18 March 2021

Today, the Care Quality Commission (CQC) publish their report into do not attempt resuscitation (DNAR) decisions during Covid-19.

The CQC found worrying variation in people’s experiences of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the pandemic. While there were some examples of good practice, the CQC also heard from people who were not properly involved in decisions or were unaware that such an important decision about their care had been made.

The CQC’s key recommendation is that DNACPR decisions need to be recognised as part of wider conversations about advance care planning and end of life care, and these decisions need to be made in a safe way that protects people's human rights. The recommendations on DNAR decisions centre around three key themes:

  • Information, training and support
  • A consistent national approach to advance care planning
  • Improved oversight and assurance.

You can access the full CQC report, Protect, respect, connect – decisions about living and dying well during COVID-19, here.

This report develops on the findings of the CQC’s interim report published in December 2020, which found that a combination of unprecedented pressure on care providers and rapidly developing guidance may have led to decisions concerning DNACPR being incorrectly conflated with other clinical assessments around critical care.

BIHR Responds

We welcome the CQC’s report. It is terrible that this report is needed, but recognising and naming DNAR decision-making as a human rights issue is important. Involvement and non-discrimination in DNAR decision-making is not simply a matter of good practice, it is the law. Find out more about DNAR decisions and human rights law here.

The CQC report echoes our own findings from the summer which found that almost 1 in 10 people had experienced a Do Not Resuscitate decision without being involved in the discussion or pressured into it. Added to this is our recent experience-led DNAR research with people accessing health and care services and their loved ones, and with staff delivering those services. Our research was carried out with Learning Disability England and Turning Point, reaching over 120 people, families, supporters and frontline workers. Our findings fed into the CQC research. Click the images below to read our full reports:

   

 

There were some examples of positive practice around DNAR decisions, focused on involvement and planning care in advance. However, what people shared with us most is evidence of DNAR that risks people's legally protected rights in every day practice. This includes huge inconsistency around involvement in DNAR decision-making and discrimination, as well as confusion on process and challenges, all of which fails to uphold the legal duties and protections in the Human Rights Act: 

You can read more about our own DNAR research and access easy read and long versions of our reports here.

Our Director, Sanchita, shares her thoughts on the CQC’s report on DNAR decisions:

You can watch Sanchita talk through her thoughts in this video, BIHR's Reponds...



Last night, 17 March 2021, Sanchita spoke to the BBC as part of their coverage of the CQC's report and unlawful DNAR decision-making. You can watch it below:



Our recommendations and final thoughts…

In our research, we made a number of recommendations. Our recommendations seem to be fairly well matched with those made by the CQC. We note the role of a Ministerial taskforce – we recognise that this could help drive change in DNAR decision-making practices, but what we really need is genuine change on the ground where health and care decisions are located as human rights decisions. This would help make sure all rights are respected and protected in health and care decisions, including DNAR decisions.

Find our recommendations below: