Joint statement on advance care planning in Wales
Personalised advance and future care planning is, and has always been, a vital factor in ensuring people receive high-quality and dignified care; particularly for people who have serious and life limiting conditions, and older people who may be frail. This has never been more important than during the COVID-19 pandemic in which we all find ourselves living with now, and which will continue in the coming weeks and months.
We fully support the current legislation and guidance to support practitioners and staff in holding these conversations. The guidance helps to ensure people’s wishes and best interests are taken into account in a personalised way through bespoke advance care planning discussions. The guidance is clear that decisions must only be made on an individual basis and never be made for groups of people.
The Mental Capacity Act requires these decisions to be taken in collaboration with the person involved. It sets out how discussions should take place if a person has capacity and what to do when a person lacks decisional capacity.
As part of advance care planning processes, there may also be consideration of a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) discussion and form. As has always been the case, personalised and compassionate communication must be central to this process. Decisions should always be made on an individual basis and in the best interests of the person.
Alun Jones, the Interim Chief Executive of Healthcare Inspectorate Wales, and Gillian Baranski, Care Inspectorate Wales’s Chief Inspector, said:
As the inspectorates of health and social care in Wales, we have always taken an active role in inspecting and promoting personalised, compassionate and effective care. This role will continue in these challenging times. During this pandemic, it is critical that all staff involved in advanced care planning follow the latest guidance and access support available to them to have these discussions.
There are a number of guidance documents to support staff and practitioners having these conversations when they are appropriate. We have listed these below and would encourage staff and practitioners to ensure they refer to these when considering and carrying out advance care planning.
Key guidance and policies to help guide advance care planning:
- British Medical Association, the UK Resuscitation Council, and the Royal College of Nursing: Decisions relating to Cardiopulmonary Resuscitation (3rd edition – 1st revision)
- General Medical Council: Treatment and care towards the end of life: good practice in decision making
- NHS Wales: Advance Care Planning forms and resources for patients and healthcare staff
- NHS Wales: The All-Wales (Adult) DNACPR form and policy
- Royal College of GPs: Supporting patients most vulnerable to coronavirus – Having Sensitive Conversations and Advance Care Planning
- NICE: Advance care planning, a quick guide for registered managers of care homes and care home service