Reports on the Discrimination of Vulnerable People in the UK During the COVID-19 Pandemic
‘Do not resuscitate’ notices forced on Covid patients, inquiry finds
Elderly and disabled targeted with ‘inappropriate and blanket’ messages without individual assessment throughout pandemic, report claims
Blanket “do not resuscitate” notices were imposed on patients with learning difficulties during the pandemic, the Covid Inquiry chairman said.
Reports began surfacing in March 2020 that “do not attempt cardiopulmonary resuscitation” (DNACPR) notices were being issued on the grounds of age, disability and health conditions including Down’s syndrome rather than on assessments of individual patients.
Baroness Hallett, the chairman of the UK Covid-19 Inquiry, said such blanket decisions were contrary to government policies and were “positively discouraged”. But, she added: “The message does not seem to have got through to everyone.”
Charity ‘furious’
Mencap, the learning disability charity, said it was “furious” at what it termed “shocking discrimination” against vulnerable people who were given DNACPR decisions without their agreement.
After publishing the third of her reports into the UK’s pandemic response, which examines the impact of Covid on the country’s healthcare systems, Lady Hallett said: “Throughout the pandemic, there were reports of inappropriate and/or blanket DNACPR notices being imposed on groups of people, such as people with learning disabilities or older people. This should not have happened.”
NHS England was so alarmed by reports of what was going on that it wrote to all English hospitals in 2020 reminding them that “the terms ‘learning disability’ and ‘Down’s syndrome’ should never be a reason for issuing a DNACPR order”.
A formal complaint about an unnamed Welsh hospital prompted the chief nursing officer and chief medical officer for Wales to send a letter to hospitals in April 2022 seeking assurance “that DNACPR decisions were not being made purely on the basis of age, disability, learning disability, autism, mental illness or other condition”.
‘Shocking discrimination’
Jackie O’Sullivan, the director of strategy and influence at Mencap, said: “Looking back at what the inquiry has uncovered, it’s impossible not to feel furious. People with a learning disability were given DNACPR decisions without their agreement and in some cases were told they wouldn’t be resuscitated simply because of their disability.
“It was shocking discrimination then and it remains shocking discrimination now. No one should ever have their life written off in this way and this must never be allowed to happen again.”
Senior doctors who gave evidence to the inquiry told Lady Hallett of concerns that “they were under pressure to make DNACPR decisions” without adequate time for discussions with patients and family members.
In October 2020, the Care Quality Commission found evidence of “inappropriate DNACPRs” being made at the start of the pandemic and concluded, in Lady Hallett’s words, that “there was a lack of assurance that decisions were being made on an individual basis”.
Lady Hallett’s report noted that, in February 2021, a junior doctor at Glangwili Hospital in Carmarthen “had attempted to complete a DNACPR notice for a patient with learning difficulties on the grounds of ‘poor quality of life’ but was stopped by a nurse”.
The report notes that only 23 per cent of patients who receive CPR in hospital live long enough to be discharged, and a study in Wuhan, China, where the pandemic began, suggested that the CPR success rate for hospital patients with Covid was only one in 136.
Doctors have to assess the chances of successful outcomes against the potential dangers of CPR causing damage to organs or infection which can “leave the patient with severely impaired quality of life”, Lady Hallett noted.
Many patients, particularly those who are terminally ill or very old, choose to have a DNACPR notice because they do not wish to be revived in the event of a cardiac arrest. The notices are not legally binding, nor are doctors obliged to attempt CPR in the absence of a DNACPR form if they think attempts at resuscitation would be futile.
Lady Hallett recommended that all four nations of the UK, working with trusts and health boards, should agree a standardised UK-wide process “for clinicians to ascertain and record their patients’ wishes and preferences for future care and treatment in order to inform individualised decision-making, including DNACPR notices”.
Elsewhere, Baroness Hallett found that the Government’s “stay at home and protect the NHS” message may have cost thousands of livesby making people think that the health service was closed.
The Office for National Statistics has estimated that more than 17,000 excess deaths from non-Covid conditions were recorded at the height of the pandemic between 2020 and 2022.The ‘stay home’ message may have led to people believing the NHS could not treat other life-threatening conditions, Lady Hallet suggestedCredit: Tolga Akmen/AFP via Getty
Lady Hallett’s report said that the “Stay Home, Protect the NHS, Save Lives” message “led some people to feel they must avoid burdening the NHS”.
It added that the message had created “a perception that general practice and services for conditions other than Covid were not available”.
Lady Hallett said: “It is important that government communication campaigns do not deter those in need from accessing healthcare.”
In future, she added, health services should be involved in messaging, not just the Cabinet Office, to “avoid unintended consequences