Demand for best interest assessor training and independent mental capacity advocates has shot up in the wake of the Supreme Court’s landmark ruling on deprivation of liberty.
Training and advocacy companies reported substantial rises in requests for their services following the judgement in the Cheshire West and P&Q cases, which was handed down in March.
The court found that the three service users in the two cases had been deprived of their liberty unlawfully because their care arrangements were the responsibility of the state, they lacked capacity to make decisions about these arrangements, did not have the option to leave their residence and were under continuous control and supervision.
The ruling means that many people in care homes and supported living arrangements will need to have their case assessed or reassessed to see if they are deprived of their liberty.
80,000 more Dols cases this year
The Association of Directors of Adult Social Services has estimated that there will be over 100,000 more referrals for deprivation of liberty cases this year as a result of the ruling. The majority of this increase – about 80,000 – are for Deprivation of Liberty Safeguards (Dols) cases in care homes and hospitals, where councils must authorise – or not – any deprivation of liberty in care.
Consequently local authorities are scrambling to train staff as best interests assessors, who play a crucial role in Dols cases in determining whether a person has or will be deprived or their liberty and whether this would be in their best interests.
Best interests assessors (BIAs) in England, most of whom are social workers, have to do a qualification course at a university and then refresher training every 12 months, which can be with a university or training company.
Steven Richards, director at Edge Training, which provides update and refresher courses for BIAs, said his company would not normally do much training at this time of year. This is because many existing assessors do their annual refresher training before April, having qualified before Dols came into force, in April 2009.
“After March we would be doing very little training but now after this ruling a lot of local authorities have come back and said we need to be retrained because our training was before the court ruling. We have seen a big increase for this time of year – 100 or 200%.”
Not enough BIAs to meet demand
He said there are not enough qualified BIAs to meet demand. Some authorities are planning to tackle the problem by training every adults’ social worker as a BIA or creating a dedicated BIA team. In the meantime he expected freelance BIAs would get a large amount of work.
He added that many local authorities now wanted longer refresher courses – two to three days instead of one – to take account of changes in the law around deprivation of liberty.
Michael Lyne, lecturer in mental health social work at Bournemouth University, which provides BIA qualifications and training, said there had been a “massive increase” in authorities wanting BIA training. He said he was fully booked for the next two and a half months. One council had asked him to train 60 members of staff and another its whole adult social worker workforce, although he declined to do this because he said the BIA role was “not suitable for everyone”. “Prior to Cheshire West I was doing well if I had fifteen people in a group and I usually only achieved that by authorities joining together,” he added.
The number of Dols cases has historically varied substantially between authorities and it had been expected that those with higher rates would see less substantial increases in cases following the Supreme Court judgement.
However, a Dols lead at a council with historically high rates said he had still seen a rise in cases of about a third in the first quarter of this year – about 70 cases – compared with the same period last year.
He said the council was trying to recruit a BIA but was having difficulty getting applicants. It plans to train more staff as qualified assessors.
“We have seen an impact on resources but we are managing,” he said. “I think we will need as many assessors as we can get and we will support as many as we can [to get qualified].”
Bristol City Council has also been working out the potential impact of the Dols ruling. It estimates the number of assessments is likely to reach 3,000 following the case and its total Dols activity will rise by about 2000 per cent. The council is training 40 people from various teams as BIAs who will go onto the rota for five days at a time and can spread knowledge of Dols amongst their colleagues. The council estimates it will have a funding shortfall of £972,500 in 2014/15 resulting from the Dols changes.
Sharp rise in demand for advocates
Meanwhile, a substantial increase in demand for independent mental capacity advocates (IMCAs) has also been reported following the ruling. Under the Mental Capacity Act, councils must instruct IMCAs to support people who are being assessed under the Dols, or who have had a deprivation authorised, and have no one else to consult; and also, where a service user under a Dols authorisation has an unpaid representative, and either the person or representative requests IMCA representation.
IMCA provider VoiceAbility said the number of referrals it received from local authorities had more than doubled on average across the country.
The organisation said that, on average, it received 64 referrals across its 30 services before the Cheshire West judgement and this has risen to an average of 144 after the ruling.
The rate of increase varied between services: 10 saw referrals double, seven reported a 300% increase, five a 400% rise and two experienced growth of 500%.
Jonathan Senker, chief executive of VoiceAbility, said: “We are seeing quite a significant increase. It is lumpy in that in some places it is quite dramatic and in others it is less so.” He said about 20% of local authorities that the organisation works with had agreed to buy more services from them. He said he was able to find enough advocates but that it is more difficult to do so in some areas. He said: “We need to work together with skills agencies to ensure there is a strong route into advocacy and get a pipeline of people that are developing the skills.”