DNAR - Do Not Attempt Resuscitation. As a Regional manager for POhWER this subject is always on my radar. Never more so, sadly, than since the start of the pandemic and in particular for people residing in care homes.

It’s been in the news a number of times and I had some hope that the practices of blanket DNARs had been stopped. After all the government announced in July of this year their intention to publish new national guidance for England on DNAR orders, amid concern and legal challenge that blanket decisions were being made during this pandemic.

Indeed POhWER has raised this issue across the country and directly challenged professionals and local authorities where we have found this practice. Read our DNAR report. DNARs had also been placed on people with learning disabilities and autism in care homes as young as in their 40s. Truly shocking; what are people thinking when they do this? Truly, they cannot be thinking as if they are, what does that say?

A spokesperson for the Department of Health and Social Care for England said ‘We have made clear that it is completely unacceptable for DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders to be applied in a blanket fashion to any groups of people. The government has taken consistent action on a number of fronts to prevent this from happening, and NHS England is currently creating patient facing guidelines on how to challenge a DNACPR and access support’

Failing to involve someone in the process breaches people’s rights under article 8 of the European Convention on Human Rights. The Humans Rights Act, and its potential erosion, there is another story all by itself, but I will stick to topic. That’s for another day. Is it not a fundamental right for us all to believe that we will be treated with respect, with humanity and care in our most difficult of times by professionals and others who hold our life in their hands? But it is simply not the case for a section of our society and they have no voice of their own. We will keep raising it, we will join our voice to others who have spoken up.

This week another form landed on my desk a TEP ‘Treatment Escalation Plan’. A Doctor had made a referral to POhWER for the support of an IMCA (Independent Mental Capacity Advocate). An IMCA is a trained professional who will support people who lack capacity about a decision where that person has no family or friends to support them or their family and friends, for whatever reason cannot support them. The IMCA will work with the person, find out about them, their wishes, their feelings, their beliefs and ensure professionals take these into consideration. They will take a case to court if they believe this is not happening. An IMCA must be appointed by law where they have no one else.

The TEP is about care planning and is similar to a number of forms used in different areas. It is in place to support discussions with people about their care, what they would like to happen/not happen in short. The idea is good and however difficult we should all think about and make known what are wishes and feelings are in regard to when we fall ill. It should never however be completed without our involvement.

And there it was! A little box, with DNAR and it was ticked. Such a small thing for the greatest decision about someone’s life. A little box, a little tick. No discussion with the person, no wishes or feelings gained on any treatment and a DNAR signed off. Just like that. Just like that, a sweep of a pen, a sweep of someone’s life. It could be your life, your loved one's life, anyone’s life.

The Doctor stated he had a number of care homes to cover and needed to do these urgently. I think to myself, well at least he has sought advocacy support, but then I see he is confused. He says he has spoken to the person, so why the need for an IMCA? But then we find out he hasn’t. Why is he in such a rush to write all these people off? Where is this coming from? He is a Doctor, trained and professional so what is going on? Again, again and again. What will stop this? Who will stop this?

How many times are we going to have the same conversation, ask the same questions?

TEP, DNAR by another name? I think so.