DNACPR review - the need for personalised, honest and sensitive conversations

Our response to CQC's report, ‘Protect, respect, connect – decisions about living and dying well during COVID-19.'
GP talking to elderly man

Today the Care Quality Commission published its report ‘Protect, respect, connect – decisions about living and dying well during COVID-19’, which has found worrying variation in people’s experiences of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions during the pandemic. 

It follows a call from the Department of Health and Social Care to conduct a rapid review of how services were using DNACPR decisions during the coronavirus pandemic. This review was prompted by Healthwatch and other organisations' concerns that DNACPR forms were being inappropriately applied to groups of people without their knowledge.

The guidance makes clear that it is unacceptable for any DNACPR decisions to be made without proper conversations with the individual, or an appropriate representative, taking into account their wishes and needs.

The report calls for the establishment of a Ministerial Oversight Group – working with partners in health and social care, local government and the voluntary sector – to take responsibility for delivering improvements in this vital and sensitive area.

Commenting on the report, Sir Robert Francis QC, Chair of Healthwatch England, said:

“We wholeheartedly welcome the recommendations of the report and in particular the emphasis on advance care planning being based on the needs of the individual. 

“The recognition of the need for compassionate and caring conversations, with staff being given the time and training to do this well and understand the process is very important. And we’d like to see the provision of other dedicated support in place, such as making appropriate adjustments for disabled people and providing interpreters for those who may need it.

This will help ensure people’s wishes are known if their circumstances change quickly, which is important where families members are involved. 

"Above all, we welcome the focus on improved oversight and monitoring of DNACPR which will help ensure the approach is used to help people live and die well.”