Cardiopulmonary Resuscitation in the Pandemic

Nadine Dorries Excerpts

Tuesday 13th April 2021 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I thank my hon. Friend the Member for Devizes (Danny Kruger) for securing this debate on the important issue of the use of “Do not attempt cardiopulmonary resuscitation” orders and the decisions that were taken during the pandemic.

We remain crystal clear that the blanket application of DNACPR decisions is unacceptable, and that standards and quality of care should be maintained even in pressurised circumstances such as we have had over the past year with the recent pandemic. Reports of inappropriate or blanket application of DNACPR decisions across groups of people, particularly our most vulnerable, have been—I think my hon. Friend used this word himself—shocking, and failure to consult people and their families on decisions around CPR causes significant distress.

My hon. Friend mentioned that the review undertaken by the CQC also saw examples of good practice. Much work has taken place over the past year, and I would like to take this opportunity to update the House on the action that the Department, the NHS and clinical leaders have taken to tackle this issue and to ensure that excellent patient-centred care is maintained.

In April and May last year, clinical leaders issued a number of joint statements and letters to health and care providers and professional bodies, making it clear that there has never been an instruction or a directive issued by the NHS to put in place blanket DNACPR orders. Those communications also directly addressed and clarified best practice around the use of DNACPRs for people with learning disabilities, and rightly challenged assumptions about clinical frailty regarding that particular group of people.

Clear messages on the use of DNACPR decisions were also reinforced in our adult social care winter plan in September last year. We made it crystal clear that any advanced care decision, including DNACPR decisions, should be fully discussed with the individual and their family, where possible and appropriate, and signed by the clinician responsible for their care.

I have personally been through this process recently. It is true, as my hon. Friend mentioned, that every end-of-life scenario is different. No two cases are ever the same. In my particular case, it was someone with very late stage 4 cancer, and the discussion was very simple and very easy and took a matter of moments. It involved family and clinician, but the person making that decision was very precise about what they wanted. That scenario exists frequently, but there are also people who may not have the full capacity or may require further input and discussions around the decisions that are being taken.

To ensure that we could take early learnings and address directly concerns about inappropriate DNACPR decisions, because we are aware of the variation, I commissioned the CQC to review how DNACPR decisions were being made during the pandemic. The CQC worked at pace to gather insight from across the health and care system. It took in views from experienced staff, and from patients, their families and representatives, to produce an in-depth thematic review of such an important yet complex—and it is complex—issue. I thank the CQC once again for its work, which was speedily and efficiently completed, as well as all those who participated in the review and shared their valuable insight and experience.

The review shone a light on what good conversations around end-of-life care should look like, illustrating examples of clinicians and care staff going above and beyond to deliver these conversations in a caring and compassionate way, despite the pressures posed by the pandemic. However, it also drew a worrying picture of the reasons that some of those conversations fell short of the high-quality and personalised care that people deserve. As my hon. Friend mentioned, the report identified three key areas where improvements must be made.

First, the CQC found a greater need for information, training and support for health and care professionals to hold DNACPR conversations. In particular, the report raised concerns that a range of equality groups, including

“older people, people with dementia and people with a learning disability,”

were not being supported in the right way.

Secondly, the report found that there lacked a consistent national approach to advanced care planning. The language used in holding DNACPR conversations was often complex, with many different types of advanced care plans in use. Clearly, this lack of consistency runs the ongoing risk of affecting the quality of care that people receive.

Finally, the report found that the right processes were not always in place to ensure that people experienced personalised, compassionate care in relation to DNACPR decisions. Poor record keeping and inconsistency in how DNACPR decisions were reviewed, as well as a lack of system oversight, meant that it was not always possible to understand how effective these conversations actually were.

Over the last year, our NHS and adult social care sectors have truly been the backbone of our nation, and staff have worked tirelessly to deliver outstanding care. Nevertheless, we must use these learnings as an opportunity to do better in areas where we can do more. Going forward, we must ensure that staff across health and social care have the tools required to hold these conversations appropriately and compassionately. We must also begin the journey towards normalising these conversations and giving patients, their families and representatives the knowledge to truly be equal partners in their care.

When staff, patients and their families have concerns, we must put in place the best processes to ensure that people feel supported to speak up. That is why we strongly recommend the findings of the review and, as the Minister responsible for this, why I am personally committed to driving forward its recommendations. To that end, I will be heading up a ministerial oversight group that will bring together partners from across the health and social care system, as well as the voluntary and advocacy sector, ultimately to ensure that everyone experiences the compassionate care that they deserve.

Sensitive and well communicated DNACPRs can and should be an important part of patient care. I am not sure whether my hon. Friend is aware that nhs.uk has now put up a public facing message to explain the process of DNACPRs, how those decisions should be taken and how those conversations should happen, so that everybody who wants to know what the process is can go to the website and see it for themselves. We deliberately made it a public facing message and wanted it to be part of the general conversation around this issue. We are committed to taking continued action to ensure that these decisions are managed and communicated well in all settings.

Question put and agreed to.

9.3 pm

House adjourned.