Two in five best interests assessors not receiving supervision

Two in five best interest assessors (BIAs) do not receive professional supervision and over a quarter believe current training is not preparing practitioners adequately for the role, a survey has found.

The findings come from a report based on separate surveys of 248 BIAs and 258 approved mental health professionals (AMHPs) produced for Social Work England by academics from the University of Central Lancashire and Sheffield Hallam University.

BIAs, the vast majority of whom are social workers, are responsible for co-ordinating the assessment process under the Deprivation of Liberty Safeguards (DoLS) and for carrying out the best interests assessment. This determines whether a person would be deprived of their liberty under proposed care or treatment arrangements, and whether this would be necessary to prevent harm to the person, proportionate to the seriousness and likelihood of that harm and in the person’s best interests.

‘Obvious concern’

Just forty five per cent of BIAs said they received supervision for the role while 40% said they did not, which the report said was “an area of obvious concern”.

Half of BIAs reported that current education and training was preparing trainees for their roles, with 28% saying it was not. Respondents felt that the five-or-six-day initial training programme was not long enough, highlighting the difference with AMHP courses, which tend to last six months full-time or a year part-time.

Many respondents said there was a need for a stronger emphasis on applying legal theory to practice on training programmes. A significant number said that there should be more shadowing of BIA assessments, and some said there should be a mandatory period of time spent in practice during the training. Others noted a need for more information on the DoLS process and how to fill in paperwork.

In some cases, respondents reported organisations sending staff on BIA courses without enough preparatory training or experience of the Mental Capacity Act.

The issues raised in relation to supervision and training came despite more respondents ranking them as the “most welcome” source of support than other initiatives, such as peer support or team meetings.

Considerable variation

Lorraine Currie, MCA and DoLS manager at Shropshire council and chair of the National DoLS Leads group, said that one explanation for the figures could be the number of independent BIAs in practice. She said: “It has long been a challenge that independent BIAs operate in a vacuum. They have to find and fund their own update training and they don’t have the same access to peer supervision or manager supervision.”

She also said there was a lack of consistency in BIA training, both for initial qualification and refresher courses, which led to variations in practice.

“I think most DoLS leads would agree that the training starts once the BIA is qualified,” she added.

She said a “lack of regulation” of courses, which are overseen by Social Work England, meant “the bar can be set quite low or it can be set really high”.

Social Work England said it would use the findings of the report to inform its update of training standards for BIA and AMHP courses, which it also regulates.

BIA role set to disappear

The report comes with the BIA role itself set to disappear with the replacement of DoLS by the Liberty Protection Safeguards next year.

The government expects about 90% of BIAs to convert to being approved mental capacity professionals (AMCP), whose role will be to review decisions to deprive a person of their liberty in order to ensure these meet the relevant statutory requirements.

Sixty four per cent of BIAs responding said they were planning to convert to the AMCP role, with only 11% saying they would not, though 25% left the question blank.

The biggest reason for BIAs being unwilling to convert to the AMCP role was upcoming retirement. Others cited planned job changes and uncertainty about what the new role would  be, with many of the details due to be fleshed out in as yet unpublished regulations.

Claire Webster, interim service manager for North Yorkshire council’s MCA/DoLS team, said that the lack of information could be part of the reason for reluctance. She added: “You probably wouldn’t want to say you’d convert unless you knew what you were signing up to. I suspect, given the chance, the majority will.”

Of the AMHPs surveyed, 25% reported not receiving supervision with 69% saying that they did. While three-quarters said their qualifying training prepared them for the role, 14% said it did not, though this group of respondents were split on whether courses were too academic or insufficiently so.

The report also set out the toll taken on staff in the two roles. Both groups, on average, rated the impact of the role on their physical, psychological, emotional and mental health as five out of 10. AHMPs reported finding their role more challenging (rating it as just over seven out of 10, compared with just over five for BIAs), which the report suggested could be due to both workload pressures and the lack of available resources.