The family of a man who died in hospital only discovered after his death that a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order had been put in place.
An investigation by the Parliamentary and Health Ombudsman (PHSO) found that Barts Health NHS Trust failed in its duty to tell Ali Asghar and his family about the order.
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.
The Ombudsman is urging all healthcare providers to make sure their teams are trained to have these crucial conversations about end-of-life care in a timely and sensitive manner.
In 2024, the Ombudsman published a report that found many people are not told as a matter of course that a DNACPR decision has been made.
Ombudsman Rebecca Hilsenrath said:
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.
“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.
“We made a series of recommendations to enhance the communication surrounding DNAPCR so that doctors, patients and their loved ones can make informed choices. These recommendations have been welcomed by healthcare leaders and we are working with the Government to explore how they can be implemented on the frontline so that patients and their families are involved in discussions critical to their future care.”
In its recent investigation, PHSO looked at the case of Ali Asghar, a 73-year-old grandfather from East Ham.
A few days after testing positive for COVID-19 in January 2021, he was struggling to breathe and taken by ambulance to Newham University Hospital. A chest X-ray showed that Ali 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.
Ali 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 Ali 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 Ali’s health was deteriorating. Ali 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 Ali’s calls for assistance, the provision of drink and pain medication, communication with his family about his condition and not allowing Ali to go home.
PHSO recommended that the Trust acknowledge its failings, apologise to Ali’s family and pay them £700 for the upset and distress caused.
PHSO also recommended that the Trust takes action to remind its doctors to follow DNACPR guidance. The Trust has complied with all recommendations.
Firdose, 66, said:
I was shocked when I found out about the DNACPR order. It feels like they went behind our backs to make this important decision, without even a phone call to us when I was calling them multiple times a day to ask about his wellbeing.
“The hospital staff never asked us what we wanted to do in that scenario and they didn’t allow us to visit him. If he was confused and deteriorating, we could have been there with him and maybe we could have accepted his passing more easily. Losing someone is hard enough but these failings in his care and the lack of communication have just added to our pain.
“When I raised my concerns with Barts Health NHS Trust, they did not take any responsibility and that made me angry. I took my complaint to the Ombudsman because I wanted justice for my husband and some kind of closure.
“This has affected my trust in the NHS to the point that when I have gone to A&E for my own health problems I have begged doctors not to admit me to a ward and when I have needed treatment I have gone abroad instead.”
Read the full case summary.