Deprivation of Liberty Safeguards costs well above estimates

Deprivation of Liberty Safeguards (Dols) cases are costing at least twice the government’s estimates, raising doubts about the adequacy of funding for local authorities to carry them out.

The average cost of a Dols assessment in 2009-10 was £1,277 compared with a government estimate of £600, found research published in the September issue of the British Journal of Psychiatry. The study said the £1,277 figure was likely to be an underestimate.

Councils and primary care trusts are allocated money to assess whether people who lack the capacity to consent to care that deprives them of their liberty in care homes or hospitals are being treated in their best interests. The funding is based on the government’s estimates of assessment costs and the number of Dols cases each year.

The study acknowledged that case numbers had been much lower than government estimates in 2009-10, a factor that also applied in 2010-11 when there were 8,982 Dols applications in England compared with an estimate for England and Wales of 18,600.

However, the report warned: “If it transpires that there are many more people who should be assessed than that may have significant budgetary implications.”

Under the Health and Social Care Bill, which will abolish PCTs, councils will take over responsibility for assessing Dols cases in hospitals next year, with funding of £1.4m to carry them out.

Local authorities risked being left out of pocket, said Roger Hargreaves, Dols lead at the Mental Health Alliance, as they “will be compensated according to the government’s estimate, not the actual cost of providing a service”.

He said the findings in the study reflected the bureaucratic nature of the Dols, which involves carrying out six assessments for each case.

“Although this research didn’t attempt to break down the time spent by assessors, the suspicion is that the real costs are so much higher than the government’s estimate at least in part because of the excessively bureaucratic nature of the Dols scheme and the huge volume of paperwork it generates.”

The report was based on interviews with 37 professionals, administrators and independent mental capacity advocates in six areas in England, and the cost figures were based on the reported time spent on assessments, travel and administration.

It said the £1,277 figure was likely to be an underestimate because it did not factor in the time spent by staff in care homes or hospitals on Dols cases, or costs incurred by the relevant person’s representative, who is appointed to speak up for clients. It said its findings were also based on 2008 figures for factors such as professionals’ earnings and travel costs.

The study was carried out by Ajit Shah and Chris Heginbotham, of the University of Central Lancashire, Mark Pennington, of the University of Newcastle, and Cam Donaldson of Glasgow Caledonian University.

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