A question has been received from a member of the public regarding County Durham and Darlington NHS Foundation Trust’s Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) policy towards those patients whose lives are deemed ‘best served’ by the surgical and medical staff’s decisions to apply those same DNACPR notices without adequate and informed discussion of that notice with patients and / or concerned family members or legal trustees.
Arrangements have been made for the question to be put to the Committee and representatives of County Durham and Darlington NHS Foundation Trust will be in attendance to respond.
The Chair advised the Committee of the procedure to follow with regards to a question from a member of the public. She confirmed that Mr Cunningham would be invited his question and representatives of County Durham and Darlington NHS Foundation Trust would respond. There would be no debate on the matter and the response would be included in the minutes of this special meeting.
Mr Cunningham asked the following question with regards to the Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR);
· It is my assertion that there has been a disconnect between the County Durham and Darlington NHS Trust, and its University Hospital of North Durham medical and surgical teams: and the patients, family members and legal Trustees of those patients: in the specific area of the Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) policy towards those patients whose lives are deemed ‘best served’ by the surgical and medical staff’s decisions to apply those same DNACPR notices without adequate and informed discussion of that notice with patients and / or concerned family members or legal trustees.
I searched through the recently published minutes of the Adults, Wellbeing and Health Overview and Scrutiny Committee for any sign that a shortcoming in the University Hospital North Durham structure in Medical / Patient End-of-Life conversations was being researched, or corrected; but found nothing.
The Court of Appeal’s ruling on Tuesday 17th June 2014 stated :- “You have the right to be involved in discussions and decisions about your health and care, including your end of life care, and to be given information to enable you to do this. Where appropriate, this right includes your family and carers.”
Mr Cunningham advised of his personal experience with the DNACPR procedure.
Given that apologies and expressions of sincere condolence were eventually stated by the Hospital, as well as promises made to me that staff would be reminded of the importance of Empathy and Sympathy by January 2022 when discussing proposed DNACPR notifications, has the Council’s Adults, Wellbeing and Health (AWH) Scrutiny Committee been recently made aware of any changes to both ‘Best Practice’; as well as abiding with published changes to the Law, in the specific area of advice and discussions of DNACPR Notifications to patients, family members and Trustees?
Dr D Oxenham, Specialist Palliative Care Consultant, gave a presentation which provided a detailed description of the complexities surrounding the DNACPR procedure and the associated form used in such circumstances was circulated to Members (for copy see file of minutes).
Members were advised of the history surrounding cardiopulmonary resuscitation (CPR) and that it was originally developed to help a minority of young, adult patients, who developed a sudden cardiac arrest. It had changed over time to an expectation of treatment for all causes of death, however it was ineffective in individuals who were ill and had multiple co-morbidities, or in catastrophic causes such as a massive haemorrhage.
The Specialist Palliative Care Consultant advised of the limited success rate of CPR and how it’s effectiveness was reduced by frailty and information was provided which confirmed that even those who had received it with mild frailty had not survived. There was a “deciding right initiative” in place in the North East and Cumbria whereby authority was given for the process under the Mental Capacity Act 2005 and this process had been adopted by NHS England as good practice nationally. The Specialist Palliative Care Consultant confirmed that Clinicians were given full training and a competency assessment was undertaken by all Clinicians who were involved in these discussions.
These decisions were often difficult and distressing for individuals as CPR did not work as well as expectations and this made it difficult to communicate decisions. Members were advised that although there were discussions with patients and their families, the decision was ultimately based on medical assessment, and there was not a choice for patients to opt-in. The Specialist Palliative Care Consultant confirmed that CPR was a procedure that was distressing for the patient and would only be performed if it was deemed to be of benefit.
The Specialist Palliative Care Consultant admitted that there were times of miscommunication, however the Trust were committed to make improvements where possible and ensured that policy and practice was as good as it possibly could be and where improvements could be made, they would be.