ReSPECT

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ReSPECT is a process that creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices.

The ReSPECT process is a new approach to encourage people to have an individual plan to try to ensure that they get the right care and treatment in an anticipated future emergency in which they no longer have the capacity to make or express choices.

The ReSPECT process is intended to respect both patient preferences and clinical judgement.

The ReSPECT process provides health and care professionals responding to an emergency with a summary of recommendations to help them to make immediate decisions about that person’s care and treatment. ReSPECT can be complementary to a wider process of advance/anticipatory care planning.

The ReSPECT plan is created through conversations between a person and their health professionals. The plan is recorded on a form and includes their personal priorities for care and agreed clinical recommendations about care and treatment that could help to achieve the outcome that they would want, that would not help, or that they would not want.

The ReSPECT process can be for anyone but will have increasing relevance for people who have complex health needs, people who are likely to be nearing the end of their lives, and people who are at risk of sudden deterioration or cardiac arrest. Some people will want to record their care and treatment preferences for other reasons.

It is hoped that the ReSPECT process will be adopted gradually and widely throughout the UK, so that a person’s ReSPECT plan will be recognised and used wherever they are when an emergency occurs.

The ReSPECT process was created because an approach that focuses only on withholding CPR in people who are dying or for whom CPR would offer no overall benefit has resulted in misunderstandings, poor or absent communication and poor or absent documentation.

Currently very few people discuss what type of care they would or would not want in an emergency situation.

“The ReSPECT process is all about thinking ahead with patients about realistic care options in a truly person-centred way. Ultimately the process aims to help people understand the care and treatment options that may be available to them in a medical emergency and enables them to make health professionals aware of their preferences”
Dr Juliet Spiller, Co-Chair of the ReSPECT Working Group & Consultant in Palliative care at Marie Curie Hospices, Edinburgh

“Let's face it - no-one really wants to think about what might happen if they were to become critically ill! But of course the best way to do that is by planning ahead and doing the thinking while there's no crisis to deal with. That way you have time to think clearly, take advice, and share your thoughts and wishes with the people who might have to care for you. The ReSPECT process provides this opportunity in a clear, straightforward way. It will hopefully make it much easier for everyone, both inside and outside the healthcare professions, to make these challenging decisions together.”

Viv Cummin, Patient Representative, ReSPECT Working Group

  • June 2019
    Latest news from Catherine Baldock, ReSPECT Clinical Lead. Read here
  • May 2019
    Latest news from Catherine Baldock, ReSPECT Clinical Lead. Read here
  • April 2019
    There is now a full time Clinical Lead for the ReSPECT process: Catherine Baldock ( catherine.baldock@resus.org.uk) and a part time ReSPECT Project Manager Vicky Simms ( vicky.simms@resus.org.uk). Catherine and Vicky will be overseeing and supporting the adoption of the ReSPECT process across the United Kingdom. They will be regularly liaising with adopter leads to monitor progress, update on developments and understand any key issues.
  • There is a newly formed ReSPECT Subcommittee which is supported by five working groups, set up to drive forward various workstreams within ReSPECT. The working groups are: Policy and Public Engagement; Education; Documentation; Digitisation; Research and Evaluation. If you feel that you have issues that you would like to bring to the attention of any of the working groups please contact Catherine or Vicky.
  • March 2019
    Latest news from Catherine Baldock, ReSPECT Clinical Lead. Read here
  • December 2018
    Latest news from Catherine Baldock, ReSPECT Clinical Lead. Read here
  • October 2018
    Latest news from Catherine Baldock, ReSPECT Clinical Lead. Read here
  • August 2018
    Latest news from Catherine Baldock, ReSPECT project manager. Read here
  • This article in the Nursing Standard regarding the ReSPECT process, includes information from Catherine Baldock on the adoption process:
  • Nursing Standard Article: Help patients plan for a potential health crisis. Read here (RCNI log in needed)
  • PRSB Blog: Personalised care is the future. Read here
  • National Voices Blog: Why person-centred, coordinated care is just as important in an emergency. Read here
  • BMJ Analysis: Resuscitation policy should focus on the patient, not the decision. Read here
  • BMJ Practice Pointer: Emergency care and resuscitation plans. Read here
  • Association of Ambulance Chief Executives: News item on ReSPECT. Read here

