The Care Quality Commission has raised concerns over the protection of vulnerable adults because of its inability to monitor deprivation of liberty assessments by social
workers and other professionals.
The regulator “has very limited” information about decisions made by councils or primary care trusts to authorise care homes or hospitals to detain people for care and treatment, under the deprivation of liberty safeguards (Dols). These decisions are significantly based on a “best interests assessment”, often carried out by a social worker, to determine whether a person who lacks capacity to consent to care is being deprived and, if so, whether this is in their best interests.
Though the CQC has a responsibility to monitor the Dols to ensure people’s human rights are protected, it no longer assesses PCTs or councils on adult social care, meaning it can only gather information from care homes or hospitals. “This restricts CQC in monitoring how [councils and PCTs] are undertaking their assessments and making decisions,” said the regulator, in its annual report on the Dols, published today.
The information gap prevents examination of the large local variations in both Dols applications to councils and PCTs and authorisations made by them, neither of which can be explained by differences in care need between areas. It also hampers CQC from probing concerns about the quality of training provided to best interests assessors, and the extent to which professionals are involving family members in assessments.
The CQC said tackling the information gap was a “high priority” and that it was planning to work with councils and PCTs to pilot how they could share information with the regulator on their decision-making. This could involve using a portal that has already been set up to help the CQC and councils share information about the quality of care homes. When PCTs are abolished in April 2013, councils will take on their responsibility for authorising Dols in hospitals.
The CQC also highlighted a number of areas where it lacked information, hampering its ability to monitor deprivations of liberty:-
• Deprivations of liberty in supported living and Shared Lives arrangements, as these are not covered by the safeguards. In such cases, the provider must apply to the Court of Protection to authorise the detention but the CQC is not routinely notified of this.
• Deprivations involving children, as the safeguards only apply to people aged over 18. Ofsted has reported cases of children’s homes applying to the Court of Protection to authorise detentions.
• Direct feedback from service users and carers as the CQC only monitors the Dols as part of its wider regulation of services, not through dedicated visits to meet affected service users, as it does with Mental Health Act patients.
• Access to independent mental capacity advocates for service users under the Dols, and information on appeals against Dols decisions by users and their families.
It also said its efforts were hampered by the fact that care homes and hospitals were not fulfilling their duty to report Dols applications to the CQC, with evidence suggesting that just one-third of cases were reported.
Image: Milton Montenegro/Photodisc/Getty Images
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