Summary: On this page you’ll find full details on the ReSPECT process and the ‘ask and check’ process as part of what matters to me.

On this page...

  • Advance Care Planning is an umbrella term covering personal, legal, clinical, and financial planning. It enables a person to think about what matters to them and plan for their future.
  • It is a voluntary process and helps a person to make known what their wishes, feelings, beliefs and values are, and to make choices that reflect these.
  • Advance Care Planning is an on-going process of conversations between a person, those important to them and those providing care, support or treatment.
  • Advance Care Planning should be an important part of life for all adults.

The ReSPECT process was introduced in Gloucestershire in October 2019.

The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices. Such emergencies may include death or cardiac arrest but are not limited to those events. The process is intended to respect both the individuals preferences and clinical judgement. The agreed realistic clinical recommendations that are recorded include a recommendation on whether or not CPR should be attempted if the person’s heart and breathing stop.

The introduction of ReSPECT across Gloucestershire has reduced variation in documentation and begun to enable an improved consistent ‘language’ around care priorities and clinical recommendations.  The ReSPECT Policy for use across all providers in Gloucestershire can be viewed here.

Improved documentation of appropriate interventions will lead to better co-ordinated care and fewer inappropriate transfers/trials of treatments where they are not wanted or are likely to cause more harm than provide benefit.

Gloucestershire is now using ReSPECT Version 3, (or 3.5 if using the Ardens template). The ReSPECT plan is nationally agreed and continues to be updated and improved by the Resuscitation Council UK (RCUK). In line with the RCUK, the yellow sticker is no longer in use. The changes are minimal and will not require additional training – of note, they make the breakdown of information in Section 3, ‘what matters to me’ and Section 4, clinical recommendations slightly clearer.

Any training will now relate to Version 3 and resources have been updated accordingly. We welcome you to view for an update.

It’s time to give each other permission to talk about death including difficult conversations around CPR decisions.

Dr Kathryn Mannix spent her medical career working with people who have incurable, advanced illnesses. With permission, Kathryn has produced a useful and compassionate article on why we need to talk to our patients about DNACPR. This can be found here.

For further information to support having these conversations and more, please see Kathryn’s Homepage – Kathryn Mannix.

More information on making CPR decisions can be found here.

In line with Ambitions for National Palliative and End of Life Care (2015), NHS Gloucestershire Clinical Commissioning Group and partner organisations are working together to improve services for adults, children and young people who require palliative and end of life care.

If you have any questions about Children and Young People’s palliative and end of life care in Gloucestershire, please email the Paediatric Palliative Care Team at: ghn-tr.paediatricpalliativecare@nhs.net

Staff can also find more information on the Gloucestershire Hospitals Trust intranet pages: click here

Please click here to go to the Children and Young Adult’s Advance Care Plan Collaborative page. This page contains the ReSPECT compatible version of the Child and Young Person’s Advance Care Plan (CYPACP) document (approved by NICE Guidelines).

Also see “Patient information” for access to ReSPECT guides for young people and parents.

The ReSPECT form is available on Ardens in SystmOne however, please follow the resource link here if you wish to download a copy.

Alternatively, if you wish to order hard copies of the ReSPECT plan please:

  • 1. Email Dale Williams-Cox at dale@colourconnection.co.uk or phone 01452 522 411
  • 2.  Give your name and delivery address
  • 3.  Use ReSPECT plan order code: E001

What is the ReSPECT process?

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment.

The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices. Such emergencies may include death or cardiac arrest, but are not limited to those events. It is intended to respect both person’s preferences and professional’s clinical judgement.

  1. As the health care professional, remember to ‘Ask’ if the person has a ReSPECT plan and ‘Check’ that it is still valid and up to date.

  1. As the ReSPECT plan is a person held document, please try and encourage people and those important to them to show their plan to any health care professionals they see. Also ensure if going into hospital or leaving hospital, the ORIGINAL plan goes with them.
  2. ReSPECT is a personalised plan and where possible should be kept in the ‘what matter’s to me’ (orange folder).
  3. Remember – this is not only a CPR discussion. Recommendations about CPR form part of the discussion, but only a small part and the recommendation may be FOR an attempt at CPR as well as not for an attempt – DNACPR.
  4. Also remember to think about the guidance, particularly clinical recommendations in relation to ‘Who Will Read This Next?’ Information should relate to the correct care environment and so needs to be reviewed if there is a change in place of care – e.g if leaving hospital it is likely to be paramedics/community services – What will they need to know? Terms like ‘For ward based care’ may not be helpful/clear.
  5. Completing a ReSPECT plan is a process and not an event. Be prepared to allow a discussion to progress and evolve over a number of consultations and probably working with other colleagues in the wider MDT. Also remember to include other family members/ spouses / carers to help gain a full picture of the person’s values and fears.
  • Consider the information you may need before you begin discussions.
  • Do you understand the current clinical situation for the individual?
  • Do you have realistic understanding of what medical interventions might mean?
  • Is everyone who might need to be present there e.g. would the individual wish to have someone else with them?

