‘Unprecedented’ number of DNR orders for learning disabilities patients

Turning Point, which provides supported living and residential care for people with learning disabilities, has raised concerns to HSJ that it has received 13 “unlawful” do not attempt cardio-pulmonary resuscitation or do not resuscitate orders from hospital specialists and GPs since the beginning of April, half of which came in the last week.

The provider said that, of the orders it usually receives, around 12 each year would require a legal challenge. 

Turning Point, which operates facilities across the country, plans on challenging the lawfulness of the orders received this month, which it said appear to have been carried out without consultation with patients or their families.

The orders have come despite NHS England telling all primary care, community trust and acute CEOs on 3 April that any decisions on a treatment for people with learning disability and or autism should be made on an individual basis.

NHS trusts, GP providers, and clinical commissioning groups were again on 7 April, in a letter from NHSE chief nurse Ruth May and medical director Stephen Powis, told not to send out blanket DNR forms. Last week, Matt Hancock reiterated this guidance during a daily briefing.

The national action was prompted following reports of GP practices sending letters to care homes suggesting patients were unlikely to be admitted to hospital and requesting DNR forms to be signed.

In a statement to HSJ, Julie Bass, chief executive of Turning Point, said: “Over the past two weeks we have come across more unlawful DNRs put in place for people who lack mental capacity than we would normally see in a year. We will always challenge these decisions robustly.

“Making an advance decision not to administer CPR if a person’s heart stops, solely because they have a learning disability, is not only illegal, it is an outrage.

“We are seeing DNR orders that have not been discussed with the person themselves, the staff who support and care for them, or their families. This is very concerning as it may potentially lead to people being denied life-saving treatment that other patients would be granted.”

HSJ has asked NHSE how it would monitor the issue and ensure DNRs were not wrongfully applied.