Parliament’s joint committee on human rights has warned that gaps remain in how vulnerable people are protected in care settings, leaving their human rights at risk of being breached.

In a report published today, the JCHR finds that mechanisms such as Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) notices and Deprivation of Liberty Safeguards are often not applied correctly, meaning treatment can be wrongfully withheld or an individual’s liberty infringed. It calls on the government to work with the Care Quality Commission (CQC) to ensure there is stringent oversight of how care providers implement safeguards designed to protect the human rights of care users.

The report also raises concerns about the slow progress in securing visitation rights for care users. It warns that continued blanket restrictions are a “needless risk” to the mental and physical well-being of care users. It says the government ought to establish a legal right for care users to nominate individuals for visiting rights, and that the CQC should better ensure care providers are not unfairly blocking care users from seeing loved ones.

The committee also finds that there is currently an imbalance in how human rights are protected in care settings. Where care is publicly funded or arranged, the Human Rights Act can be used directly to uphold the rights of care users, but that is not necessarily the case where care is privately funded. This means that individuals in the same care setting might have different human rights protections. It recommends a governmental consultation on whether the protections of the Human Rights Act should be extended to those receiving care and support from all regulated providers.

The joint committee’s chair, Joanna Cherry MP QC, said this morning:

“We are concerned that too often safeguards are not being applied correctly. Measures that should be tailored to individual needs, whether it concerns the right to a visit from a loved one or the question of whether someone should be resuscitated, are instead applied across a ward or age group. This is wrong and should not happen.

“We have called on the government to do more to ensure there is a water-tight framework in place to ensure that the treatment of care users is adequate and their human rights respected. The government must also make sure that care providers are actually following applicable guidelines as they should.”

Do Not Attempt Cardiopulmonary Resuscitation notices

DNACPR notices mean that if an individual goes into cardiac arrest cardiopulmonary resuscitation should not be attempted as it would be futile or not in the best interests of the patient.

Concerns have been raised that notices are being applied to individuals based solely on their age or condition, and without adequately consulting the individual or their relatives. There are additional concerns that DNACPR notices have been wrongly applied, meaning that other treatments have been withheld.

The report notes that Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) must only be used to decide whether an individual receives cardiopulmonary resuscitation. Care users and their relatives or representatives should be adequately involved in DNACPR notices, with comprehensive record keeping, monitoring and review at an organisational level to ensure best practice is being observed. Notices should never be applied to groups of individuals or affect decisions about other treatment decisions.

The committee calls on the CQC to ensure that organisations involved in overseeing and applying DNACPR orders place care users at the centre of decision-making, ensuring their human rights are protected.

Visiting rights

Some restrictions on visiting rights that were implemented during the pandemic and national lockdowns persist in the care sector, despite government guidance indicating that “there should not normally be any restrictions to visits into or out of the care home”. The committee says such restrictions can be harmful to care users and detrimental to their wellbeing.

The report urges the government to introduce legislation to give care users the legal right to nominate one or more individuals to visit and provide care and emotional support, with the same infection prevention and control rules to be followed as care staff.

It further finds that the government should legislate to mandate care providers to inform the CQC of any changes to visiting. The CQC should also make visiting restrictions a central consideration when carrying out monitoring and regulation of care homes.

A department of health and social care spokesperson said: “The rights and wellbeing of people receiving support across care settings will always be our top priority and the vast majority of services provide high quality care.

“It is completely unacceptable for Do Not Attempt CPR orders to be applied in any kind of blanket fashion and we have taken decisive action to address this  including making sure the health and social care workforce know the rules and how they should be applied.

“We are also clear that care home residents should receive one visitor inside the care home in all circumstances – even in an outbreak or isolation – because we know the positive difference care home visits make for residents and their families.”