Investigation launched into claims of blanket ‘Do not resuscitate’ orders during early pandemic

An investigation has been launched into allegations of the blanket use of “Do not resuscitate” orders in England during the early part of the coronavirus pandemic.

Concerns have been raised that blanket orders were applied to some groups – such as residents in some care homes – as the NHS faced the first peak of Covid-19.

The Care Quality Commission (CQC) said it is proceeding with the review “at pace”.

Compassion In Dying has been calling for an inquiry into the use of Do Not Attempt Resuscitation (DNAR) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders during the coronavirus pandemic.

The charity said that, since March, it has heard several reports about blanket orders being made for patients across a range of healthcare settings.

It welcomed the review, as it revealed polling suggesting most people do not understand DNACPR orders.

Health Minister Lord Bethell announced the investigation in the House of Lords on October 1.

He said: “The department is very clear that the blanket use of DNACPR and DNR is unacceptable. An agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their family, carer, guardian or any other legally recognised advocate.

“I can inform the House that the minister for patient safety and mental health will be writing to the Care Quality Commission requesting that it investigates and reports on DNACPR issues.”

Dr Rosie Benneyworth, chief inspector of primary medical services and integrated care at the CQC, said: “We welcome this commission from Department of Health and Social Care and are taking it forward at pace.

“This builds on the concerns we reported earlier in the year and we are pleased that they are being given closer attention.

“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.”

Research for Compassion in Dying suggests more than half of people do not know a decision is made if a clinician thinks that attempting CPR will do more harm than good, that a decision must be explained to a patient or their family, and that they will still receive other care.

The YouGov survey of 2,026 adults in Britain also found that 77% would welcome a discussion with a healthcare professional or be willing to explore the topic.

Director of partnerships and information, Usha Grieve (pictured), said: “Coronavirus has highlighted and exacerbated ongoing problems with decision-making and communication around DNRs, which have proliferated under a lack of clear national guidance.

“This has had devastating effects on patients and families right across the spectrum – from DNRs being issued in a blanket way, to decisions not being properly communicated or explained to patients or families, to people who want to protect themselves from potentially harmful or futile CPR feeling ignored.

“Our new polling further underscores the urgent need for clear national guidance on DNR and for more open, honest communication between healthcare professionals, patients and families.”

Fiona Carragher, director of research and influencing at the Alzheimer’s Society, said it was “appalling” to hear of a blanket approach, adding: “It’s vital that the CQC investigation ensures this never happens again, correcting any cases where it may have been inappropriately applied.”

Kate Allen, Amnesty International UK director, said: “As we speak, countless do-not-resuscitate orders may remain in people’s files. Many of these people could fall ill in the coming months.

“The CQC should urgently begin this review, and in the meantime the Government should instruct that every single DNACPR added to a resident’s care plan since 1 March this year is reviewed immediately.”

Health leaders in England wrote to medics across the country on April 7 reminding them that “blanket policies are inappropriate”.

Professor Stephen Powis, medical director for the NHS in England, and Ruth May, chief nursing officer for England, said orders should only be made on an individual basis and in consultation with the individual or their family.

The letter followed a joint statement from the CQC, the British Medical Association, the Care Provider Alliance and the Royal College of GPs, reminding medics it is “essential” that these decisions are made on an individual basis.

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