Page last updated: 12 May 2022

The coronavirus pandemic has placed unprecedented pressure on health and care services, clinicians, professionals and workers.

Together, they have worked to respond to the challenges that the pandemic has created, and to provide people with the care, treatment and support they need.

This support has included talking about whether people would want to receive cardiopulmonary resuscitation (CPR) if they stopped breathing or their heart stopped. At the beginning of the pandemic we heard concerns that decisions were being made without involving people or their families, and were being applied to groups of people, rather than taking into account each person’s individual circumstances. We acted quickly to remind providers that such actions were unacceptable, and we welcomed the Secretary of State’s request to look more widely at this issue.

Our review has set out to establish a picture of how ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions were being made in the earlier stages of the pandemic – shining a light on what contributed to important conversations around end of life care being done well, and what may have led to them falling short. While it is not in our gift or the scope of our review to make judgements about what may or may not have contributed to specific deaths, it is important to understand the impact of not discussing DNCAPR decisions at an appropriate time as part of a holistic conversation about advance care planning.

What we have found through our review is a worrying picture of poor involvement, poor record keeping, and a lack of oversight and scrutiny of the decisions being made. Without these, we cannot be assured that decisions were, and are, being made on an individual basis, and in line with the person’s wishes and human rights.

Our report highlights that more work is needed to support health and care clinicians, professionals and workers in holding conversations about DNACPR decisions as part of a holistic approach to advance care planning. More widely, it shows the need for a cultural shift to ensure that everyone feels supported to hold open and honest conversations about what they would like to happen at the end of their lives.

When done in the right way these conversations can be a positive experience for all involved. The outbreak of the pandemic has provided an opportunity for change. We need to capitalise on this momentum to ensure that conversations about advance care planning and DNACPR decisions are high on everyone’s agenda.

Rosie Benneyworth
Chief Inspector of Primary Medical Services and Integrated Care

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