Thousands could be sent to their deaths because of ‘Do Not Resuscitate’ orders imposed by care homes
MPs are calling for a review of “Do Not Resuscitate” orders on care home residents, amid fears that blanket decisions which end lives are being taken on behalf of the elderly.
Charities are concerned that care homes are routinely applying such orders – along with those which say residents should not be taken to hospital – despite warnings that the practice is unacceptable.
Concerns emerged during the first wave of the pandemic, when it was found that some care homes had placed such orders on every single resident.
Last month the Care Quality Commission (CQC) opened an investigation into the matter. But it is still ongoing, and MPs and campaigners are concerned that “blanket” orders which were imposed months ago could send thousands to their death this winter.
A cross-party group of MPs, backed by Amnesty International, is calling for every order on care home residents’ files to be urgently reviewed.
Kate Allen, Amnesty International UK Director, said the unlawful use of the orders for care home residents was “one of the most deeply disturbing scandals of the pandemic” and a “clear violation of residents’ human rights”.
She said that while the policies may already have caused needless deaths, no one knows how many orders – also known as Do Not Attempt Resuscitation (DNAR) orders – remain on file, without families being consulted.
“Many of those vulnerable people could get ill over the coming winter and unless action is taken now, more lives could be lost,” she told The Telegraph.
One former director of nursing from Lancashire said she was shocked to learn during the first wave that such an order was to be placed on her 85-year-old mother – and on all her mother’s fellow care home residents.
She said: “We felt absolutely helpless. At this stage we weren’t allowed any visits at all. If mum had been ill we might not even have known; we were reliant on what the care home staff were telling us, not even nurses, and there weren’t even any doctors going in.”
The family fought the order, but are concerned that many more such orders have been placed on vulnerable care home residents throughout the country.
What now for care homes abandoned to Covid?
Sixteen MPs, including the chairmen of the All Party Parliamentary Groups on Coronavirus, on Ageing and Older People, and on Rural Health and Social Care, have written to the Health Secretary, calling for an urgent review of every DNAR placed on file.
The letter, also signed by former Tory ministers Baroness Altmann and David Davis, cross bench life peer Lord Alton, Ed Davey, leader of the Liberal Democrats, and Green MP Caroline Lucas, said the orders were imposed “without proper consultation” with residents or families.
They said they were “incredibly disturbed” by reports of “clearly unlawful and unethical” policies being in place in a number of areas.
“In one example, a care home inspected by the Care Quality Commission at the end of June 2020 was found to have imposed blanket DNAR forms on every single resident – almost three months after the Government, the Care Quality Commission, British Medical Association and the Royal College of GPs had issued statements warning against the practice,” the letter notes.
The care home – Everley Residential Home in the West Midlands, for those with dementia or physical disabilities – was put on “special measures” in August after inspectors found it “failed to recognise people’s right to life” in line with the human rights act.
MPs warned that no one knows how many orders remain on the files of the elderly, without proper consultation with them or their relatives.
They say that while the ongoing CQC review is welcome, its findings may come too late.
“An unknown number of DNARs remain in care home residents’ files that have been imposed in a blanket, unlawful manner without consultation. Many of those people could get ill over the winter – they cannot wait for the outcomes of the CQC review and neither should they need to,” they warn.
Between March and June, care homes in England had around 30,000 more deaths than would have been expected, with two in three attributed to Covid.
Charities are concerned that in too many cases, those who fell ill in care homes were forced to stay there, because DNAR signs and “do not convey to hospital” notices had been placed.
In March, NHS clinical commissioning groups in Sussex were found to have issued guidance to at least 98 care homes and 35 GP surgeries, telling them to “check they have resuscitation orders on every resident”. While the guidance said orders could specify “for” or “not for” resuscitation, the guidance came with a “script” for conversations with relatives which said hospital admission was “undesirable” for those who were frail and elderly.
Local MP Peter Kyle said one care home with 26 residents had 16 sign DNARs in a 24-hour period.
“Care homes felt like they were being turned into hospices,” he said.
In August a study by the Queen’s Nursing Institute found one in 10 care home staff were ordered to change DNAR plans without discussion with family members, nursing staff, or with the residents themselves.
A Department of Health and Social Care spokesman said it was "completely unacceptable" for "do not attempt resuscitation" policies to be applied in a blanket fashion to any group of people.
He said: "This has never been policy and we have taken action to prevent this from happening. We have asked the CQC to undertake a review of notices issued during the pandemic. This review has started and will report early in 2021. As this proceeds, we will continue to work across the health and care system to address the issue.”