DNACPR decision-making: the CQC report and a shedinar on getting the law right

The CQC published on 18 March 2021 Protect, respect, connect – decisions about living and dying well during COVID-19, a hard-hitting report looking at DNACPR decision-making during the first year of the pandemic, finding

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.

We will be covering the report in more detail in the Mental Capacity Report, but I set out below the overview of the recommendations.  I have also updated my shedinar on DNACPR decision-making and advance care planning.

  • 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.

Information, training and support

  • People must always be at the centre of their care, including advance care planning and DNACPR decisions.
  • Everyone needs to have access to equal and non-discriminatory personalised support around DNACPR decisions, that supports their human rights.
  • Clinicians, professionals and workers must have the knowledge, skills and confidence to speak with people about, and support them in, making DNACPR decisions.

A consistent national approach to advance care planning

  • People, their families and representatives need to be supported, as partners in personalised care, to understand what good practice looks like for DNACPR decisions.
  • People, their families and/or representatives, clinicians, professionals and workers need to be supported so that they all share the same understanding and expectations for DNACPR decisions.
  • People need to have more positive and seamless experiences of care, including DNACPR decisions, when moving around the health and care system.

Improved oversight and assurance

  • There must be comprehensive records of conversations with, and decisions agreed with, people, their families and representatives that support them to move around the system well.
  • Integrated care systems need to be able to monitor and assure themselves of the quality and safety of DNACPR decisions.
  • Health and social care providers must ensure that all workers understand how to speak up, feel confident to speak up and are supported and listened to when they speak up.
  • CQC must continue to seek assurance that people are at the centre of personalised, high-quality and safe experiences of DNACPR decisions, in a way that protects their human rights.
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