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Background and engagement

In 2012 the Chief Medical Officer requested Dr Paul Buss, then Assistant Medical Director of Aneurin Bevan Health Board, to establish a core group of senior NHS clinicians in Wales to review existing arrangements and to develop a unified approach across Wales to Do Not Attempt Cardiopulmonary Resuscitation.
The publication of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report ‘Time to Intervene?’ on 1 June 2012 gave added impetus to the need for a clear framework.
The All Wales Policy, Form, Quick Reference Guide and Patient Information Leaflet have been developed through an extensively inclusive process, including with the Ethics Committee of the Royal College of Physicians, the Resuscitation Council, BMA, RCN and GMC in England and Wales, in close collaboration with experts.
Three workshops across Wales involved a wide range of stakeholders and clinicians to produce a draft DNACPR form and an algorithm to support decisions.

The All-Wales framework for DNACPR is grounded in the public sector equality duty of evidence; transparency; engagement and leadership.  

Two stakeholder reference groups, with support from colleagues in NHS Centre for Equality and Human Rights (CEHR), consulted with relevant third sector organisations.  Mencap Cymru and the Older People’s Commission were consulted over the needs of people with learning disabilities and older people.
The policy and its supporting documents were subject to a wide consultation through NHS health boards, trusts and NHS CEHR public websites and via their patient experience teams.  

Workshops were held as part of the Welsh Government’s ‘Dying to Talk’ conferences in north and south Wales to raise awareness of the consultation and the draft policy.  

More than 50 responses contributed edits to the policy and information leaflet, as did the recent Judicial Review in England. and NHS Cymru medical directors have been regularly updated on the development of this all Wales policy.
The national All Wales DNACPR Implementation Group, which includes representatives of all health boards and trusts, has guided the new policy’s introduction to NHS Wales, working closely with local implementation groups and communication leads.
At a local level, executive led task and finish groups are addressing the requirements for local implementation and training, including awareness-raising among staff, partner professionals and organisations, patients and carers.  

All related policies and protocols have been reviewed to reflect the all Wales DNACPR policy. Implementation will be subject to local audits to test compliance with the new policy and form.