NHS managers told care homes to put blanket ‘do not resuscitate’ orders on ALL residents at height of Covid crisis, report shows

Professor Alison Leary MBE authored investigated DNR orders in care homes

One in 10 care home staff were told to change DNR orders for their residents

Professor Leary is now calling for an inquiry to be held over the practice

NHS managers told care homes to put a blanket ‘do not resuscitate’ order on all of their residents during the peak of the COVID crisis, according to a report.

The Queen’s Nursing Institute found one in 10 care home staff were told to change resuscitation orders for patients, The Telegraph reports. In some cases, they didn’t consult family members first.

Other care home staff said that during the height of the coronavirus crisis, hospitals were refusing to admit residents from care homes.

The orders mean doctors will not attempt to restart a patient’s heart with defibrillators or cardio-pulmonary resuscitation (CPR) and will be allowed to die if it happens naturally.

Professor Alison Leary MBE, an expert in healthcare and workforce modelling at London South Bank University who wrote the report, said she was surprised to see so many people come forward about the ‘do not resuscitate’ orders.

She told the Telegraph: ’10 per cent of the respondents raised an issue, because they were either blanket decisions for whole populations, or they were imposed without discussion with the care home or the family or the residents, and that is really worrying.’

The report comes after the chief of the Aged Care in April told hospitals and GP practices not to request the orders en masse, banning the use of blanket forms.

Stephen Powis, boss of NHS England, wrote to staff to ban the forms after it was revealed that doctors in Wales had asked elderly patients to agree not to call the emergency services.

Jonathan Ashworth, the Labour Party’s shadow health secretary, today said it was ‘scandalous’ that DNR forms had been used in this way.

IMAGE: Professor Alison Leary MBE  Professor Alison Leary MBE (pictured) wrote the report which found that one in 10 care home staff were told to change resuscitation orders for patients, in some cases without consulting family members first

Care home residents revealed at the start of the UK’s outbreak that they had been urged to sign forms agreeing that they wouldn’t go to hospital if they caught COVID-19.

Jonathan Ashworth said: ‘It’s scandalous that blanket do not resuscitate orders were used.

‘Ministers should have done everything to protect care home residents.

‘To have left care home residents and staff not just unprotected and exposed to COVID-19 but to have put in place procedures that actively allowed COVID-19 to spread in care homes is an atrocious failure of Boris Johnson. ‘Instead families are left with the tragic consequences of heartbreaking loss of life.’

IMAGE: One fifth of the 128 nurses  One fifth of the 128 nurses and care home managers involved in the survey claimed to have received patients from hospitals who had tested positive for coronavirus (Pictured: Stock photo of care home staff in the UK – those pictured are not thought to have been involved with the investigation)

Deborah Alsina MBE, chief executive of the charity Independent Age, said the report’s findings were ‘very concerning’.

She said: ‘Older people should not have their choice and control removed regarding how their life ends, simply because of their chronological age.

‘Older people need to be given clear information so they can make the decision that’s right for them. This new research shows that sadly, in many cases, people seem to have had their wishes and preferences ignored.

‘Do not resuscitate orders should, wherever possible, be made in consultation with the person concerned and their family and be based on fitness to be treated, as well as personal preference.

‘Care home staff have been under enormous pressure over the last five months and it is unfair on both staff and residents, to be instructed to change DNR plans without consultation.’

It emerged early on in April that doctors were discussing DNR orders with their patients who were considered particularly vulnerable to COVID-19.

GPs told the Health Service Journal at the time that those over 80 and those who were very likely to die if they caught coronavirus were being contacted to make plans.

The Royal College of GPs encouraged doctors to have these discussions early on so that people could get their wishes clear before the virus started spreading wildly and doctors became overwhelmed.

The British Medical Association also helped to draft the guidance urging doctors to sort the issues out before the outbreak worsened.

Dr Jonathan Leach, a member of the Royal College, said it was ‘more humane’ to talk about it in advance than to wait until someone was already ill.

The RCGP advice published on March 23 said some should: ‘Proactively complete Respect/DNAR forms and prescribe anticipatory medications in advance of a worsening spread of disease’.

Some of the people reached out to were care home residents.

Professor Alison Leary, who did the Queen’s Nursing Institute report, has called for an inquiry to be conducted into the way that care homes were dealt with during the crisis.

One fifth of the 128 nurses and care home managers involved in the survey claimed to have received patients from hospitals who had tested positive for coronavirus.

Almost half of the staff surveyed said that residents sent to them from hospitals had arrived before being tested.

The chief executive of the Queen’s Nursing Institute, Dr Crystal Oldman CBE, said that more needs to be done to understand the pressures faced by care homes during the pandemic.

Charities have warned throughout the crisis that elderly people across Britain feel they are being pressured into signing ‘do not resuscitate’ forms.

It led to some British pensioners feeling as if their lives ‘do not matter’, organisations including Age UK and Independent Age wrote in an open letter in April.

The Care Quality Commission, British Medical Association, Care Provider Alliance and the Royal College of General Practitioners, warned against the practice at the start of the pandemic, calling it ‘unacceptable’.

