NHS training on ‘do not resuscitate’ orders must not be cut, says doctor

The chair of the Resuscitation Council calls for public education on end-of-life decisions after patient’s husband sues hospital NHS training in making “do not resuscitate” orders and communicating them to patients and families must not fall victim to spending cuts, according to a senior doctor who provides professional guidance on the issue. Jasmeet Soar, chair of the Resuscitation Council, said that while the existing framework governing the use of such orders in England did not need changing, there was room for improvement in explaining the issues. The Royal College of Nursing (RCN) also called for a public education drive on the complexities of end-of-life decisions. Alan Dobson, its acute and emergency care adviser, said more should be done to inform society, “let alone patients and their families”, without scaring people. Their pleas came after the Guardian revealed that the husband of a patient had launched legal action against Addenbrooke’s hospital in Cambridge and the health secretary, Andrew Lansley, alleging illegal use of such orders and seeking to force the government in England to follow Scotland by having a national policy on the use of “do not attempt cardiopulmonary resuscitation” orders. David Tracey claims doctors twice put such orders in his wife Janet’s medical notes, cancelling the first after she objected to it, only to put in a second three days later without her consent or any discussion with her. The hospital and Lansley are fighting the case. Professional guidance on the issue is provided jointly by the Resuscitation Council, RCN and British Medical Association. This has been reinforced by the General Medical Council, which regulates doctors, and insists doctors’ decisions on treatment are final. The Department of Health says these documents provide a sufficient basis for local policy-making. Soar, a consultant in anaesthetic and critical care at Spire Bristol hospital, said: “Clearly, sometimes there is a lack of consensus on what the best course of action should have been between patient, family and doctors. That is where the problem lies. A form or guidance is not going to sort that out.” He said the picture had improved since 2000 when the health department last had to formally tell trusts they had appropriate policies . The professional framework was in place. “The issue is how this is implemented at local level. If there is anything that should be raised centrally by the Department of Health, it may be a reminder that training of staff in these issues is paramount. “At a time when savings are being demanded, it is vital training continues in this area.” Dobson, of the RCN, said: “The issue is so complex that no matter what guidance or policy you have, ultimately it is going to come down to a judgment call between senior clinicians and patients and relatives. The reason you are going to get variations is because of interpretation. Every situation is very, very different because it is unique to every individual patient and every individual family.” Dobson added there was a need for more information for patients. “It is good practice to inform society, let alone patients and their families, about the complexity of decisions. The more we do proactively the better. This is not to scare people but to let people know we do consider these things and how we do things in the future.” The Janet Tracey case has reignited public interest in the issue. In February, the health service ombudsman in England, Ann Abraham, voiced her concerns over how “do not resuscitate” decisions for older patients were being taken in a report that accused the NHS of failing to meet even the most basic standards of care for older people. In the ten anonymised cases she used to illustrate her general criticisms , she highlighted a failure by medics to involve a woman’s husband in a “do not resuscitate” decision and, in another case, reported how a notice not to resuscitate was included in a patient’s medical records without the knowledge of his family. NHS Health policy Public sector cuts Andrew Lansley Public services policy Public finance Health James Meikle guardian.co.uk

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