Independent Review into Do Not Attempt Cardiopulmonary Resuscitation Orders

The Government are announcing today the publication of the Care Quality Commission’s (CQC) report into the use of do not attempt cardiopulmonary resuscitation (DNACPR) decisions taken during the covid-19 pandemic. We would like first to thank the CQC for their swift work on the review, as well as the people, their families, representatives and staff who shared their experiences on such an important and complex issue. A copy of the report is available at: https://www.cqc.org.uk/.

The report follows concerns raised at the beginning of the pandemic around the use of “blanket” DNACPR decisions across groups of people, particularly our most vulnerable. The Care Quality Commission has investigated these concerns.

Sensitive and well communicated DNACPR decisions can be an important part of patient care and end of life experience. It is essential, therefore, that good practice is embedded across the health and care system to build understanding of the role good DNACPR decisions play in high-quality personalised care.

We are pleased to see the numerous examples of good practice, across both health and social care settings, highlighted by the report. We heard about experiences of people and their families seeing health and care providers go above and beyond to overcome the challenges posed by the pandemic.

However, such good practice was not true everywhere. The report tells the stories of people who were denied the opportunity to discuss their DNACPR decisions, as well as of families and carers feeling unable to support their loved ones or challenge DNACPR decisions. This is completely unacceptable.

Inappropriate or “blanket” application of DNACPRs decisions are wholly unacceptable, even in pressurised circumstances. All decisions about DNACPR must, in all circumstances, be made on an individual basis according to need.

We must be able to ensure that people feel equal partners in their care and that staff across all care settings feel well equipped to hold these difficult conversations. We must have processes to ensure that people feel supported to speak up when they have concerns. We support the recommendations of the CQC, including ensuring that staff have the training needed to be able to support people with DNACPR decisions; that there is national guidance and system level oversight; and that people are well informed of what good practice looks like, what their rights are and for DNACPR decisions to be considered as part of good end of life care.

The Government are determined to tackle bad practice and welcome the report’s recommendation for a ministerial oversight group to drive progress on this important issue. We are committed to driving forward the delivery of these recommendations and ultimately ensure everyone experiences the compassionate care they deserve.