No assessment of the potential merits of amending Do not attempt cardiopulmonary resuscitation (DNACPR) forms to include a confirmation of consultation field that must be signed by the patient or family has been undertaken.

When a DNACPR decision is being made, the clinician should consider the patient’s wishes and every effort should be taken to reach an agreement with the patient or, if they lack capacity, their family or representative. If the patient or their family or representative do not agree with the decision, they should be given time to ask for a second opinion or review. This is in line with the National Health Service guidance for DNACPR decisions. Guidance and information for the public on DNACPR decisions is available on the NHS website, including information on asking for a second opinion or a review and what to do if there are concerns about, or disagreement with, a DNACPR form in a patient’s or family member’s medical records.

Professional guidance on Cardiopulmonary Resuscitation is provided by clinical bodies such as the British Medical Association, the Resuscitation Council UK, and Royal College of Nursing, to support consistent decision-making, and to reflect these principles.

The Government is clear that the inappropriate or blanket use of Do not attempt cardiopulmonary resuscitation (DNACPR) decisions is wholly unacceptable, and that no one should have a DNACPR decision in place simply because they have a learning disability. All DNACPR decisions must be made on an individual basis, involving the person concerned and, where appropriate, their family or legally recognised advocate.

A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision is made on an individual, on a person by person basis, and should, wherever possible, involve the person concerned or, where the person lacks capacity, their families, carers, guardians, or other legally recognised advocates. Professional guidance on cardiopulmonary resuscitation is provided by clinical bodies such as the British Medical Association, The Resuscitation Council UK, and Royal College of Nursing, to support consistent decision-making, and reflect these principles.

In 2021, the Department established a Ministerial Oversight Group, responsible for the delivery and required changes to ensure adherence to guidance across the system about how DNACPRs are used. As part of this work, a set of Universal Principles for Advance Care Planning were jointly published in March 2022 by a coalition of partner organisations across health and social care. The principles can be applied in all settings to provide safeguards and support people and their families, and professionals share the same understanding and expectations for DNACPR decisions.

NHS England has also published patient-facing information on DNACPRs and where to get support if they are concerned about a DNACPR. This information can be found at the NHS.UK website.

The Care Quality Commission continues to take action to ensure providers understand their responsibilities if allegations of inappropriate application of DNACPR decisions are brought to their attention, as well as raising cases with the relevant bodies, including the General Medical Council, as appropriate.

A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision is made on an individual, on a person by person basis, and should, wherever possible, involve the person concerned or, where the person lacks capacity, their families, carers, guardians, or other legally recognised advocates. Professional guidance on cardiopulmonary resuscitation is provided by clinical bodies such as the British Medical Association, The Resuscitation Council UK, and Royal College of Nursing, to support consistent decision-making, and reflect these principles.

In 2021, the Department established a Ministerial Oversight Group, responsible for the delivery and required changes to ensure adherence to guidance across the system about how DNACPRs are used. As part of this work, a set of Universal Principles for Advance Care Planning were jointly published in March 2022 by a coalition of partner organisations across health and social care. The principles can be applied in all settings to provide safeguards and support people and their families, and professionals share the same understanding and expectations for DNACPR decisions.

NHS England has also published patient-facing information on DNACPRs and where to get support if they are concerned about a DNACPR. This information can be found at the NHS.UK website.

The Care Quality Commission continues to take action to ensure providers understand their responsibilities if allegations of inappropriate application of DNACPR decisions are brought to their attention, as well as raising cases with the relevant bodies, including the General Medical Council, as appropriate.

The Department remains clear that it is unacceptable for Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions to be applied in a blanket fashion to any group of people and should be fully discussed with the individual and their family where possible and appropriate. NHS England clinical leaders have issued a number of statements and letters to health and care providers which emphasise personalised approaches to care and treatment and which reiterate that there has never been an instruction or directive issued by the National Health Service to put in place a DNACPR solely on the basis of disability, learning disability, or special needs.

Agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their families, carers, guardians, or other legally recognised advocates. Guidance from clinical bodies such as the British Medical Association, the Resuscitation Council UK, and Royal College of Nursing reflects this. These decisions should take into account the patient’s wishes, or those of people close to the patient, informed by a sensitive explanation of the risks and burdens associated with giving cardiopulmonary resuscitation. The treating doctor should try to reach agreement with the patient or those close to the patient. If, after discussion, the doctor remains of the view that cardiopulmonary resuscitation would not be clinically appropriate, there is not an obligation to attempt it. However, the rationale for not doing so should be clearly articulated. NHS England has published public-facing guidance on DNACPR decisions on the NHS.UK website. This includes advice on asking for a second opinion or review if patients, or their families, disagree with a DNACPR decision.

The Department has not received any complaints regarding DNACPR decisions being applied without consent in the last five years.

The Department remains clear that it is unacceptable for Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions to be applied in a blanket fashion to any group of people and should be fully discussed with the individual and their family where possible and appropriate. NHS England clinical leaders have issued a number of statements and letters to health and care providers which emphasise personalised approaches to care and treatment and which reiterate that there has never been an instruction or directive issued by the National Health Service to put in place a DNACPR solely on the basis of disability, learning disability, or special needs.

Agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their families, carers, guardians, or other legally recognised advocates. Guidance from clinical bodies such as the British Medical Association, the Resuscitation Council UK, and Royal College of Nursing reflects this. These decisions should take into account the patient’s wishes, or those of people close to the patient, informed by a sensitive explanation of the risks and burdens associated with giving cardiopulmonary resuscitation. The treating doctor should try to reach agreement with the patient or those close to the patient. If, after discussion, the doctor remains of the view that cardiopulmonary resuscitation would not be clinically appropriate, there is not an obligation to attempt it. However, the rationale for not doing so should be clearly articulated. NHS England has published public-facing guidance on DNACPR decisions on the NHS.UK website. This includes advice on asking for a second opinion or review if patients, or their families, disagree with a DNACPR decision.

The Department has not received any complaints regarding DNACPR decisions being applied without consent in the last five years.

The Department remains clear that it is unacceptable for Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions to be applied in a blanket fashion to any group of people and should be fully discussed with the individual and their family where possible and appropriate. NHS England clinical leaders have issued a number of statements and letters to health and care providers which emphasise personalised approaches to care and treatment and which reiterate that there has never been an instruction or directive issued by the National Health Service to put in place a DNACPR solely on the basis of disability, learning disability, or special needs.

Agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their families, carers, guardians, or other legally recognised advocates. Guidance from clinical bodies such as the British Medical Association, the Resuscitation Council UK, and Royal College of Nursing reflects this. These decisions should take into account the patient’s wishes, or those of people close to the patient, informed by a sensitive explanation of the risks and burdens associated with giving cardiopulmonary resuscitation. The treating doctor should try to reach agreement with the patient or those close to the patient. If, after discussion, the doctor remains of the view that cardiopulmonary resuscitation would not be clinically appropriate, there is not an obligation to attempt it. However, the rationale for not doing so should be clearly articulated. NHS England has published public-facing guidance on DNACPR decisions on the NHS.UK website. This includes advice on asking for a second opinion or review if patients, or their families, disagree with a DNACPR decision.

The Department has not received any complaints regarding DNACPR decisions being applied without consent in the last five years.

NHS England does not audit the use of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in cases involving vulnerable adults. However, the Learning from Lives and Deaths Review (LeDeR) includes questions on the quality and content of DNACPR records. The review supports local service improvement and has been running for several years.

A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) is a clinical decision made on the basis of a senior clinical assessment of a patient’s condition. It remains best practice to communicate this decision to the patient and if they lack capacity, their family or representative.

If the patient or their family or representative do not agree with the decision, they should be given time to ask for a second opinion or review. This is in line with the National Health Service guidance for DNACPR decisions. Guidance and information for the public on DNACPR decisions is available on the NHS website, including information on asking for a second opinion or a review and what to do if there are concerns about, or disagreement with, a DNACPR form in a patient’s or family member’s medical records.

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) is a medical decision made by a qualified clinician.

A DNACPR decision is made on an individual, namely person by person, basis, and should, wherever possible, involve the person concerned or, where the person lacks capacity, their families, carers, guardians or other legally recognised advocates. Guidance from clinical bodies such as the British Medical Association, The Resuscitation Council UK and Royal College of Nursing reflects this.

