AQW 14794/17-22


Ms Paula Bradshaw
Alliance Party
South Belfast


Tabled Date: 16/02/2021
Answered On Date: 04/03/2021
Priority Written: Yes


Question:
To ask the Minister of Health, in light of the concerns raised by Mencap in the press on 13 February 2021, to detail the ways in which the application of Do Not Attempt Cardiopulmonary Resuscitation Notices varies in Northern Ireland compared to England, especially with regard to people with learning disabilities.


Answer:
Established clinical and professional guidance is available to support clinicians in decision-making and providing quality treatment and care for patients towards the end of life. This includes the General Medical Council’s ‘Treatment and care towards the end of life: good practice in decision making’ which outlines key principles and models to underpin decision-making, including decisions relating to cardiopulmonary resuscitation and The British Medical Association, Resuscitation Council and the Royal College of Nursing guidance ‘Decisions relating to Cardiopulmonary Resuscitation’. Policies to support decision-making in relation to cardiopulmonary resuscitation in Health and Social Care Trusts in Northern Ireland reflect the principles set out in this guidance and apply to all patients (whether with or without a learning disability) with decisions made on an individual basis taking into account the relevant professional and legal frameworks. National Institute for Health and Care Excellence (NICE) Guidelines such as NG142 End of Life Care for Adults and NG31 Care of Dying Patients in the Last Days of Life also provide guidance for clinicians.
A Regional Ethical Advice and Support Framework for Northern Ireland has been developed and published to assist and support clinical decision making during the COVID-19 pandemic. The Framework was developed by the regional HSC Clinical Ethics Forum, with membership drawn from a wide range of clinicians from health and social care, representatives from HSC Trust Clinical Ethics Committees, representatives from the Critical Care Network, Palliative Care in Partnership and the Frailty Network, as well as a range of lay members including hospital chaplains. The Forum also engaged with a number of interested parties (such as the Patient and Client Council and NI Ambulance Service) and reference groups (such as Disability Action and the Alzheimer’s Society) at different points in the development of the Framework.
The Framework sets out a series of ethical principles in a rights-based approach and applies at all levels of health and social care delivery in Northern Ireland, in hospitals, care homes and the community. The Framework notes that clinical decisions should continue to be guided by the codes of professional practice as well as available evidence and provides links to relevant legislation on human rights, disability, equality and consent. Importantly, it re-emphasises that all clinical staff are required to act in accordance with professional guidance and with their legal obligations.
The Framework also includes practical guidance that considers a range of issues and settings such as advance care planning, decisions around resuscitation, access to critical care, care homes, end of life, visiting and mental health. This is a live document which is updated as new information becomes available.
A link to the latest version of the Framework (September 2020) is provided below.
https://www.health-ni.gov.uk/sites/default/files/publications/health/COVID-19-Guidance-Ethical-Advice-and-Support%20Framework.pdf
It is important to stress that blanket decisions about cardiopulmonary resuscitation based solely on age, disability or a senior clinician’s view of quality of life are discriminatory and unethical. All treatment decisions must be individual to each patient and follow the relevant professional and legal frameworks. This principle is clearly set out in the professional guidance noted above and also in the regional Ethical Advice and Support Framework for Northern Ireland.
A Joint Statement issued by the Royal College of General Practitioners, British Medical Association, Care Providers Alliance and Care Quality Commission on 1st April 2020 reiterated that it was unacceptable for advance care plans, with or without a decision on resuscitation, to be applied to groups of people of any description and that any such decisions must be made on an individual basis.
Decisions about cardiopulmonary resuscitation are best made as part of a holistic approach to advance care planning which includes timely, honest and sensitive discussions with a person to identify their wishes, feelings, beliefs and values for their future care including, where they are content to discuss this, their wishes in relation to cardiopulmonary resuscitation in the event of a cardiac or respiratory arrest.
Work is underway to develop an advance care planning policy for adults in Northern Ireland. This is a key element of a wider public health approach to palliative care. The policy will be underpinned with a suite of supporting documentation, staff training and public messaging.