The PHSO has found that Barts Health NHS Trust failed to explain to the family of a man that it had put a do-not-resuscitate order in place. 

An investigation by the Parliamentary and Health Ombudsman (PHSO) has found that Barts Health NHS Trust failed in its duty to explain to the family of a man that a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order had been put in place. 

A DNACPR order means that, if someone’s heart or breathing stops, doctors will not attempt resuscitation. The decision is made by a doctor and does not require patient consent but a patient must be informed if they have capacity. If they do not have capacity their next of kin must be informed.

“End-of-life care is so important in providing dignity, empathy, and compassion to both the patient and their family during the most difficult of times. It is therefore vital that these crucial discussions are held in the right way and at the right time,” said ombudsman Rebecca Hilsenrath. 

“It is a legal requirement that a doctor has a conversation with a patient or their family about DNACPR. Failing to do so is a breach of human rights. In a report published last year, we found that these conversations were not always happening. This must improve as a matter of urgency,” she added. 

Trust failed to consult

A few days after testing positive for COVID-19 in January 2021, Ali Asghar, a 73-year-old grandfather from East Ham, was struggling to breathe and was taken by ambulance to Newham University Hospital. 

A chest X-ray showed that Asghar had COVID pneumonia, a lung infection caused by COVID-19. A DNACPR order was put in place that day.

The reasons for the order were cited as a stroke he had experienced the year before, his frailty and the severity of his illness.

Asghar was not told that the order had been made. His wife, Firdose Asghar, and family only found out about the order following his death six days after he was admitted to hospital.

The Ombudsman found that while the DNACPR order was appropriate, the Trust failed to consult about it with the patient or the family beforehand.

PHSO found no evidence to suggest that Asghar lacked the mental capacity to discuss the order at the time. 

Their investigation also revealed that the Trust failed to allow his family to visit when it was clear that Asghar’s health was deteriorating. He was not assessed for malnutrition and there were further failings with the Trust’s complaint-handling.

The Ombudsman did not find any failings with other issues raised by Firdose, including how staff responded to Asghar’s calls for assistance, the provision of drink and pain medication, communication with his family about his condition and not allowing Asghar to go home.

PHSO recommended that the Trust acknowledge its failings, apologise to Asghar’s family and pay them £700 for the upset and distress caused.