CQC review of DNACPR must consider wider issue of blanket decisions

Charlotte Gill 18 November 2020

We need accountability mechanisms to make sure that decisions are never taken on a blanket basis, or without a proper process that places the person’s interest front and centre.

Charlotte Gill, Head of Policy, Public Affairs, and Communications, VoiceAbility

Yesterday, the Care Quality Commission shared more information about the scope and approach of its review into the use of Do Not Attempt Cardiopulmonary Resuscitation (DNACPRs) orders.

VoiceAbility welcomed the news of the review when it was announced in October. We have raised concerns previously about the improper application of DNACPRs and blanket decisions about people’s access to healthcare and treatment. We encourage the CQC to make sure that blanket decisions about access to treatment and care are considered within the remit of the review. These blanket decisions are often connected with DNACPR orders within advanced care plans. 

The coronavirus pandemic brought attention to the improper use of DNACPRs and blanket decisions, but this is not a new problem and it won’t stop unless we get to the bottom of why they happen in the first place and what is happening right now. But blanket healthcare decisions are not just about DNACPRs. They are also about a wider issue of people’s access to medical care and treatment. We are aware of blanket decisions that meant people would not get medical care or would not be taken to hospital if they became unwell. The review must consider these broader aspects of advanced care planning. This would have much more impact on the lives of many more people and help make sure people’s rights are respected when difficult decisions need to be made about their care.

In our joint Valuing Voices report, we reported that: 

There is a consistent failure to implement the Mental Capacity Act which means people who are unable to make decisions are not being listened to and their interests are being ignored. Nearly a third (31%) of advocates had seen Do Not Attempt Cardio Pulmonary Resuscitation orders (DNACPRs) being placed on the people they support without regard to the person’s feelings, wishes, values or beliefs, and without formal capacity assessments or consultation with family. One in five reported that people were being blanketly denied healthcare. Blanket decisions about access to treatment and visitors are being taken without clear justification.”

Responding to the latest update from the CQC about its review, Charlotte Gill, Head of Policy, Public Affairs, and Communications at VoiceAbility said:

A DNACPR order can be an important part of advanced care planning. For many people, having an advanced care plan is a positive step as part of taking control of their care. But it is vital that they are made only on an individual basis, and always take into account the person’s wishes, and relevant clinical information. Decisions must involve family members and independent advocates as required and appropriate. People should always have as much control as possible over their care and treatment. If someone doesn’t have capacity to make decisions, there are safeguards in place that mean their interests and wishes can be reflected – these processes must never be overlooked, whether in the context of a pandemic or not.

The CQC is well-placed to make actionable recommendations to make sure people are respected as individuals. Its review must get under the skin of these processes so that we can ensure the guidance that already exists is fully embedded across all health and care settings. But we also need accountability mechanisms to make sure that decisions which can have such a significant impact on a person and their family are never taken on a blanket basis, or without a proper process that places the person’s interest front and centre.”