Coronavirus: Disabled and vulnerable patients must be involved in treatment decisions including resuscitation, says NHS England

NHS England has said disabled and vulnerable patients must not be denied personalised care during the coronavirus pandemic and repeated its warning that blanket do not resuscitate orders should not be happening.

In a joint statement with disabled rights campaigner and member of the House of Lords, Baroness Jane Campbell, NHS England said the Covid-19 virus and its impact on the NHS did not change the position for vulnerable patients that decisions must be made on an individualised basis.

It said: “This means people making active and informed judgements about their own care and treatment, at all stages of their life, and recognises people’s autonomy, as well as their preferences, aspirations, needs and abilities. This also means ensuring reasonable adjustments are supported where necessary and reinforces that the blanket application of do not attempt resuscitation orders is totally unacceptable and must not happen.”

The statement came after a roundtable meeting with disabled rights advocates, voluntary organisations and specialist clinicians on 14 May which was chaired by Baroness Campbell and NHS England’s director of personalised care James Sanderson.

It comes amid a potential judicial review against health secretary Matt Hancock over the government’s refusal to issue national guidance on controversial do not resuscitate orders after a number of examples where GPs attempted to apply blanket DNRs to care home residents or called vulnerable patients at home without warning and have never seen them in person.

A do not resuscitate notice is designed to prevent frail or vulnerable patients undergoing resuscitation if their heart stops when it has little chance of success and could lead to them having broken ribs and prolonging their suffering.

While a DNR is ultimately a decision for doctors, imposing one without consulting the patient or their family is unlawful.

NHS England said the aim of the roundtable was to “maintain and champion personalised approaches to care and treatment” adding: “The current pandemic has brought into sharp focus the need for everyone, regardless of background or circumstance, to have the opportunity for their needs, wishes and preferences to be considered.”

In the statement it said: “The outbreak of coronavirus does not change long-established best practice that decisions around care and access to treatment, including end of life care, are made on an individual basis and with clinicians, following the principles of personalised care.”

It said patients should be given the chance to participate in decisions that affect them and be supported with clear advice and options with support where possible for this with mental health issues.

The meeting followed a letter to health chiefs from NHS England’s chief nurse Ruth May and medical director Steve Powis in April which also stressed do not resuscitate orders should not be applied en masse.

The groups involved in the discussions agreed to meet with NHS England again.