Anticipatory care planning, treatment escalation and what matters to the person

Urgent responses should reflect the current illness and the person's documented wishes, likely benefit from treatments, and agreed care plans. NHS England's PIER approach and care home framework emphasise personalised care and support planning. Scotland's care home healthcare framework highlights treatment escalation, and Resuscitation Council UK explains the ReSPECT process where it is used locally. In practice, care home staff need to know which plans exist and how to use them.

This includes anticipatory care plans, treatment escalation plans, ReSPECT documentation where used locally, Do Not Attempt CPR decisions, emergency healthcare plans, palliative care plans and other agreed records. These documents are not instructions to do nothing. They guide responses that match the person's goals, realistic treatment options and lawful decisions.

What staff need to understand

• Plans guide escalation: they indicate the most appropriate route and response for the person.
• Plans do not cancel deterioration: the person may still need urgent review or symptom management.
• Preferences must be current: out-of-date or unclear documents should be checked with the person or clinician rather than assumed.
• Families need clear information: explain concerns and the plan honestly and promptly.
• Staff should not make legal or clinical decisions alone: follow documented processes and escalate to the right clinician or manager.

Manager focus: plan visibility and review

Treatment escalation planning is about matching urgent response to the person, not about withholding attention when they deteriorate.