Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether his Department has plans to issue guidance to (a) Clinical Commissioning Groups and (b) care homes on the use of Do Not Resuscitate (DNR) orders; and whether he has made an assessment of the veracity of claims that people have been pressured into signing DNR forms.

We are aware of some recent reports concerning the inappropriate use of Do Not Resuscitate (DNR) forms. It is long-standing best practice that conversations about the end of life decisions and treatments, that may or not be appropriate, should take place on a case by case basis. Discussions and decisions should take place between the individual (and those people who are important to them should they wish) and the multi-professional care team supporting them. Where a person lacks the capacity to engage in such conversations, a plan should be developed following best interest guidelines with the involvement of those who know the individual best.

In response to concerns, the British Medical Association, Care Provider Alliance, Care Quality Commission and Royal College of General Practice issued a joint statement on advanced care planning on 1 April 2020, setting out best practice and making clear that it is unacceptable for advance care plans, with or without DNR form completion, to be applied to groups of people of any description and decisions and discussions should take place on an individual basis. The statement can be viewed at the following link:

www.rcgp.org.uk/about-us/news/2020/april/joint-statement-on-advance-care-planning.aspx

Furthermore, a letter to the system from Ruth May, Chief Nursing Officer, and Steve Powis, National Medical Director at NHS England and NHS Improvement was sent out on 7 April 2020, addressing concerns recently raised regarding the use of DNR forms and supporting best practice in the application of advance care plans. The letter can be found at the following link:

www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/maintaining-standards-quality-of-care-pressurised-circumstances-7-april-2020.pdf

Finally, guidance on the appropriate use of DNR forms and management of end of life care plans was set out in the Adult Social Care Action Plan, published on 15 April 2020. The guidance can be found at the following link:

www.gov.uk/government/publications/coronavirus-covid-19-adult-social-care-action-plan