Councils’ new Dols role in hospitals
From April 2013, councils will become the “supervisory body” for deprivation of liberty safeguards (Dols) cases in hospitals.
Where hospitals suspect they are depriving a patient of their liberty for treatment, where the person lacks the capacity to refuse, they will need to apply for authorisation from their local authority, not the primary care trust, as at present.
The council will then need to ensure that the six assessments required under the Dols are carried out, within 21 days, most significantly the best interests assessment. This assesses whether the person is being deprived of their liberty and, if so, whether this is in their best interests.
BIAs, who can be social workers, nurses, occupational therapists or psychologists, will then make recommendations to the councils as to whether the person should remain deprived of their liberty, for how long and under what conditions.
Council Dols authorisers or leads will then decide how far to accept the BIA’s recommendations and whether to authorise the deprivation, and with what conditions.
Hospitals will remain responsible for compliance with Dols legislation, for knowing when to make referrals and ensuring treatment is compliant with the Mental Capacity Act (MCA) 2005. Clinical commissioning groups, which replace PCTs, will oversee these MCA responsibilities across the NHS in their areas.
Councils will get over £5m a year to assume responsibility for safeguarding people deprived of their liberty in hospitals from next April, a significant increase on the funding levels initially proposed.
The resources, announced today by the Department of Health, are designed to fund councils to assess whether people should be detained for treatment in hospital where they lack the capacity to refuse, under the deprivation of liberty safeguards (Dols). Councils assume responsibility for this role from primary care trusts on PCTs’ abolition in April 2013.
The DH originally proposed giving councils £1.4m to cover the first year of their new responsibilities, based on estimates of existing PCT funding.
However, today it said £5.4m would transfer in 2013-14 followed by £6.2m in 2014-15. The DH said its latest estimate was based on “current data on Dols assessments in hospitals, our best estimate of future trends and a Dols unit cost of £1200”. The latter figure includes both the costs of a single Dols assessment plus an additional amount per case to cover training for best interests assessors and Dols staff, awareness raising and any Court of Protection costs.
It said at the time of last year’s estimate, there was “no factual evidence on numbers or costs of unlawful detentions on which to base estimates of the cost”, but there was now better information available.
The money is not ring-fenced, though will be allocated in two separate chunks in 2013-14: £1.35m as part of councils’ general grant for services and £4.05m as part of a new grant from the Department of Health.
Councils are currently responsible for assessing Dols cases in care homes; but in many areas, local authorities and PCTs have set up joint arrangements, with pooled budgets, to assess and authorise Dols cases across hospitals and care homes.
Next April’s change is likely to be more significant in areas that do not have joint arrangements, where councils Dols teams will not have experience of assessing cases in hospitals.