Dear Advocacy Colleagues,
We hope this find you all safe, well and finding ways to support each other in these incredibly difficult times. We don’t know about you, but we’re finding it hard to keep up with the ever-changing guidance and legislation as the environment in which we work changes so quickly. That in itself can be hugely stressful, so I (Gail), am trying to remember to be kind to myself and those around me. We’re all doing our best in unprecedented circumstances.
What is clearer than ever is the need for us to have a solid understanding of people’s rights and our role in these being upheld. I’m sure many of you were tuned into the fantastically helpful webinar with Steve Broach from 39 Essex, hosted by Kate Mercer on Monday 6th April. Kate has made a recording of this freely available and I urge you to find the time to watch this back here.
The rest of this update aims to point you to some additional resources which may be of use at this time. These resources are shared in good faith and to the best our knowledge, are current at the time of publishing. Please do be mindful that as things are changing so rapidly, it is always worth double checking the current validity of information.
In addition, we’re working with colleagues on a ‘Myth Buster’, specifically focusing on our different advocacy roles and how the Coronavirus and COVID-19 legislation and guidance impacts on us and the ways we work as a sector. We will share this as soon as we are able!
We’re sure you will be aware of some issues and challenges towards the end of last week in relation to blanket DNACPR (do not resuscitate) decisions, potentially inappropriate use of ReSPECT forms and processes, as well as letters being sent to people, informing them that if they become ill a hospital admission will not be sought. As you will all know, these decisions must be made on an individual basis.
Many organisations have let us know that this has been as issue and clearly one which advocates are challenging with, and for, the people they support. Whilst the situation has been clarified in the latter part of last week, we’re aware it will remain an issue for some. The following resources are aimed at assisting you in your challenges:
- VoiceAbility have developed a template letter which is available for use/adaption on their website – you can find it here and with additional information here. It clarifies that clinicians have a duty to consult with patients, or members of their family, before completing a DNACPR notice and placing this on their records. This is the case unless the clinician thinks the patient or family member will be so distressed by being consulted that it might cause them physical or psychological harm. Nothing in the Coronavirus legislation repeals this case law. It also reminds professionals to instruct an IMCA for serious medical treatment decisions, including Advance Care Planning and DNACPR decisions.
- NHSE have shared this letter which clarifies the need for decisions to be made on an individual basis.
- Here is a joint statement on advanced care planning/DNACPR from BMA, CPA, CQC and RCGP which also reinforces this message
- NICE guidance on Decision Making and Mental Capacity
- UPDATED Government Guidance on hospital admissions for people in residential care
- Resus have shared this information
- Here’s an open letter published on Disability Rights UK regarding the need for individualised care and treatment during the pandemic, along with the reply from NHSE
- Many of you will have the support of your solicitor colleagues who may also be in a position to support you where you are concerned an individual’s rights may be being breached.
- Alex Ruck Keene’s video on DNACPR and Advance Care Planning – getting it right
- This really helpful analysis and information about how and when Local Authorities decide to use the Care Act easements, from Sian Davis at 39 Essex – remember it isn’t automatic!
- BMA COVID-19 Ethical Issues Guidance note
- Royal College of Psychiatrists – Guidance for Clinicians – whilst IMHAs aren’t clinicians, it can be helpful to understand the guidance they are following
- CQCs 1st April update for Adult Social Care Providers
- Blog, The fight against Covid-19: Whose life counts? By Sanchita Hosali, BIHR
- Doughty Street piece on Coronavirus, contact, creativity and the Court of Protection
Connected Voice have shared a template letter they are sending out to local hospitals, care homes and the MCA leads, gently reminding people of the duty to refer for IMCA support along with some information about when and how to refer. If you’d like a copy, please email us at firstname.lastname@example.org
VoiceAbility have produced similar guidance re the duty to continue to refer, which can be found here
We’re looking forward to having a cuppa and a natter with some of you on zoom on Thursday 9th at 11am. If you’d like to join us, please email email@example.com and we’ll send you an invite.
Keep well, keep safe and look after yourselves.