Support and scrutiny of best interests assessors variable, finds CQC

Training and scrutiny of social workers assessing people under the Deprivation of Liberty Safeguards (Dols) is variable across local authorities, the Care Quality Commission has found.

While most councils are providing significant access to continuing professional development for best interests assessors (BIAs) and quality assuring their decisions, a minority are not. The findings were outlined in the CQC’s third annual report on Dols, covering 2011-12, published today.

This included a study of 13 “supervisory bodies”: teams within local authorities or primary care trusts whose role is to decide whether people who lack capacity to consent to their care are being deprived of their liberty in care homes or hospitals, and if so, whether this is in their best interests. Twelve were joint local authority and PCT teams and one was solely a council team.

One of their key roles is appointing BIAs – who are mostly social workers – to assess whether a deprivation of liberty is taking place and make recommendations on whether this is in the person’s best interests.

Variable training for BIAs

By law, supervisory bodies must ensure that all BIAs they use have had refresher training in the previous year and possessed the necessary analysis and evaluation skills. However, the CQC found that three of the 13 supervisory bodies made “very few demands and checks” on BIAs, something it said it plans to explore further.

Eight of the 13 actively monitored compliance with these regulatory requirements, while 10 had an annual training requirement for BIAs. Just three required BIAs to regularly reapply to be able to carry out their role, while just one provided an annual appraisal for BIAs and one required practitioners to have carried out an assessment in the previous year.

Twelve of the 13 supervisory bodies directly employing some or all of their BIAs, with the other exclusively using self-employed assessors.

Peer support for practitioners

While practitioners in 10 of the supervisory bodies were able to access regular peer support through engagement in local or regional networks of Dols practitioners, this was entirely lacking in two teams, while the other reported informal contacts with neighbouring authorities.

The CQC also found that BIA recommendations were largely accepted by supervisory bodies. Eight of the 13 reported never having changed a BIA recommendation in relation to the authorisation a Dols application from a care home or hospital and the imposition of any conditions limiting deprivation of liberty.

This was despite 11 of the 13 carrying out pre-authorisation quality checks on BIA recommendations, typically made by other members of the Dols team.

Government considering tougher BIA requirements

The news comes with The College of Social Work having produced the first set of practice standards for BIAs last week. The Department of Health is now considering how supervisory bodies should be held to account for monitoring BIAs’ against these standards, including potentially introducing a compulsory system of reapproval of BIAs, as is now the case with approved mental health professionals.

The department is also considering how the College’s standards should inform the approval of initial training courses for BIAs.

Greater scrutiny of local authorities

The CQC study was a pilot designed to fill a gap in the regulator’s monitoring of Dols created by the government’s abolition of annual assessments of councils and PCTs by the commission. This has meant that the CQC could only directly monitor the Dols performance of care homes or hospitals, as it regulates them, but not the organisations with responsibility for approving Dols applications.

From next week, with the abolition of PCTs, councils will take over supervisory body responsibilities for hospitals as well as care homes. The CQC said it wanted to develop its scrutiny of their performance but that this would “depend to a significant extend on the willingness of local authorities to collaborate with CQC”.

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