Best interests assessors (BIAs) could soon face regular tests of their capability to continue performing the role, which involves deciding whether it is right to deprive people of their liberty in care settings.
Practitioners’ views on BIA training
“One of the key challenges of BIA work is keeping up to date with recent case decisions…It is difficult to keep on top of developments when you are working as a hard-pressed social worker with many other competing demands. I think team managers need to be educated as to the importance of the work.”
“The course I did focused almost entirely on the law and procedures. I would like to see more in the course on practice issues with particular service user groups, e.g. techniques to maximise and test capacity.”
“Reapproval should be based partly by attending an in-depth course, and partly by completing a minimum number of assessments during the year, all of which should be to a professional standard.”
“I think that the (false) perception of most local authorities is that the BIA role is easier, quicker and less complex than the AMHP role, therefore inexperienced and inappropriate candidates are often put forward for training.”
Source: College of Social Work survey on improving training and professional standards for BIA
Introducing a reapproval system similar to that applied to approved mental health professionals (AMHPs) won the backing of 83% of respondents to a College of Social Work survey designed to inform the development of the BIA role. Seventy eight per cent of the 197 respondents were practising BIAs.
The College has been commissioned by the Department of Health to develop proposals for capabilities, training and continuing professional development standards for BIAs, which it is due to submit for DH consideration by the end of this month.
The result of the survey means that the College is likely to recommend that the DH introduce a reapproval system.
The BIA role
BIAs assess whether people who lack capacity to decide on their care arrangements have been deprived of their liberty in hospitals or care homes and, if so, whether this is in their best interests, under the deprivation of liberty safeguards (dols).
Currently, BIAs need two years’ post-qualifying experience as a social worker, occupational therapist, nurse or psychologist; must have taken a Department of Health-approved training course and have undergone refresher training in the 12 months prior to the case in question. In addition, the councils or primary care trusts who appoint them must be satisfied that BIAs have the “the skills necessary to obtain, evaluate and analyse complex evidence and differing views and to weigh them appropriately in decision-making”.
However, unlike for AMHPs, there are no nationally defined capabilities for the role, nor a system of periodic approval to test whether professionals remain up to the job; AMHPs are reapproved every five years. There is also significant variation in the duration and content of BIA training courses, which range from four to 15 days.
A number of local authorities use local systems of reapproval for BIAs. The College’s practice development adviser, Claire Barcham, who is overseeing the project, said the College would look at “bringing together the best of these systems” in any national repproval system.
Reapproval would be judged against a set of capabilities. The College has produced a draft set, based on consultations with BIAs around the country, in which the capabilities are structured under the five principles of the Mental Capacity Act 2005. The proposed capabilities are:-
- maintaining an awareness of the relevant legal and policy framework;
- the ability to work in a manner congruent with the presumption of capacity;
- the ability to take all practical steps to help someone to make a decision;
- the ability to balance a person’s right to autonomy and self-determination with their right to safety, and to respond proportionately;
- the ability to make informed, independent best interests decisions within the context of a deprivation of liberty assessment process;
- the ability to effectively assess risk in complex situations and use analysis to make proportionate decisions.
Support for practical training
Some survey respondents also stressed that BIAs needed to undertake a minimum number of assessments per year to keep up their skills, while others raised concerns about the lack of extra pay for undertaking best interests assessments in some areas.
Among other findings from the College’s survey:
- 77% of respondents felt candidates for BIA training should be undertaking best interests decisions, on behalf of people who lack capacity to take them, in their day-to-day work, and 67% felt they should have shadowed someone undertaking a best interests assessment.
- 72% felt the training should involve being observed undertaking a best interests assessment by a qualified BIA;
- 87% felt BIA training should involve a minimum number of taught days and 49% felt it should be at masters’ level.
“Probably at the moment there is too much of an emphasis on classroom training, which reflects the fact that when the training was introduced in 2009 there wasn’t the possibility of doing practical assessments [because Dols] was just being introduced,” said Barcham. “I think the fact that so many people thought you should be observed undertaking a Dols assessment by someone who was already a BIA was quite significant because it says ‘we should be able to show we can do it’.”
Enforcement of training standards
Barcham said it would be “ideal” if any capabilities and training standards were enforced by regulations, as is the case with the standards applying to AMHPs.
“Clearly that would be ideal but I’m not saying that’s what the Department of Health would do,” she added.
- Read the results of the survey and the draft capabilities on the College’s communities of interest group on the Local Government Association’s Knowledge Hub, for which you will need a Knowledge Hub login and to request membership of the group from the College.