SPECIAL REPORT: Do Nicola Sturgeon’s claims on Do Not Resuscitate orders stand up to scrutiny?

Were families of elderly and ill patients at Crosslet House and elsewhere pressurised (or not even told) that Do Not Resuscitate notes had been placed with their relatives’ medical notes?

By Bill Heaney

The Scottish Daily Express is reporting exclusively today that research commissioned by the Scottish Covid Inquiry’s has cast doubt on former First Minister Nicola Sturgeon‘s claim that the policy on Do Not Resuscitate orders ‘did not change’.

Many campaigners believe that elderly and disabled people had their status updated during the Covid-19 pandemic, with medics told not to attempt to save their lives if they fell gravely ill.

Some younger Scots have even discovered a DNR – or Do Not Attempt CPR – form in their medical notes despite being entirely fit and healthy.

The Democrat and BBC Scotland’s Disclosure programme reported of instances of this happening during the pandemic at Crosslet House in Dumbarton in particular and care homes elsewhere.

Crosslet House is one of the care homes for which West Dunbartonshire Council’s Health and Social Care Partnership is responsible.

One serious blemish on its record is that it wrongly shut down the practice of a popular local GP, who later won his case against them at an employment tribunal.

The committee did not even bother to look at a petition from more than 1,000 of his patients objecting to the practice closure and the doctor being put out of a job.

Now the Scottish Daily Express have revealed that academics carrying out introductory research and ‘stakeholder engagement’ for the SNP’s public inquiry also raises grave doubts about the use of DNACPR.

One report states: “There is significant anecdotal evidence during the pandemic of ‘blanket’ DNACPR forms being used, and of people being informed of a DNACPR form being put in place without their involvement, or feeling pressurised to agree to one.

“There are also suggestions of particular groups, such as people with learning disabilities in care settings, being made subject to DNACPR when this was not clinically justified.”

The researchers from Edinburgh Napier University have also uncovered evidence that some of the clinical guidance issued by Scottish Government on the use of DNACPR in the early stages of the pandemic was “unjustified and discriminatory”.

The report also discusses the use of Anticipatory Care Plans (ACP) which are put in place to help patients plan for their death and often include the point at which DNACPR will begin.

Fiona McVey was shocked to see on her file that she was marked as Do Not give CPR, despite being a fit 44-year-old
Fiona McVey, left,  was shocked to see on her file that she was marked as Do Not Attempt CPR, despite being a fit 44-year-old. Picture by Daily Record

On March 17, 2020, GPs were told to review the ACP and DNACPR arrangements for vulnerable patients before further guidance on March 23 telling GPs to “consider proactive anticipatory care for those who need it most”.

More updates were sent out over the next few weeks, including one telling Scottish care homes that ACPs “should be in place for as many residents as possible”. Some of the advice is described as “puzzling” and “contradictory”.

One letter sent to GPs stated: “For the majority of residents in care homes, who have significant underlying health problems and are generally very frail, CPR is unlikely to work if they were to have a cardiopulmonary arrest due to falling ill with Covid, and it would be inappropriate to attempt it because it would be futile and may indeed cause harm and distress.”

The same letter states: “There is no requirement to discuss DNACPR unless the patient (or next of kin/guardian)wishes it or the GP or other clinician feels it is important to do so. These are usually sensitive and difficult discussions at any time but can feel especially difficult during a pandemic.”

‘Unethical, discriminatory or unlawful?’

The research also notes that a review in England and Wales found evidence of the “blanket” use of DNACPR and states: “We are not aware of any similar review in Scotland.”

As concerns about the use of DNACPR began to emerge in public, Ms Sturgeon told one of her daily televised briefings that “nobody … should be pushed into anything like that”.

The Napier team say Ms Sturgeon must answer key questions at the inquiry, including: “If the Government was clear that no-one was being pressured into agreeing to DNACPR, why do people report feeling that this was so?

“Were people made subject to DNACPR notices in a way which was unethical, discriminatory or unlawful? Were these notices used for inappropriate purposes, beyond their true scope?”

In response to concerns raised earlier this year, the Scottish Government said: “As the First Minister has made clear the pandemic did not change the use of Do Not Attempt CPR forms in NHS Scotland.”

However, you will see from The Democrat report that this did happen at Crosslet.

The Napier team states: “It is correct that the general guidance on DNACPR was not changed during the period but, as shown above, how that guidance should be operated during the pandemic was a subject of several pieces of advice.”

Linda and Eddie Henderson
Linda Henderson at her Perth home with husband Eddie in January 2023. After being in Perth Royal Infirmary, Linda discovered a Do Not Resuscitate note on her records.

Three other introductory studies by experts Edinburgh, Glasgow and Birmingham universities also examine the use of DNACPR for the inquiry, although they tend to summarise the evidence already in the public domain.

However, the Glasgow team notes: “There has been no formal evaluation of DNACPR decision-making in Scotland during the pandemic in relation to individuals in their own homes, in care homes or in hospitals.

“The Equality and Human Rights Commission Scotland highlighted concerns about DNACPR forms being applied against wishes and without consultation among those living in care homes.”

The following report appeared in The Dumbarton Democrat in April 2020

Baillie 10

Admissions to Crosslet House care home in Dumbarton, which has had 15 virus-related deaths since March 24 should be suspended,  Jackie Baillie, the Labour MSP for Dumbarton, Vale of Leven, Helensburgh and Loch Lomondside, said today.

The shock news emerged during a media conference at which First Minister Nicola Sturgeon gave an update  on the current #coronavirus situation in Scotland:

• 8,450 positive cases confirmed, an increase of 263 since yesterday
• 1,809 patients in hospital
• 12 further deaths, taking the total to 915

The Scottish Labour Party’s deputy leader, Ms Baillie, is furious about the situation in Dumbarton.

She has raised serious concerns over the handling of the outbreak at Crosslet House, a relatively new home which was built at a cost of £10 million…

And this one in May …

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By Bill Heaney

Dumbarton Labour MSP Jackie Baillie is determined to hold First Minister Nicola Sturgeon’s feet to the fire over the Covid 19 death toll in Scotland’s care homes during the past year.

And demand answers about the part the government decision to transfer infected patients from hospital into care had played in that tragedy.

Ms Baillie, pictured right, told MSPs at Holyrood yesterday that on 18 April, in relation to care home transfers, the First Minister said that ‘with the benefit of knowledge we have now (but did not have then), it was a mistake’, but demanded to know if that was strictly true.

She said: “NHS Scotland had classified Covid-19 as a group 3 biological agent, in line with health and safety legislation. That was immediately at the start of the pandemic, and risk assessments were carried out on national health service employees.

“Why were no risk assessments carried out on patients who were transferred to care homes without being tested—which, by law, requires to be done?

“How many times have health boards broken the law in carrying out the Scottish Government’s instructions?

Further reports on this elsewhere on The Democrat today ….

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