To ask Her Majesty’s Government what assessment they have made of the report by the Care Quality Commission Protect, respect, connect—decisions about living and dying well during COVID-19, published on 18 March, on decisions about the use of ‘do not attempt cardiopulmonary resuscitation’ orders for (1) care home residents, and (2) people with learning disabilities, during the pandemic.
My Lords, the department warmly welcomes the publication of the CQC report on the use of DNACPR decisions taken during the Covid-19 pandemic. We are pleased to see examples of good practice detailed in the report across both health and social care, but this was not true everywhere, particularly for our most vulnerable people. That is why the department is committed to driving forward the delivery of the report’s recommendations and ultimately ensuring that everyone experiences the compassionate care that they deserve.
The Lord Bishop of Newcastle
My Lords, this report from the Care Quality Commission highlights that
“unprecedented pressure on care providers”
and the rapidly developing guidance has led to blanket “do not attempt cardiopulmonary resuscitation” orders being imposed at a local level, particularly affecting care home residents and people with learning disabilities. Failure to consult people about their care betrays a lack of decency and compassion, but it is also a human rights violation. I am very grateful to the Minister for his reassurance about the recommendations, but may I press him, in particular, to assure the House that the recommendation of a ministerial oversight group will be implemented?
My Lords, I can absolutely reassure the right reverend Prelate that the Minister with responsibility for patient safety and mental health care will be heading the ministerial oversight group to drive forward progress. The group will bring together a range of stakeholders across both health and care to ensure that the recommendations are implemented.
My Lords, given the significantly higher number of excess deaths among people with learning disabilities last year, will the Minister commit to finding out what proportion of those deaths were associated with DNACPRs? Does he agree that the use of blanket DNACPRs for people with learning disabilities is an indication of the extent of the lack of confidence and competence among healthcare staff to accommodate their needs, and adds to the urgent need to introduce the Oliver McGowan mandatory training currently being piloted? A timetable for the widespread introduction of that training would be very welcome.
My Lords, we will address the audit points made by the noble Baroness. I completely endorse the importance of training; that is at the heart of the report and we acknowledge its importance. We are concerned about the number of people with learning disabilities who have died during the pandemic, and there will be a report on what the connections are.
My Lords, we know that it is unlawful for DNACPRs to be imposed, and I wonder why the research has not sought to identify why physicians and care workers continue to impose them in the way that they have. Does the Minister agree that the solution must lie in completely clear, unambiguous policy to advance care planning and DNACPR decisions, and a consistent use of accessible language, communication and guidance to enable clear understanding by commissioners, providers and the public?
I will gently push back against the noble Baroness: the policy is absolutely crystal clear. Blanket DNACPR is not the policy of this Government, as was repeated time and time again in our communications, which I would list if I had more time. Training is the issue: we need to give the front-line workforce the skills it needs to apply these very delicate but critical interactions. That is the recommendation of the report, and that is where we are focused on applying the lessons.
My Lords, does the Minister agree with Age UK that the report is the tip of the iceberg and requires the Government to bring forward proposals as part of a complete overhaul of the advance care planning system?
No, my Lords, I do not accept that the report is simply the tip of the iceberg; it is very thorough and goes into the matter extremely carefully. However, there are important lessons on training to be learned and they will be driven by the ministerial oversight group.
Lord Flight (Con)
My Lords, the Care Quality Commission wrote up its findings at the time of the outbreak of Covid-19, which may have made them less reliable. A number of factors have served to raise exposure to decisions on whether or not to accept DNACPRs, and these were taken for groups rather than individually. Such groups included individuals suffering with dementia and learning disabilities who needed briefings that they could understand. The Care Quality Commission report is about how hospitals, care homes and doctors should support people to make decisions properly about how to restart. Are the Government satisfied that the decisions in this territory are now being taken properly?
My Lords, the report is crystal clear that we accept that more training is needed. Front-line care support workers need to be given more support in their interactions, and we will be putting that in place.
My Lords, I draw attention to my interests in the register, in particular the fact that I am a nurse involved with the Outcomes First Group, which supports people with learning disabilities. In order to increase the population’s awareness of care planning in relation to living and dying well, will the Government, in addition to training, consider incentivising healthcare workers to ensure that they have sufficient time to undertake proper assessment of individuals with cognitive impairment and learning difficulties as part of their routine care planning, which should be recorded and reviewed at least biannually?
The noble Baroness makes a very fair point; such care needs to be in the work plan particularly of those with learning difficulties, but of all those in care. We absolutely endorse the approach taken by the Resuscitation Council, which has extremely good guidance in this area.
My Lords, no one doubts the events described by the right reverend Prelate and noble Lords. By when can we be confident that the same could not happen again?