiatives are already in place that can be replicated elsewhere.

“We want to help ensure that everyone gets the end-of-life care that’s right for them, and that ambulance crews are fully supported to play their part in achieving this.”

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