In 2021, the Department established a Ministerial Oversight Group, responsible for the delivery and required changes to ensure adherence to guidance across the system about how DNACPRs are used. As part of this work, a set of Universal Principles for Advance Care Planning were jointly published in March 2022 by a coalition of partner organisations across health and social care. The principles can be applied in all settings to support people; their families and professionals share the same understanding and expectations for DNACPR decisions.

Patient-facing guidance setting out how DNACPR decisions should be made and how individuals or their families can get support if they have concerns about a DNACPR, including second opinions and review, is provided on NHS.UK in an online-only format.

Currently, no active work is being undertaken to revise DNACPR guidance.

We want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. With regard to palliative care and end of life care, this must include the opportunity for individuals to discuss their wishes and preferences so that these can be taken fully into account in the provision of their future care. This is also known as advance care planning (ACP). ACP is a voluntary process of person-centred discussion between an individual and their care providers about their preferences and priorities for their future care. ReSPECT is one tool that can be used to support wider ACP conversations. NHS England has published Universal Principles for ACP, which facilitate a consistent national approach to ACP in England. Further information on the Universal Principles for ACP is available at the following link:

https://www.england.nhs.uk/publication/universal-principles-for-advance-care-planning/

Cardiopulmonary resuscitation (CPR) decision policies are determined locally by organisations providing National Health Service care. The Resuscitation Council UK, British Medical Association, and the Royal College of Nursing have jointly produced guidance on decisions about CPR. It states that the overall clinical responsibility for decisions about CPR, including Do Not Attempt Cardiopulmonary Resuscitation decisions, rests with the most senior clinician responsible for the person’s care, as defined explicitly by local policy.

The Government commissioned Professor Gillian Leng CBE to lead an independent review of the physician and anaesthesia associate professions. The review considered the safety of the roles and their contribution to multidisciplinary healthcare teams.

The review has now concluded and will be published shortly. The conclusions of the review will inform the workforce plan to deliver the 10-Year Health Plan, as well as future Government policy.

The Department and NHS England do not hold data on individual Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions at National Health Service trusts in England.

ReSPECT is a process which records personalised recommendations for a person’s clinical care and treatment for a future emergency in which they are not able to make decisions or to express wishes. These recommendations, including a cardiopulmonary resuscitation (CPR) decision, are developed through conversations between a person and the health care professionals involved with their care. Recommendations are recorded on a non-legally binding form.

The Resuscitation Council UK has produced guidance for organisations and healthcare professionals using the ReSPECT process. CPR decision policies are determined locally by organisations providing NHS care.

The Resuscitation Council UK, the British Medical Association, and the Royal College of Nursing have jointly produced guidance on decisions about CPR. It states that the overall clinical responsibility for decisions about CPR, including DNACPR decisions, rests with the most senior clinician responsible for the person’s care as defined explicitly by local policy.

The Government has commissioned Professor Gillian Leng CBE to lead an independent review of the physician and anaesthesia associate professions. It will consider the safety of the roles and their contribution to multidisciplinary healthcare teams. The conclusions of the review will inform the workforce plan to deliver the 10-Year Health Plan.

The review will consider the approach that was adopted in England to support the safe introduction, employment, and deployment of these new roles.

I have responded to the Parliamentary and Health Service Ombudsman's March 2024 report entitled End of life care: improving Do Not Attempt cardiopulmonary resuscitation conversations (DNACPR), in a letter dated 5 November 2024. In this response, the Department set out the ongoing work on each of the recommendations in the report.

The Department is committed to ensuring that DNACPR discussions do not happen in silo or only in emergency settings, which is often too late and carried out under extreme stress, but as a part of wider advance care planning (ACP) conversations. To facilitate this, the Department and the Parliamentary and Health Service Ombudsman will jointly convene a roundtable to further discuss ACP and the findings of this report.

The Department will respond to the report by the Parliamentary and Health Service Ombudsman entitled End-of-life care: improving 'do not attempt CPR' conversations for everyone, in due course.

The Department will respond to the report by the Parliamentary and Health Service Ombudsman entitled End-of-life care: improving 'do not attempt CPR' conversations for everyone, in due course.

The Department will respond to the report by the Parliamentary and Health Service Ombudsman entitled End-of-life care: improving 'do not attempt CPR' conversations for everyone, in due course.

The Department will respond to the report by the Parliamentary and Health Service Ombudsman entitled End-of-life care: improving 'do not attempt CPR' conversations for everyone, in due course.

The Department does not hold this data.