By Blair McPherson
Some practitioners are celebrating the Supreme Court ruling in the cases of P v Cheshire West and Chester Council and P&Q v Surrey County Council as bringing many more people under the scope of the Deprivation of Liberty Safeguards (Dols), including older people who have dementia.
Others argue that evidence from Care Quality Commission reports already identifies widespread under-compliance due to resource shortages. Broadening those covered will not improve this situation but make it worse. So now may be a good time to take a step back and remind ourselves what happened in the past and why the Dols were introduced.
When I was a specialist social worker working with older people who had dementia I was very concerned about the willingness of relatives, housing officers, ward staff, GPs and fellow social workers to ignore the wishes of people with dementia bases on the fact that they were confused and forgetful.
What this meant was they were admitted to a residential or nursing home without being involved in the decision. As a result, anyone visiting one of these homes would be accosted by a distressed resident asking to be let out as they wanted to go home.
In response, staff would lock the doors, keep the individual under sedation or use the tray attached to the armchair to, in effect, pin the individual into their chair. Their home having been given up or sold staff would inform them ” you live here now”; and if this distressed them or they became aggressive in their attempts to leave then staff simply upped their medication.
Being old and suffering from dementia all too often meant the risks they posed to themselves overruled their human rights. The difference in these cases to people with a mental health problem was the total lack of any protection for the individual who was to be deprived of their liberty to the end of their days.
And, of course, a whole range of other decisions would be made about their home, their possessions, how they spent their personal finances, when they had a bath an even if they had sugar in their tea.
It is over 30 years since I was a social worker, attitudes have changed, care staff have specialist training, the law has changed with the introduction of the Dols and rights are now independently balanced against risks.
Well that’s the theory. But the Care Quality Commission’s annual report on the Dols concludes it is not the reality. All too often dementia in old age leads to relatives and professionals disregarding an individual’s rights in a way no one would get away with in younger people. The report states that hospitals and care homes often act to deprive an individual of their rights either through ignorance or convenience and that too many local authorites are under-resourced to carry out their duties of assessment and safeguarding.
The law should not be interpreted to fit existing resources. Yet to expect local authorities to carry out new duties and responsibilities without providing the necessary resources is to set them up to fail.