Health chiefs in the spotlight over ‘do not resuscitate’ guidance for elderly coronavirus patients
Guidance from health chiefs in Brighton and Hove over whether care home residents with coronavirus should go to hospital have prompted a watchdog and an MP to raise concerns.
The BBC reported that the Brighton and Hove Clinical Commissioning Group (CCG) had sent the guidance to GPs (general practitioners) working in 35 family doctors’ surgeries.
The document is reported to have encouraged GPs to use a script which said: “Frail elderly people do not respond to the sort of intensive treatment required for the lung complications of coronavirus and indeed the risk of hospital admission may be to exacerbate pain and suffering
“We may therefore recommend that in the event of coronavirus infection, hospital admission is undesirable.”
The BBC said that the 98 nursing homes and care homes in Brighton and Hove were asked to “check they have resuscitation orders on every patient”.
Some patients sign “do not resuscitate” or “do not attempt resuscitation” forms – also known as DNR or DNAR forms – as part of their “end of life” care preparations.
And the CCG is understood to have said that end of life care should be sensitive and individually planned and those involved should be well-informed.
But Hove MP Peter Kyle said: “Managers I have spoken to have been offended and deeply appalled by this.
“One care home manager I spoke to had 16 residents out of 26 sign DNR forms in on day.
“You can’t tell me that was done as part of a thoughtful, considered and sensitive process which involved each of their families.
“Right now, our care homes are being asked to act like hospices.”
The Labour MP said that the goal should be to protect care home and nursing home residents from covid-19.
Mr Kyle called for proper testing for people who work or show symptoms in homes, proper personal protective equipment (PPE) for staff and a halt to agency workers moving from home to home.
He added: “It is simple but not one of those things are being done.”
Healthwatch Brighton and Hove said: “We have asked for some comment and explanation about the context in which the advice has been provided.
“Healthwatch are not making any judgments about the advice although, as reported, it would seem at the very least to be insensitive.”
Fran McCabe, who chairs Healthwatch Brighton and Hove, said today: “These are difficult times and the NHS is making tough decisions every day with the sole intention of protecting everyone.
“However, what seem to be particularly challenging guidelines have been issued in a situation where the Care Quality Commission (CQC), the official regulator for health and care, are not undertaking routine inspections.
“The Health and Wellbeing Board in the city is not meeting as normal, nor is the Health Overview and Scrutiny Committee at Brighton and Hove City Council – and organisations like local Healthwatch have focused our energies on the covid-19 response.
“Many care homes have restricted visiting – and it would be a concern if some people are asked to consider completing ‘do not resuscitate’ requests without normal access to the support of their family and friends.
“Established good practice is all about individual care planning where everyone’s unique circumstances and preferences are considered as paramount.
“This is not a time for rushing to criticise NHS decision-makers but it is important that local people are made aware and are involved in decisions that deeply impact some of the most vulnerable people in our community.”
The concerns emerged as the number of coronavirus cases confirmed in Brighton and Hove jumped from 50 to 71.
At least four local homes have reported cases – including Oaklands, in Dyke Road Avenue, Hove, where coronavirus is understood to have claimed the life of one resident, 95-year-old Giuseppe Casciello.
The other three homes known to have confirmed cases are Lindridge, in Laburnum Avenue, Hove, St Christopher’s, in Rutland Gardens, Hove, and Craven Vale, in Craven Road, Brighton.
In West Sussex 199 cases have been recorded and in East Sussex there have been 129 cases, making 399 cases across Sussex as a whole.
Nationally the latest rise of 4,450 cases takes the national total to 38,168, while the number of deaths leapt by 684 to 3,605.
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Just sometimes, we have to consider the greater good.
The stats for elderly people recovering from Covid once it’s bad enough for them to need ventilation are very grim, especially if they have underlying health issues.
Surely it’s far better for ventilation capacity to be targeted on people who are much more likely to recover – and have many years of healthy life.
My 88 year old mother is in care with severe dementia – she would be hugely confused & distressed to be hospitalised. It would also be outrageous if she was using the ventilator needed for a nurse, or similar…..
And no, Mr Kyle, none of your suggestions are simple in the middle of a pandemic.
Who has the right to play God. Some people literally make me vomit. No compassion at all.
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