Councils receive qualified praise over Deprivation of Liberty Safeguards

Local authorities’ knowledge of the Deprivation of Liberty Safeguards (DoLS) “generally appears to be good”, the Care Quality Commission has reported.

As part of its fourth annual report on use of the Mental Capacity Act, the CQC surveyed local authorities on their monitoring.

The survey – covering 118 out of 152 local authorities – found that “most had appropriate structures and processes in place to operate the system effectively”.

However, “some did not actively encourage people’s representatives or their Independent Mental Capacity Advocates (IMCAs) to enable people to challenge authorisations”.

The Commission said it would be working more closely with local authorities in 2014 to support them in their roles as supervisory bodies – including the ‘outliers’ who do not seem to authorise many or in contrast approve many Deprivation of Liberty applications.

In its report the CQC said the number of applications to use the DoLS had increased every year since the regime was introduced in 2009.

There were 11,887 applications in 2012/13, up 4%. This rate of increase was smaller than in previous years.

The number of authorisations also increased to 6,546 – up from 6,339 in 2011/12.

The report also said that:

• Checks on implementation of the MCA would become a routine part of hospital and care home inspection, as the regulator implements its Raising standards strategy;
• There remained concern that the MCA was “still not understood and implemented consistently across health and social care services”;
• People in care homes and hospitals might continue to be subject to restraint and possible deprivation of liberty without legal protection. They, their families and close friends “may not always be as involved as they should be”;
• People’s experiences of the DoLS were mixed. A survey of IMCAs provided “some evidence of good practice, but also evidence that people are still not always being listened to, or involved in important decisions about their lives, or the lives of a relative or friend";
• There had been a significant increase in the number of applications for the use of DoLS to protect the rights of people aged over 85;
• Application rates continued to vary by region. However the CQC said the reasons for this were unknown;
• Around two thirds of care homes and hospitals were failing to notify CQC of the outcome of DoLS applications as required by law.

The Commission called for NHS England to include an expectation on the effective use of the DoLS into the standard contract for providers.

It also encouraged IMCA services to monitor their levels of activity around requesting reviews and supporting challenges to the Court of Protection.

The CQC urged local authorities which do not robustly monitor the DoLS to analyse various aspects of their systems, “especially about meeting statutory deadlines and communication with people directly affected”.

A copy of the CQC’s report can be found here.

CQC chief executive David Behan said: “We expect more focus on reducing the restraint and restriction of vulnerable people lacking capacity.

“We want to ensure people who are unable to consent to treatment because they lack capacity receive high quality care as a fundamental part of health and care services. While there has been an increase in the use of DoLS there is still much more that needs to be done to ensure people are appropriately cared for.”