National, unified approach’ to DNACPR a welcome step forward following CQC’s latest review

18 March 2021

In response to the publication of the report of Care Quality Commission’s rapid review into the use of Do Not Attempt Cardio Pulmonary Resuscitation (DNACPRs) orders, VoiceAbility welcomes the recommendations made by the CQC and emphasises that there is no place for blanket decisions about people’s access to medical care or treatment.

In response to the report, Charlotte Gill, Head of Policy, Public Affairs, and Communications at VoiceAbility said:

There is no place for blanket decisions about whether somebody gets medical care or treatment and that includes decisions about DNACPRs. The CQC makes it clear that it has heard evidence of DNACPR decisions being applied in a blanket fashion in some places. We welcome the recommendation that there be a Ministerial Oversight Group to look in depth at the issues raised by the CQC and to take responsibility for overseeing the delivery and changes needed.

The findings in the report make clear what many people have been saying for a number of years: that a lack of consistency and clear national guidance makes people’s experience of conversations about advance planning their care and treatment patchy and at times very poor. It is encouraging that the CQC propose a national, unified approach to DNACPR decision-making, including a unified approach to policy, guidance and tools that supports a positive experience of DNACPR decisions’. 

Advocacy organisations and advocates have a crucial role to play in advance care planning. We welcome the recommendation of a national campaign in partnership with the voluntary sector and advocacy services. This should increase wider understanding of advance care planning and the positive experience that it can, and should, be for people. VoiceAbility stands ready to support the CQC’s recommendations and play an active role in continuing to ensure people’s voices are heard when it matters most.”

We welcome the recommendation of a national campaign in partnership with the voluntary sector and advocacy services. This should increase wider understanding of advance care planning and the positive experience that it can, and should, be for people.

In its report, the CQC notes that medical professionals and providers can lack understanding of the Mental Capacity Act and of how to effectively support people to be fully involved in their care planning. This is something advocacy organisations face on a daily basis and something that we collectively highlighted in our Valuing Voices report of last year, stating:

A lack of understanding of people’s rights under the Mental Capacity Act (MCA) is a common thread through many responses [to the survey of advocates]. Advocates reported serious concerns that people who do not have capacity were not being appropriately assessed. […] A lack of understanding of the MCA by hospital and care staff is a consistent challenge and more must be done to address this knowledge gap.

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.”