Survey reveals postcode lottery in Ambulance Trusts’ approach to advance care plans

Categories: Featured and Research.

A report published today reveals that Ambulance Trusts across the UK vary significantly in their approach to patients’ advance care plans. This could result in ambulance crews not being aware of, and therefore failing to respect, a patient’s stated preferences for medical treatment and care.

Findings from a Freedom of Information request conducted by national charity Compassion in Dying highlight a lack of a unified system for recording and implementing advance care plans, as well as a widespread absence of systems to monitor their adherence. Compassion in Dying is now appealing to Trusts and paramedics to implement the report’s recommendations to ensure that the end-of-life wishes of people in their area are known and followed.

The charity was prompted to conduct the research after receiving frequent enquiries from people who are concerned about whether their advance care plans will be respected in an emergency situation or when being transported between care settings. The plans can include an Advance Decision (to Refuse Treatment – often known as ‘Living Will’), a Do Not Attempt Cardiopulmonary Resuscitation (DNAR) form, and/or a Lasting Power of Attorney (LPA) for Health and Welfare.

Key findings include:

  • 23 per cent of Trusts (3 of 13 Trusts) surveyed have no systems at all for holding advance care plans for patients in their areas. The remaining Trusts vary significantly over whether they simply record the existence of plans, keep physical or electronic copies, or have access to systems used by GPs which include this information.
  • There is a diverse approach among Trusts regarding who they will accept advance care plans from, and in what form. 46 per cent (6 of 13) accept them from individuals, whereas 31 per cent (4 of 13) will only do so from healthcare professionals. 15 per cent (2 of 13) require original documents to be seen and one Trust will only accept their own version of an Advance Decision form.
  • 85 per cent of Trusts (11 of 13) were unable to report on the number of advance care plans adhered to in 2017.

Compassion in Dying has also found that confusion over policy can cause distress not only to individuals and their loved ones but also to the paramedics treating them, according to previous research:

“At the age of 96, my mother had a severe aneurysm and the paramedics wanted to take her to hospital to have a stent fitted. She was adamant she was not going into hospital and I respected these wishes… I explained about her Advance Decision, which they knew nothing about. Halfway to hospital, having finally read the relevant document they had subsequently been given, they changed their minds and palliative care was put in place,” Christine Erskine

“As a paramedic it is immensely frustrating and upsetting when things are not put in place allowing us to leave someone at home where they wish to be. I was not prepared for the heartache of having to take a dying patient away from their home and into general hospital,” Donna Main-Clancy.

Davina Hehir, Director of Policy at Compassion in Dying said:

“We recognise that ambulance crews work in time-pressured and stressful environments. However, if person-centred care is to become a reality, it is crucial that Ambulance Trusts consider how systems for respecting end-of-life wishes can be strengthened and improved – for the benefit of patients, their loved ones and paramedics alike.

“We propose a number of recommendations on improving policies, systems and training strategies. Most importantly, we want to open up conversations with Ambulance Trusts and paramedics about what support they feel they need in order to achieve these objectives and what initiatives are already in place that can be replicated elsewhere. We want to help ensure that everyone gets the end-of-life care that is right for them, and that ambulance crews are fully supported to play their part in achieving this.”

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