Personalised care is the future

RC (UK) Executive Committee member, ReSPECT Expert Working Group Co-Chair and PRSB Advisory Board member Dr Peter-Marc Fortune has written a blog on the ReSPECT Process for the Professional Record Standards Body (PRSB).

In this blog, Peter-Marc explains why personalised care is the future, because personalisation is integral to good quality healthcare and should be applied in all situations, including urgent and emergency care. Read more.

A Quantitative and Qualitative Evaluation of the ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) Process in Forth Valley. Thank you to Lynsey Fielden for allowing us to share their evaluation report following the pilot on the use of the ReSPECT process in Forth Valley. Read the report.

The Easy Read Guide to the ReSPECT process has now been updated and separated into five separate leaflets following advice from Mencap. We would like to thank Mencap and Dr Claud Regnard for their work on these documents.

ReSPECT has been made available for adoption by health and care communities in the UK. It aims to promote more conversations between clinicians and patients, and with those close to patients, in order to make agreed recommendations for a person’s care and treatment in a future emergency situation in which the person does not have capacity to make or express choices at the time.

The ReSPECT form is a summary plan that records recommendations to guide clinical decision-making in a future emergency; it is not a legally-binding document.

The ethical and legal principles that underpin the guidance in Decisions relating to cardiopulmonary resuscitation by the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing are valid also for the ReSPECT process. ReSPECT supports and enhances recommendations within Decisions relating to cardiopulmonary resuscitation by promoting more advance planning, good communication, shared decision-making, and good documentation with cross-boundary recognition.

Implementation of ReSPECT is expected to be a gradual process, with different health communities adopting and implementing this using different timeframes, according to local or regional circumstances.

Health communities adopting ReSPECT are directly responsible for establishing an implementation group and developing an implementation plan (e.g. including training, resources, risks, interdependencies and audit). The ReSPECT guidance and materials do not lessen their responsibility in that regard.
In 2014, the results of a systematic review of DNACPR decisions and documents were presented by the team from Warwick University at the Royal Society of Medicine. This meeting was attended by a group of more than 100 patients, clinicians (multidisciplinary and multiprofessional), healthcare commissioners and regulators. In the light of the evidence presented, the group agreed on a need to improve patient and family involvement in decision-making, to consider CPR decisions in the context of broader care and treatment, and to record the outcome on a form that would be used and recognised across the UK. Following this, over 30 individuals, representing both the public and professional organisations from across the health sector, formed a Working Group to develop a new approach.

The agreed aims of the Working Group were to develop a process and form that would:

  • be acceptable to –
    • patients and the public
    • those important to patients
    • health professionals
    • carers
    • other members of the public
  • be underpinned by a good decision-making process
  • promote good decision-making
  • promote dialogue between individuals and clinicians
  • be used across all care settings
  • be used for individuals of all ages
  • use evidence and experience from other successful initiatives
  • consider decisions about CPR within overall goals of care.


The Working Group reviewed examples of best practice in the UK and internationally and a new approach was developed iteratively over two years. Development work included a public consultation, patient focus groups and usability testing. Responses to these informed further revisions of the ReSPECT form and other materials to support the process.

The Working Group wishes to thank:

Alex Ruck Keene, an experienced barrister, writer and educator, who has kindly provided invaluable informal input to the Working Group.

Colin McKay, Chief Executive, Mental Welfare Commission for Scotland, who has kindly provided invaluable advice on issues of capacity and incapacity in relation to Scotland.

ReSPECT partners