Issues being investigated under Term of Reference 2(i)

ToR 2(i) requires the Inquiry to investigate the strategic elements of the handling of the COVID-19 pandemic in Scotland relating to:

“the delivery of end-of-life care and the use of DNACPR (do not attempt cardiopulmonary resuscitation decisions)”.

In relation to ToR 2(i) the Inquiry will examine:

1. The adequacy of the training, support and advice given to health and social care staff in delivering palliative and end-of-life care, including their access to information such as Extension for Community Healthcare Outcomes and Key Information summaries in care homes.
2. Impacts on individuals receiving palliative or end-of-life care, including accessibility of services and changes to standards of care.
3. The introduction, delivery and implementation of guidance for alternative arrangements to visiting recipients of palliative or end-of-life care in hospitals, hospices, care homes and residential homes, including: the extent to which such guidance was adequately consulted upon; the effectiveness of any guidance review processes; the nature and consistency of the implementation of alternative arrangements for visiting; and disparities arising from differing restrictions between healthcare facilities. 
4. Access to additional Scottish Government funding to hospices.
5. The adequacy and appropriateness of the care and treatment provided by staff and/or health care facilities to address the healthcare needs of recipients of palliative and end-of-life care, including anticipatory care planning.
6. The appropriateness of the creation of and changes made to DNACPR decisions, including the relevant information considered by healthcare providers when creating or changing DNACPR decisions; their consistency with clinical guidelines and conventional practice; disparities of application and/or access; any engagement with DNACPR holders and their families; and the mechanisms for challenges to DNACPR decisions.
7. The appropriateness of the introduction, delivery and implementation of guidance for any blanket DNACPR decisions.
8. The adequacy and appropriateness of any guidance, rules or regulations given to health and social care services by the Scottish Government regarding DNACPR decisions, palliative and end-of-life care, including the form and timing of the communication of such guidance and rules; the adequacy and timing of consultation by the Scottish Government with interested parties regarding the guidance and rules, the real or perceived enforceability of the rules and guidance; the regularity of change; and any consideration given to reconvening Scottish Government DNACPR Groups.
9. Impacts on the availability and standard of medical treatment provided to recipients of palliative care, end-of-life care, or DNACPR holders, including routine screening, ambulance services, GP consultations or hospital treatment, and the use of sedation.