Have we become so inoculated – even before the vaccine roll-out – by the actions of our NHS that we have lost the capacity for outrage? Are we so numbed by all that’s happened this year that we can’t be shocked any more?
Surely the news that GPs, at the start of the Covid outbreak had been applying blanket Do-Not-Resuscitate (DNR) orders to care home residents should have prompted widespread public anger, critical media coverage and questions in parliament.
England’s Care Quality Commission (CQC) has found that the orders were wrongly allocated during the Covid-19 pandemic causing potentially avoidable deaths.
The regulator warned that some of the “inappropriate” do not attempt cardiopulmonary resuscitation (DNACPR) notices applied in the spring may still be in place and called on all care providers to check with the person concerned that they consent.
The review was prompted by concerns about the blanket application of the orders in care homes in the early part of the pandemic, amid then prevalent fears that NHS hospitals would be overwhelmed.
The CQC received 40 submissions from the public, mostly about DNACPR orders that had been put in place without consulting with the person or their family.
These included reports of all the residents of one care home being given a DNACPR notice, and of the notices routinely being applied to anyone infected with Covid. Some people reported that they did not even know a DNACPR order had been placed on their relative until they were quite unwell.
“There is evidence of unacceptable and inappropriate DNACPRs being made at the start of the pandemic,” the interim report found, adding that the practice may have caused “potentially avoidable death”.
“It is unacceptable for clinical decisions – decisions which could dictate whether someone’s loved one gets the right care when they need it most – to be applied in a blanket approach to any group of people,” said Rosie Benneyworth, chief inspector of primary medical services and integrated care at the CQC.
“Sadly, in the experiences that people have generously shared with us, there is very real concern that decisions were made which not only overlooked the wishes of the people they affected, but may have been made without their knowledge or consent.”
The CQC cited reports that care providers and staff had raised concerns about GPs “putting blanket DNACPRs on care homes”.
One unidentified source told the regulator that some care homes and, even more outrageously, learning disability services had received instructions from GPs to impose a blanket DNACPR on people in their care.
A few sources said there had been inappropriate GP communications to people in their own homes about advance care planning and DNACPRs.
I’m certainly no fan of resuscitation in these circumstances having seen my mum put through it and the trauma of it lives with me to this day. I understand that they are a common part of end-of-life care and that it is an invasive medical intervention that is mostly unsuccessful.
In truth, if I was old and frail I would probably ask for a DNR to be applied to myself but it’s a huge decision and I’d want to make it myself in conjunction with a loved one.
What this report shows is that those front line health professionals who we literally entrust with our lives are at best prioritising their own personal safety, at worst letting older people die because it’s convenient.
Has our NHS doctor’s Hippocratic – hypocritical? – Oath “First Do No Harm” become “First Look After Yourself”.