Summary: Miss X complains that carers would not attempt CPR on her mother, Mrs Y, when she was found unresponsive because there was a DNACPR in place. Miss X had to call 999 and perform CPR herself which she found very distressing. The Ombudsman will not investigate this complaint because it is unlikely we would identify fault by the Council.

The complaint

1. Miss X complains about a care provider acting on behalf of Calderdale Metropolitan Borough Council (the Council), who provided care to her mother, Mrs Y. She complains carers did not attempt to resuscitate Mrs Y when they found her unresponsive and did not call an ambulance.
2. There was a ‘Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order in place that Miss X had previously ripped up. Miss X states carers should have attempted CPR on Mrs Y and called an ambulance. She believes this may have prolonged her life. Miss X tried to resuscitate Mrs Y and called the ambulance herself, which she found distressing.
3. Miss X wants an acknowledgement the carers should have performed CPR and called an ambulance.

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The Ombudsman’s role and powers

4. The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service but must use public money carefully. We do not start an investigation if we decide there is not enough evidence of fault to justify investigating. (Local Government Act 1974, section 24A(6))
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)

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How I considered this complaint

6. In my consideration, I spoke to Miss X and read the information she sent to me. I also looked at the complaint responses and correspondence from the Council. I also asked them for information about how they handed Miss X’s complaint.
7. I considered the Ombudsman’s Assessment Code.
8. I have also considered relevant guidance and legislation.
9. I considered Miss X’s comments on my draft decision statement.

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My assessment

DNACPR

10. In 2016 The British Medical Association produced guidance which explains the decision-making process relating to cardiopulmonary resuscitation. It recognises some circumstances where trying to prevent a natural and inevitable death could do harm. A DNACPR order is made by a doctor which ensures that dying people are not subjected to the trauma and indignity of attempted CPR, with no realistic prospect of benefit.
11. NHS guidance on ‘Do Not Attempt Cardiopulmonary resuscitation decisions’ from 2021 explains that DNACPR is a medical treatment decision made by a doctor. If a clinician is considering making a DNACPR decision, they should discuss this with the patient and their family. However, this is ultimately a clinical decision and the clinician does not need the consent or agreement of the patient or their family to proceed. The decision is final unless the patient’s condition improves significantly.

Background

12. Mrs Y went into Huddersfield Royal Hospital in October 2018 after a fall in late September 2018. She was discharged in November 2018 after a five-week stay with a care package of carers attending her home four times a day. The care provider provided palliative care to Mrs Y. Miss X lived with Mrs Y and helped with her daily care.
13. Mrs Y’s doctor placed her on palliative care from late December 2018 after they determined she had days left to live. Mrs Y was prescribed morphine for a carer to administer. Miss X has explained that she administered the morphine herself. Carers found Mrs Y unresponsive in mid-January. Carers called Miss X who called 999 and they instructed Miss X on how to perform CPR. Mrs Y died shortly after, and the cause of death was recorded as vascular dementia.
14. Miss X explained that she did not agree with the DNACPR order and voiced this to the doctor who issued it, as well as to two other doctors afterwards. After Mrs Y’s return home, Miss X ripped up the DNACPR form. When the care provider took over Mrs Y’s care, Miss X told the Deputy Manager that she had ripped up the DNACPR form as she did not agree with it. They got a photocopy and put this in Mrs Y’s medical records.
15. In their complaint response of 29 July 2020, the care provider explained that when a DNACPR order is in place, their carers cannot attempt CPR. They also explained the Council considered Miss X’s concerns at the time and could find no evidence the carers acted inappropriately.

Analysis

16. Miss X is unhappy that the carers did not try to resuscitate her mother when they found her unresponsive, and she had to perform CPR. Miss X asked why the carers would not try to resuscitate the unresponsive Mrs Y. The carers explained this was because there was a DNACPR order in place. Miss X explained the carers did not stop her from calling 999 and taking the action that she thought was fitting in the circumstances, but they could not do it.
17. The care provider has provided an explanation why the carers did not try to resuscitate Mrs Y. We recognise this must have been distressing for Miss X. However, the decision to issue a DNACPR order is a clinical decision, and it would not have been appropriate for the carers to perform CPR on Mrs Y. The clinical decision is not something that carers can override, and we are unlikely to find any evidence of fault in their actions. The carers did not call an ambulance because even if Mrs Y was admitted to hospital, hospital staff would not have performed CPR, because of the DNACPR. It is likely that ambulance transport and hospital admission would have been distressing for Mrs Y, who was at the end of her life. We again recognise this was distressing for Miss X but are unlikely to find evidence of fault in the carer’s actions.

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Final decision

18. The Ombudsman will not investigate this complaint. I recognise the distress the events caused Miss X, but I consider it unlikely an investigation by the Ombudsman would identify fault by the Council.

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Investigator's decision on behalf of the Ombudsman