In May and June of 2020, a survey of the Queen’s Nursing Institute’s (QNI) Care Home Nurses Network was carried out by the QNI International Community Nursing Observatory (ICNO) to understand more about the impact of COVID-19 on the Care Home Nurse workforce within the UK. The report was authored by Prof Alison Leary.
Amongst the findings was a comment that ‘Worryingly, some who responded raised serious ethical and professional concerns, for example GPs, Clinical Commissioning Groups and hospital trusts making resuscitation decisions without first speaking to residents, families and care home staff or trying to enact ‘blanket’ ‘do not resuscitate’ decisions for whole groups of people.’ The report makes it clear that the instruction was given in a small number of cases (Approx.10% of the 163 responses to the survey) but correctly calls this ‘worrying’.
The National Pensioner’s Convention has reported the findings of the Report from the Queens’s Nursing Institute and has now written to Professor Alison Leary MBE, Dr. Crystal Oldman CBE & Rt. Hon. Matt Hancock, and has published these letters on their website.
Concerned that Care homes in Southampton might have been included or at least may have been involved with blanket DNACPR decisions, Healthwatch Southampton, wrote to the Clinical Commissioning Group (CCG) asking for their position on this matter. Since the General Hospital in Southampton received many Covid 19 patients, we also wrote to them.
The CCG responded as follows:
From a Primary Care angle there have been no local blanket decisions or changes to policies in relation to DNACPR. Any decisions around DNAPCR should always be made on a very pers
onalised basis and involve discussion with patient and/or their carers and families. This is the position that the CCG has and would always endorse – irrespective of our recent challenges around the COVID19 pandemic.
The Commissioner referred us to one of its doctors that had led on a lot of work for the CCG recently around care planning and end of life care in our Primary Care preparation and response around the COVID19 pandemic, She replied:
Thank you for this, it is really important that our population are assured that these sensitive discus
sions are conducted appropriately and represent the holistic care of the individual we expect. I will answer your two separate points re DNACPR forms.
Re blanket DNACPR:
The information and guidance given to primary care in Southampton was that, as always with these types of discussions, they must continue to be made on an individual basis according to need.
It is unacceptable for DNACPR form completion to be applied to groups of people of any description.
Discussions of DNACPR:
Any discussion of DNACPR would need to involve the person being cared for. Where a person lacks the
capacity (as per the Mental Capacity Act) to engage with this process then it is reasonable to follow best interests guidelines with the involvement of family members or other appropriate individuals. These discussions would be recorded in the person’s medical records.
The Chair of the Resuscitation Committee at Southampton General Hospital replied:
I’m not surprised that there have been concerns about the potential impact of the COVID pandemic on decision making around escalation decisions and DNACPR.
Currently within the Trust we have not made any changes to our DNACPR policy, and I would absolutely reassure you that decisions continue to be made on an individual basis as they have done before. We are certainly being more proactive about having the discussion with patients who are admitted, and making appropriate escalation decisions with all patients who are admitted to the Trust regardless of their age, or what condition they a
re admitted with. We do not envisage making any changes to our policy in the future, and I would strongly resist any pressure to do so, not that there has been any.
So in summary, DNACPR decisions should absolutely be discussed with either the patient or their family if the patient is not competent to have the discussion. This has not changed, and there is no plan to change this. There is no plan to make DNACPR decisions on groups of patients en masse, and I and the Resus Committee would absolutely be against this.
These are really important questions to be answered, and thanks very much for coming to us for clarification. I hope this comes as some reassurance to you and the members of the public that you represent.
I hope that one good thing that can come out of this situation is that conversations about planning in the event of serious illness become much more common, both in patients that we admit to hospital, but also amongst families at home.
Members will be pleased and reassured by these responses and Healthwatch Southampton has replied to the CGG and the hospital trust to thank them for their input.