Health Minister says issue is ‘obviously, incredibly sensitive’ and recognises strength of feeling amongst patients and families

By Bill Heaney

Do Not Resuscitate Orders placed on people’s medical records have become an increasing cause for concern.

During the Covid pandemic one Dumbarton family complained that a local GP had placed one of these orders without their permission on their grandmother’s medical notes at Crosslet House Care Home, which is run by West Dunbartonshire Council.

BBC Scotland’s Disclosure programme journalists went to Crosslet House Care Home in Dumbarton and interviewed Nicole Keenan, whose grandmother, 78-year-old Margaret Gourlay, has been resident in the relatively new, £10 million showpiece home for some months.

Left to right: 78-year-old Margaret Gourlay, Nicole Keenan, Miles Briggs MSP and Health Secretary Neil Gray, who will now have a private meeting about government attitude to DNR notices.

The home had been built as an austerity measure and was part of the health and social care budget cuts the council had been asked to make by the government.

There was a public outcry in Dumbarton when it was sited “at the back of beyond” on an old estate on the periphery of a wood at the foot of the Long Crags to replace at least five council-run community-based homes.

The intention was to include the old folk within the community where they could keep in close touch with relatives and friends who would have easy access to visit them.

Some people felt the old folk were being written off and ignored at the expense of others.

Nicole Kennan said her gran still had a good quality of life but, like all old people, she was slower than she used to be, but that was only to be expected — “She still gets up and about and goes for walks. She does need to take breaks though. She’s getting old. She gets her hair done and things like that. Her quality of life is still pretty good.”

Everything seemed alright, she said, until the family received a call from a concerned care worker at Crosslet House, who told them that a DNR (do not resuscitate) notice had been put on her file. The call was not from the management, but from a care worker they knew.

They were angry about this and got in touch with the home. The DNR notice had been put in place on her file without the family’s knowledge. They had not been asked about this. Neither had they been asked by telephone or lettered about it.

They hadn’t even been lettered retrospectively to see if they still wanted it.

“The notice was put in place without our permission. We were angry. We felt they had done this without our consent because to them it did not really matter that much because these were old folk, “ said Nicole.

Nicole said the family were “angry” about what had happened. Her aunt telephoned the home and were told their family GP had arranged for that to happen. The family would have to speak to the doctor about it.

When the GP was asked for an explanation he said that this had happened early in the crisis – just the day after lockdown – when it was feared the NHS would be overwhelmed by the crisis.

Mrs Gourlay’s family remained unhappy about the whole business.

Meanwhile, Conservative MSP Miles Briggs yesterday (Thursday) asked the Scottish Government what assessment it has made of the number of people who are not aware of a do not resuscitate order being placed on their medical notes, including in relation to next of kin and power of attorney holders.

Cabinet Secretary for Health and Social Care Neil Gray told him: “The Scottish Government does not centrally collect information or data relating to the number or use of do not attempt cardiopulmonary resuscitation—DNACPR—forms.

“As with all other clinical treatments, decisions about CPR should be based on the individual clinical circumstances and wishes of the patient, and should be recorded appropriately.

“That is done in hard copy on a DNACPR form, the existence of which is then recorded on an individual’s key information summary. Such information is shared only for the purposes of direct care, and is therefore not centrally collected.”

Miles Briggs told him though: “Serious concerns have been raised, especially during the pandemic, about the use of do not resuscitate—also known as do not attempt resuscitation—orders. Is the Scottish Government looking at changing that process?

“What investigation have ministers undertaken to assess how many patients may still be unaware that a DNR order has been placed on their medical notes? Will the cabinet secretary review that, and review the collection of data by the Scottish Government?”

Neil Gray said the issue was “obviously, incredibly sensitive” and that he recognised the strength of feeling about it among patients and their families.

He addede: “In 2016, the DNACPR policy was reviewed to reflect feedback on changes in the United Kingdom-wide national good practice guidance from the British Medical Association, the Royal College of Nursing and the Resuscitation Council UK.

“A note of legal changes, which had resulted from case law, and specialist legal advice were provided as part of the formation of that policy.

“The Scottish Government continually reviews best practice and advice relating to resuscitation. We are undertaking work to improve our electronic recording systems, to allow us to provide more clarity on care planning at a local and national level.

“In recognition of the sensitivity of the issue, if further discussion in a more private space would be helpful to Miles Briggs, I will be happy to facilitate that.”

Transparency about such important matters is not the strong suit of Scotland’s politicians. Editor