For more information on ReSPECT conversations please see this short video.

Always Ask and Check

  • i. Ask – if the person has any form of care documents including ReSPECT and consider if a discussion is needed if not.
  • ii. Check – that ReSPECT is coded correctly.
  • b. Please ensure you code ReSPECT on SystmOne or your electronic system to allow the alert to pull into the Summary Care Record. This allows other organisations to be made aware of the presence of ReSPECT.
  • c. Where possible, if a discharge summary highlights ReSPECT, please review the recommendations and counter-sign as soon as able. We know this is frustrating BUT copies of forms cannot be sent from the hospital directly and there is risk of inaccurate transfer if the recommendations are added to the discharge summary. The discharge summary should give some key details but you need to see, review and maybe refine the document as soon as you can – remember secondary care may not be fully familiar with local services that might be appropriate for that person.

For more information on ReSPECT conversations please see this short video.

Always Ask and Check

  • i. Ask on admission if the person has any form of care documents including ReSPECT plan.
  • ii. Check on admission if someone has documentation highlighted on their Summary Care Record – visible through JUYI
  • This is just as relevant in out-patient settings, especially for people with long-term conditions.
  • b. Please review the ReSPECT document on discharge, remember people and those important to them may have forgotten conversations they had at the start of an admission and their condition/priorities/wishes may have changed so a review prior to discharge is really vital. Keep a copy of forms in the notes –marked as copies.

For information on ReSPECT conversations please see this short video.

The more we explore everyone’s wishes/values/fears and hopes, the easier it is to make recommendations in clinical situations – what are yours and those of people important to you?

Breaking down the barriers of discussion is the first step.

The Resus council website has a lot of useful information on the ReSPECT process.

The leaflet which is most suitable for practices to use to give to patients can be downloaded here.

For further information and resources about ReSPECT Version 3, please follow these links:

For questions or concerns regarding ReSPECT please contact your ReSPECT champion or:

brenda.ward6@nhs.net – Palliative Care Consultant, GHFT / Sue Ryder Hospice -Clinical Lead for ReSPECT

s.vazfernandes@nhs.net – Consultant Geriatrician & Physician, Frailty Assessment Service/Cheltenham Community Services Care of the Elderly, GHFT – Clinical Lead for ReSPECT

helen.ballinger@nhs.net – Clinical Commissioning Manager, ICB – Clinical Project lead for ReSPECT

There has been a lot of information about ReSPECT plans for people with a learning disability over the past few years.

During the Covid-19 pandemic in November 2020, CQC published an interim report, ‘Review of Do Not Attempt Cardiopulmonary Resuscitation decisions during the COVID-19 pandemic’ which was ‘prompted by concerns about the blanket application of DNACPR decisions, that is applying them to groups of people rather than on an assessment of each person’s individual circumstances, and about making decisions without involving the person concerned’ (p.2).

CQC published the final report, ‘Protect, respect, connect – decisions about living and dying well during COVID-19’ in March 2021.

In March 2023, NHS England wrote reminding ICBs, Trusts and Primary Care of ‘the importance of implementing the Universal principles for advanced care planning and ensuring that DNACPR decisions for people with a learning disability and autistic people are appropriate, are made on an individual basis and that conversations are reasonably adjusted’. The letter stated: ‘The NHS is clear that it is unacceptable that people have a DNACPR decision on their record simply because they have a learning disability, autism or both’.  To read the full reports, please see External links & resources.

Following these reports, ReSPECT plans have become part of the learning disability annual review.

Further information about Learning Disabilities and End of Life care can be found here.

For further Information for people with a learning disability and their carers, ReSPECT easy read leaflets can be found here.

In partnership with RCUK and Inclusion Gloucestershire, the ICB helped produce two short ReSPECT videos for people with a learning disability to help demonstrate the ReSPECT process and conversation required in making a RESPECT plan for people in different situations.

Page last updated: 8 August 2024