Parliament’s joint committee on human rights has warned that gaps remain in how vulnerable people are protected in care settings, leaving their human rights at risk of being breached.
In a report published today, the JCHR finds that mechanisms such as Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) notices and Deprivation of Liberty Safeguards are often not applied correctly, meaning treatment can be wrongfully withheld or an individual’s liberty infringed. It urges the government to work closely with the Care Quality Commission to ensure that strict oversight is given to how care providers implement safeguards to protect the rights of care recipients.
The report also raised concerns about the slow progress made in securing visitation rights to care users. It warns that continued blanket restrictions are a “needless risk” to the mental and physical well-being of care users. It suggests that the government should establish a legal right for care recipients to nominate individuals for visiting rights and that the CQC should ensure that care providers don’t unfairly block care users from seeing their loved ones.
The committee also found that the current system of protecting human rights in care settings is not optimal. The Human Rights Act can be used to protect the rights of care recipients where care is publically funded or arranged. However, private funding is not always possible. This means that individuals may be protected by different human rights in different care settings. It recommends that the government consults on whether the protections provided by the Human Rights Act should extend to all those who receive care and support from regulated providers.
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The joint committee’s chair, Joanna Cherry MP QC, said this morning:
“We are concerned that too often safeguards are not being applied correctly. Instead, measures that should be tailored to individual needs are applied across a ward and age group. This is wrong, and it should not be allowed to happen.
“We have called on the government to do more to ensure there is a water-tight framework in place to ensure that the treatment of care users is adequate and their human rights respected. The government must also make sure that care providers are actually following applicable guidelines as they should.”
Do not attempt cardiopulmonary Resuscitation notices
DNACPR notices are for individuals who have experienced cardiac arrest. This means that cardiopulmonary resuscitation should be stopped immediately.
Concerns have been raised about notices being applied to individuals solely based on their age or condition and without consulting the individual or their family. Additional concerns are that DNACPR notices may have been incorrectly applied, resulting in withholding other treatments.
The report states that Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), should only be used to determine whether an individual is eligible for cardiopulmonary resuscitation. Care users, their families, or representatives, should be fully involved in DNACPR notices. Comprehensive record keeping, monitoring, and review at an organizational level are all necessary to ensure that best practice is being followed. Notifications should not apply to groups of patients or affect other treatment decisions.
The committee requests the CQC to ensure care users are placed at the heart of decision-making by all organisations involved in the monitoring and application of DNACPR Orders. This will ensure their human rights protection.
Visit rights
Some restrictions on visiting rights that were implemented during the pandemic and national lockdowns persist in the care sector, despite government guidance indicating that “there should not normally be any restrictions to visits into or out of the care home”. According to the committee, such restrictions can be detrimental to the well-being of care users and could even be harmful.
The report calls on the government to pass legislation that gives care users the legal right of naming one or more individuals to provide care and emotional support. It also includes the same infection prevention rules as care staff.
It also found that the government should legislate to require caregivers to inform the CQC about any changes to their visiting patterns. When regulating care homes, the CQC should make visiting restrictions a priority.
A department of health and social care spokesperson said: “The rights and wellbeing of people receiving support across care settings will always be our top priority and the vast majority of services provide high quality care.
“It is completely unacceptable for Do Not Attempt CPR orders to be applied in any kind of blanket fashion and we have taken decisive action to address this including making sure the health and social care workforce know the rules and how they should be applied.
“We are also clear that care home residents should receive one visitor inside the care home in all circumstances – even in an outbreak or isolation – because we know the positive difference care home visits make for residents and their families.”