It comes after the Government was last month pressured into issuing new guidance on ‘do not resuscitate’ orders after a woman threatened legal action over concerns ill coronavirus patients’ human rights were being ignored.

Kate Masters had threatened to sue the Government over its failure to provide consistent advice on DNRs during the COVID-19 pandemic.

She previously said the decision-making process around DNRs had ‘become opaque, inconsistent and deficient’ amid reports of poor practice, including elderly patients apparently being pressured into signing DNR forms, during the crisis.

The Government said it would publish two documents to ensure patients and families understand how DNR decisions are currently being made.

A study last month revealed more than half of all adult patients treated for coronavirus at a leading hospital were given ‘do not resuscitate’ orders or barred from treatment in intensive care.


What is a Do Not Resuscitate order?

A DNR order is a legal order which tells a medical team not to perform CPR on a patient. However, this does not affect other medical treatments.

Who can invoke a DNR?

The British Medical Association and the Royal College of Nursing say that DNR orders should only be issued after discussions have been held with patients or their family.

A patient may decline resuscitation if they have capacity as defined under the Mental Health Act 2005.

If patients want to record this in a legally binding document they should plan to make an ‘advance decision to refuse treatment’ (ADRT), but it is often best to have it recorded on a CPR decision form as well, so that healthcare professionals will recognise it easily. Or they can simply ask your healthcare professionals to record your decision on a CPR decision form.

When would it not be appropriate to attempt resuscitation?

Not everyone wants to receive attempted CPR, so it is important to respect people’s wishes and to make sure that they are offered a chance to make choices that are right for them.

When someone’s heart and breathing stop because they are dying from an advanced and irreversible condition, CPR will subject them to a vigorous physical intervention that deprives them of a dignified death. For some people this may prolong the process of dying and, in doing so, prolong or increase suffering.

When there is a chance CPR may bring someone back from cardiac arrest to a length and quality of life that they would want, they should be offered:

The chance to be given clear and accurate information about their condition and the likely risks and benefits from CPR if they should suffer cardiac arrest;

The chance to express their beliefs and wishes and to make a shared decision with their health professionals on whether or not they should receive attempted CPR if they should suffer cardiac arrest.

Less than one in five patients – 18 per cent – was admitted to the intensive care unit (ICU).

A total of 61 per cent of COVID-19 patients had treatment limitations placed on them on admission to King’s College Hospital in London at the peak of the crisis. This meant they were denied access to potentially life-saving care.

The study heightened fears about care rationing for elderly and vulnerable patients amid concerns that they were rushed into agreeing do not resuscitate (DNR) orders.

As well as DNR orders, elderly people also revealed that they were asked to sign forms agreeing not to be taken from care homes into hospital if they fell ill.

It emerged in April that elderly people were being asked to sign the agreements en masse as hospitals were coming under intense pressure from thousands of patients with the infectious disease.

People over the age of 80 are known to be the most at risk of dying if they catch COVID-19 and those in their 60s or older have accounted for more than nine out of 10 deaths.

And the NHS admitted that life-support machines could have to be prioritised for younger or healthier patients if overloaded hospitals were left with a 50/50 choice.

One woman living in a care home in Wiltshire, Elizabeth Diacon, 97, said she and ‘several friends’ were asked to sign the letters but claims she did not feel pressured.

Ms Diacon, who worked in military intelligence at the Bletchley Park code-breaking operation in Milton Keynes in World War Two, said at the time: ‘I’m not afraid of dying but I’m rather afraid of how I might die. I’d rather do it here than go to hospital.’

Speaking on BBC Radio 4’s Today programme on April 16, Ms Diacon said ‘all who could’ at her care home had been asked to sign the letter.

‘To say that if we fell ill that we would not go to hospital,’ she said. ‘Unless of course we broke a hip or something.’

Ms Diacon said she ‘presumed’ the form was referring to the event in which they became critically ill with the coronavirus, which causes pneumonia.

She added: ‘I don’t know where the form came from but I’ve spoken to several friends in care homes and they’ve all had to sign it.’

Asked whether she felt she had been pressured into signing the form Ms Diacon told the BBC: ‘You didn’t have to – you were asked if you would sign it, to agree.

‘And I thought I would rather be ill here than go to hospital. Our local hospital is much overworked and it has the virus there. I’m not afraid of dying but i’m rather afraid of how I might die. I’d rather do it here than go to hospital.’

When questioned about the letter, Health Secretary Matt Hancock said they were ‘standard procedure’ and that it was appropriate as long as people aren’t pressured.

He claimed that residents often say they would rather die in the home than a hospital ward, adding: ‘It is reasonable and right, I’d argue a good thing, to ask people their wishes.’

The form was not the same as a Do Not Resuscitate (DNR) order, which dictates that someone should not be given CPR if they die.

It would, however, mean someone wouldn’t get the lifesaving medical care available in a hospital and be limited to what care home staff and on-site doctors can provide.

Original Source: Date-stamped: 2020 AUG 24 | Time-stamped: 10:15 AEST | Author: Sam Baker and Sam Blanchard | Article Title: NHS managers told care homes to put blanket 'do not resuscitate' orders on ALL residents at height of Covid crisis, report shows | Article Link: dailymail.co.uk