A quarter of councils lack enough practitioners to assess people under the Deprivation of Liberty Safeguards (Dols), potentially leading to people being detained in care settings without legal protections
That was the warning from the Care Quality Commission in its report on the Dols for 2012-13, published today.
A survey of 118 of the 152 English local authorities, found 27 lacked enough best interests assessors (23%) to identify whether care homes or hospitals were or would be depriving service users of their liberty, and whether this was in their best interests.
Also, 29 (25%) lacked enough mental health assessors to determine whether the person had a mental health disorder, a qualifying requirement for protection under the Dols.
BIAs are mostly social workers and 69% of councils employ all such assessors, while others use self-employed or agency staff; mental health assessors are doctors with psychiatric experience.
The CQC linked the shortage of assessors to delays in handling urgent Dols authorisations, where care homes or hospitals declare that they are depriving a person of their liberty in their best interests, leaving the council seven days to assess whether this is the case.
Eleven of the councils reported delays in processing at least 20% of their urgent cases, with staffing issues, including annual leave and problems finding a BIA, a significant factor.
In addition, in 13.4% of urgent authorisation cases, councils had extend the time period for carrying them out by up to seven days, something they are permitted to do in an emergency.
For the individuals involved each extension means that they were detained for more than seven days without the full protection of the assessment and authorisation processes of the Deprivation of Liberty Safeguards,” said the CQC. “This is a significant proportion of the total number of applications over the year and could potentially cause confusion or distress for the individuals involved, as well as any families or close friends.”
It said councils needed to keep this under review and ensure extensions to urgent authorisations were minimised. It suggested that councils set up arrangements so that they could call upon neighbouring authorities’ BIAs if there was an unexpected surge in urgent authorisations.
Lack of senior management oversight
The CQC also raised concerns about a lack of senior management scrutiny of Dols cases, with just half of councils saying that this took place. Councils reported a variety of ways in which they quality assured assessments, including through supervision, checking whether timescales were met and checking levels of activity.
It recommended as good practice that councils manage BIAs’ workloads to enable them to attend local BIA practice forums, commission independent reviews of Dols cases, set up Dols and Mental Capacity Act committees to analyse cases and developing regional Dols networks.
The CQC also warned that authorising signatories – whose role is to sign off on Dols authorisations – were not being given sufficient training; 11 councils reported providing no training to their signatories and 33 provided less than half a day’s training.
The regulator warned that it would expect all councils to give signatories appropriate training, given developments in safeguarding and the fact that many authorities used signatories to scrutinise the quality of assessments.
The report also warned that many care homes and hospitals were failing in their regulatory duty to inform the CQC of applications they made to deprive people of their liberty and the outcomes of these. Of 8,464 Dols applications received by councils from care homes and reported to the Health and Social Care Information Centre in 2012-13, just 2,977 were reported to the CQC by residential providers.
This “removes an important element of protection for people subject to the Deprivation of Liberty Safeguards” and “obstructs us in our statutory duty to monitor the Dols”, said the report.
Eighty five per cent of councils said that a lack of knowledge among care homes and hospitals was a barrier to good practice under the Dols. The regulator recommended the following actions for councils to support providers in implementing the Dols and MCA:-
- Setting up MCA helplines for providers;
- Providing focused training for care homes and hospitals with low Dols application rates;
- Including requirements on the Dols and MCA in contracts with care homes;
- Providing train the trainer programmes to equip care home and hospital staff to train their colleagues.
Improve your Dols practice
For the latest case law updates and practice advice, register for Community Care’s forthcoming conference on the Mental Capacity Act and Dols, which takes place in London on 19 March.