In October, the Department of Health and Social Care (DHSC) asked CQC to review how do not resuscitate orders were used during the COVID-19 pandemic, building on concerns that we reported earlier in the year.
Person-centred, advance care planning enables people to have conversations and make informed decisions about their future care and what matters most to them. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders can be part of this planning and to allow people to make their wishes clearly known ahead of time.
Since the announcement we have been working with people who have experience of this issue to help shape our approach. The valuable insight shared by stakeholders, people who use services, and providers, means we can focus our attention on the things that matter to people.
What will the review look at?
By talking to a wide group of people with experience in this area, we have been able to hear examples of good practice and where decisions or processes do not appear to have been person-centred.
The review will take a national view of how these decisions were made in and across different types of services – including hospitals, GPs and care homes – using all the information available to us. By doing this it will inform national learning and support good practice development as the nation continues to respond to the pandemic.
It will include examples of best practice in this complex area, as well as times when procedures may not have always been followed so that any mistakes are learnt from.
How will the review be carried out?
We are currently analysing what we know so far from initial conversations with people who have been affected by this issue and other stakeholders, concerns raised with us, and the existing literature and guidance on this sensitive topic. Interim findings from this work will be reported later this year.
The interim findings will also provide a base for fieldwork that we will carry out in seven local Clinical Commissioning Groups across the country. This will focus (but not exclusively) on the experience of older people and people with a learning disability or autism. Doing this will allow us to explore how primary, secondary, social care and system partners have worked together in an area – including the impact of commissioning arrangements.
As well as taking into account the information shared with us, these CCGs have been selected to cover a cross-section of areas and a mix of demographics so that the lessons we learn will be of value to people in health and social care across the country, wherever they are working.
To look at a range of ways of working and experiences, the seven areas we will be looking at are:
- NHS Birmingham and Solihull CCG
- NHS Bristol and North Somerset CCG
- NHS Cambridge and Peterborough CCG
- NHS Morecambe Bay
- NHS Sheffield
- NHS South East London CCG with a focus on Greenwich
- NHS Surrey Heartlands CCG with a focus on East Surrey
We have now completed fieldwork and a report will be published in early 2021. We anticipate this will include recommendations on how people can be properly supported in this area and support good practice that protects people’s human rights.
We are now reviewing evidence gathered as part of the review. A national report of our findings and recommendations will be published by March 2021. This report will set out our findings, including any known themes and trends. It will also describe good practice and outline any known changes to the use of DNACPR in response to the pandemic.
Care and support should always be delivered in a person-centred way. Advance care planning is no exception. Our interim report sets out the progress of our review so far and our expectations around DNACPR.
We continue to monitor and review the application of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the COVID-19 pandemic.
Giving feedback on care
We have now completed fieldwork and are reviewing evidence for our review, but we are keen to hear from people who would like to share their experiences of health and social care.
If you would like to tell us about your experience, or that of a loved one, we would be grateful if you could get in touch. Please let us know using our Give Feedback on Care service, or by contacting our National Customer Service Centre.