Blanket DNACPRs inappropriate for people with learning disability

BLANKET DNACPR (do not attempt cardiopulmonary resuscitation) orders for patients with a learning disability and/or autism are inappropriate, NHS England has confirmed in a recent letter to primary care providers.

The letter points out that each patient has needs and preferences which must be taken account of individually.

It states: "Blanket policies are inappropriate whether due to medical condition, disability, or age. This is particularly important in regard to DNACPR orders, which should only ever be made on an individual basis and in consultation with the individual or their family.

"The terms 'learning disability' and 'Down’s syndrome' should never be a reason for issuing a DNACPR order or be used to describe the underlying, or only, cause of death. Learning disabilities are not fatal conditions."

The letter further cites the joint statement from NHS England and NHS Improvement and Baroness Campbell in May 2020 on the importance of decisions around care and access to treatment being made on an individual basis. It asks clinicians to consult specialty guidelines from NICE on the active management of Covid-19 patients, which include specific guidance on the management of people with autism and/or a learning disability.

The 2020/21 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF) states that all DNACPR decisions for people with learning disabilities are to be reviewed to ensure they were appropriately determined and continue to be clinically indicated.

Download letter

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