Number of completed DoLS cases up by 20% in past year but backlog continues to grow

The number of completed Deprivation of Liberty Safeguard (DoLS) applications rose by 20% in 2017-18 compared with the previous year, an NHS Digital study has found.

The Mental Capacity Act 2005, Deprivation of Liberty Safeguards 2017-18 report showed the number of completed DoLS applications increased from 151,970 in 2016-17 to 181,785, representing a 19.6% rise.

While the the number of completed applications that were granted rose by 15.2%, there was a sharper, 27.3%, rise in the number that were not granted, from 55,630 to 70,805.

The results mean DoLS teams and assessors are getting through almost three times as many cases as they did in 2014-15, when they completed 62,645 applications.

Yet, despite the rise in completed applications, the backlog in cases that remained unfinished at the end of the year has continued to grow, from 108,545 in March 2017 to an estimated 137,065 in March 2018. This was because the number of new applications, 227,400, outstripped the number of completed cases and the number that were withdrawn during the year (17,090) combined.

Lesser rate of increase

The number of new DoLS applications represented a 4.7% increase on 2016-17, continuing the year-on-year rise in numbers triggered by the Cheshire West judgement in March 2014, which, in effect, lowered a threshold for what constituted a deprivation of liberty. However, report authors noted that the rate of increase was not as great as in previous years.

The report comes with the government having issued legislation to replace the DoLS system, in large part to help local authorities, the NHS and providers to deal with these pressures.

The pressures created by Cheshire West have meant that the statutory timescales for completing DoLS cases – 21 days for a standard application and seven days when it is accompanied by an urgent authorisation – are routinely breached.

The average length of time it took to complete a DoLS application increased from 120 days in 2016-17 to 138 days in 2017-18, with 11.4% taking a year or more.

The proportion of standard applications that were completed within 21 days fell from 23.3% in 2016-17 to 21.7% in 2017-18.

However, reflecting the rise in the number of finished cases, requests completed in 90 days rose by a fifth from last year, from 99,285 to 119,390.

Regional variations

Beneath the national picture, the report showed substantial regional variations in the number of DoLS applications, the time taken to process them and the completion rate.

The North East was highlighted by the report as showing differences to other regions on most measures.

The region received a substantially higher number of DoLS applications in relation to its population than any other region, with just over 1,054 DoLS applications per 100,000 adults in 2017-18, double the national rate of 520 per 100,000 adults. The other regions all received between 445 (the South West) and 579 (the North West) applications per 100,000 adults.

The number of applications completed was also much higher in the North East, at 986 per 100,000 population, well over double the national rate of 415. The East of England recorded the lowest rate of complicated applications, with 271 per 100,000 adults.

Lastly, it was found that DoLS applications in the North East took a shorter time to process, with 43.4% of standard applications completed within 21 days, compared with the England average of 21.7%. The lowest rate was for the South East at 11.6%.

The South East region also accounted for almost a quarter (23.0%) of the national number of uncompleted applications as of March 2018, although the report pointed out that 82.0% of the region’s figure was accounted for by five of its 19 local authorities.

DoLS reform

In July, the government introduced a bill to overhaul the law on deprivation of liberty in a bid to tackle the huge demand on the current system and save councils an estimated £200 million a year.

Under the proposals, a scheme called the Liberty Protection Safeguards would replace DoLS. This would see the number of assessments carried out to scrutinise a deprivation of liberty authorisation reduced from six to three and replace the best interests assessor role with that of approved mental capacity professional.

The new scheme would also give care home managers the role of arranging assessments in their services; something which was flagged up as “a massive conflict of interest” by peers in the second reading of the bill last month.

The bill is set to be discussed again on 15 October as it passes through the committee stage of the House of Lords.