NHS wanted Do Not Resuscitate orders on all care home residents

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Care homes in the UK were asked by some National Health Service managers and GPs to place blanket “Do not resuscitate’ (DNR) orders on all their residents at the height of the coronavirus pandemic, in order to keep hospital beds free.

The Queen’s Nursing Institute (QNI) – the world’s oldest nursing charity – discovered one in 10 care home staff surveyed was ordered to change DNR plans without discussion with family members, nursing staff, or with the residents themselves. Some unnamed GPs, hospitals and clinical commissioning groups (CCGs) sought to impose the policy at the height of the outbreak in March and April – when pressure on healthcare was at its greatest amid fears the NHS would not cope with the outbreak.

Some nurses challenged the advice as “unethical”, the report said. The findings were based on surveys from 163 care home nurses and managers across the UK.

The Daily Telegraph reports half of staff members who said they had been asked to change DNRs worked in homes for the elderly, while half worked in homes for younger people with learning or cognitive disabilities. Staff said that some hospitals were operating a “no admissions” policy for care home residents – even for non-COVID-19 conditions such as heart attacks – and some said they had struggled to make appointments with GPs for elderly people.

Report author Professor Alison Leary MBE said the findings were “worrying” and called for an inquiry. Leary, professor of healthcare and workforce modelling at London South Bank University, said: “I was quite surprised how many people reported issues with DNRs, as I was expecting one or two.

“But that 10% 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.

“These decisions were being made by NHS managers not clinicians. And this wasn’t just happening with elderly people, it was those with learning disabilities or cognitive problems of all ages.

Dr Crystal Oldman CBE, the QNI’s CEO, said: “Overall, as would be expected, the picture presented is of an extremely stressful and anxious period for professionals working to care for and protect their residents.

“More needs to be done to understand the effect of COVID-19 on the workforce and residents in care homes.

"Urgent attention must be paid to the sector if the workforce is to withstand the additional demands of the pandemic, particularly in planning, guidance and employment practices.”

It has been previously reported that the UK Department of Health was on record last month as saying “it is completely unacceptable for DNACPR [do not attempt cardiopulmonary resuscitation] orders to be applied in a blanket fashion to any group of people”.

 

Full report in The Daily Telegraph

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