Commissioner calls for public inquiry on care home Covid death rate and unseen Do-Not-Resuscitate orders on elderly residents

Commissioner Eddie Lynch said it was possible that some older people died during the pandemic due to a Do Not Resuscitate (DNR) notice being placed on their file, leading to life saving treatment being withheld - and their families still do not know that this is how they died.

He said: “There has been a huge number of excess deaths in care homes with latest figures from the Northern Ireland Statistics and Research Agency revealing that deaths of care home residents account for 30% [over 1000 deaths] of all covid related deaths. “COVID has impacted us all, but for older people, and particularly care home residents, those impacts have been exceptionally arduous. Over the past year we witnessed the incorrect recording of care home deaths, families having no access to loved ones, personal protective equipment (PPE) supply problems, inappropriate use of do not attempt resuscitation orders, the slow introduction of testing, the transfer of COVID-positive patients into care homes – the list goes on.”

The Prime Minister’s UK wide public inquiry will consult with devolved governments across the UK, but he is urging the NI Executive to conduct its own inquiry which specifically looks at the care and management of residents.

“Families deserve an answer on why deaths in care homes here were so extensive and why care home residents were disproportionately affected by this pandemic,” he said.

Mr Lynch told the News Letter that he had been given anecdotal information on cases in the early days of the pandemic about DNR notices being put in place on certain residents coming out of hospital or going into hospital. In some cases instructions were given to care homes for workers to put DNR notices on older people. The number of cases raised with him was in single figures - and spread across NI, he said, “although it was enough to raise concerns”.

He said it was impossible to say how widespread the use of DNR notices without family or patient consultation might have been.

“Exactly, and that is one of the issues I would like a public inquiry to look into to see how extensive that was. Certainly some families raised concerns about poor communication with them on the issue. So to me that is one of the reasons why a public enquiry is needed, to get to the bottom of how extensive that practise was.”

He added that it is not unusual for DNR notices to be put in place with some older people, particularly those living in care homes. “It is usually a medical decision about the treatment somebody can receive in later life and possibly in their last days. But the best practise is that families should be consulted about this and the older person themselves should also be consulted at an earlier stage, if they have capacity to make that decision.

“And I think what was concerning to the people who brought it to my office - some of these orders were put in place without their knowledge and I think that is what is disturbing; that because they were a certain age, that they may not be treated. So I think that is something that needs an inquiry to see what was happening.”

The inappropriate application of DNR notices to patient files could have been happening without the knowledge of the older person themselves and their families, he added.

“There were definitely families that contacted us to say that they weren’t aware that an order had been placed on the resident. In some of those cases the person may have been living with dementia and not aware of it [the DNR notice].” The mood of the people contacting him would have been “concern and worry”.

“Naturally there would be concern if somebody is feeling that their relative may have medical care withheld if they are seriously ill,” he said. He affirmed that some older people may have died during the pandemic as medical treatment was withheld due to a DNR notice in their file - but that some families may still not be aware the DNR notice was there.

“That is why we need an inquiry because I don’t have the answers to that [question] and an inquiry should look at that in more detail.”

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