Transcript Slide 1

Deprivation of Liberty
Safeguards
• Susanne Moffatt
• Team manager DOLS – BIA Team /
Safeguarding Manager East Lancs
Dignity in Care and
DOLS
• What is DOLS?
• DOLS was introduced in April 2009 as a
supplement to the Mental Capacity Act
Who is covered by the
Safeguards?
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People aged over 18 who lack the
mental capacity to consent to care &/or
treatment
People who are, or are about to be, in a
residential/nursing home or hospital in
circumstances which may be a
deprivation of liberty
Capacity?
People who lack capacity are likely to be those
with:
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Significant learning disabilities,
Dementia
Serious mental health problems
Neurological conditions (e.g. brain injury)
Illnesses affecting the brain
Acute confusional state e.g. U.T.I.
5 Principles
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Presume capacity
Least restrictive
Unwise decisions
Maximise capacity
Best interest
Why DOLS?
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Human Rights Act adopted by the U.K.
Government and gives universal rights to all
To ensure people’s rights under the Act are
protected
DOLS is specifically concerned with Article 5
(right to Liberty and Security) & Article 8 (right
to Privacy & Family Life)
Case law e.g. Bournewood, JE & DE
Prevent arbitrary decisions
What is a DOL?
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What is liberty? What is deprivation? We
all live with restrictions e.g. laws, society
rules, codes of conduct in the work
place, visiting hours
There is no definition in law of DOL
Restrictions versus deprivation
Multiple restrictions may result in a
deprivation
Continuum of Restriction
Liberty >>> Restriction >>>Deprivation
The Process made
simple
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Managing authority (care home) becomes aware that to keep a
resident (or potential resident) safe & deliver care, they need to
deprive the person of their liberty
MA completes paperwork to submit to the Supervisory Body
(Lancashire County Council)
SB appoints a Best Interest Assessor to examine all the
circumstances of the relevant person (service user)
A section 12 doctor (someone approved under the MHA) will
undertake some assessments if it appears to the BIA that a DOL
may be occurring
The DOL is either authorised or not
If it is a DOL a relevant persons representative is appointed
Restraint
• Where restraint is involved:
• the decision must comply with Section 6 of the
MCA (6.40 main Code of Practice p105/6) i.e.
• necessary to prevent harm to the person who
lacks capacity
• Amount of use and times used must be a
proportionate response to the likelihood and
seriousness of harm
Case Study 1
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CASE STUDIES - please note that all names have
been changed
Mrs Dixon has dementia and objects to her leg
bandages being changed. Her condition requires that
the dressings are changed at least once a day, as she
is often incontinent. She is at risk from septicaemia.
She screams, shouts and swears at the care workers
demanding that they leave her alone. It is in her best
interests that the bandages are changed as she would
be at risk from infection. Care staff have to physically
restrain her in order to carry out the care task. Does
this amount to a Deprivation of Liberty?
Case Study 1
continued
• It most likely does and so a full Best
Interest assessment for DOLS would need
to be carried out by a qualified BIA.
• What happens next?
Authorisation
• The care home issued an Urgent
Authorisation for Deprivation of Liberty for
7 days for Mrs Dixon and following this a
standard request was granted by
Lancashire County Council.
LCC Authorisation
• The restraint is now legally authorised
under the Deprivation of Liberty
Safeguards legislation by LCC with a
number of recommendations which relate
to her care.
Recommendations
• These include a reassessment of her pain
relief, continence assessment and
reassessment for waterproof dressings.
Mrs Dixon will be reviewed in three
months by the DOLS team to see whether
she still needs to be a detained resident.
Question
• Mr Catterall has alcohol related dementia
and short term memory loss. Staff at the
care home in which he lives prevent him
from going out to buy alcohol by ensuring
the doors to the care home are locked.
• Should he be assessed by the DOLS
team?
Answer
• Yes, because it may be a DOL but without
undertaking a full best interest assessment
this could not be ascertained.
Is this a DOL?
• Mrs Varley is bed bound and has severe
rheumatoid arthritis and dementia. Her
physical condition restricts her from getting
out of bed or moving around the care
home. The front door is locked with a
keypad.
• Is this a DOL?
Possibly
• It depends on a number of factors, e.g. what
impact the locked door is having on Mrs Varley;
she may be unaware of the fact and therefore it
has no impact on her. It appears to be her
physical condition which is restricting her
movement but staff at the care home have an
obligation to minimise the effect this has on her
life.
• What should you do if unsure? Call the DOLS
team and/or speak to a Best Interest assessor
for advice.
Mrs Fox’s story
• Mrs Fox is in hospital and has cognitive and
short term memory impairment which prevents
her from recognising risk and her significant care
needs. The hospital has issued a Section 2
notification that a needs assessment is required;
the outcome of which is that Mrs Fox needs to
live in a dementia registered care home. Mrs
Fox is adamant that she wishes to return home
and opposes going to a care home believing
she does not require any looking after.
Mrs Fox- capacity
assessment
• The mental capacity assessment carried
out by the hospital discharge social worker
concluded that Mrs Fox lacked the
capacity to make a decision regarding
where she lived and the best interest
decision was that Mrs Fox needed to live
in a care home. Would Mrs Fox be
deprived of her liberty if she were to go to
the care home?
Mrs Fox – the process
• The hospital discharge social worker and the care home
which was to admit Mrs Fox decided there would be a
potential deprivation of liberty. Mrs Fox had a history of
attempting to leave the hospital ward and of being so
distressed in respite care placements that she had been
asked to leave early. She would therefore need to reside
in a locked part of the care home and she would be
prevented from leaving the home without supervision.
The care home submitted a standard authorisation
request and the hospital ward were made aware that
they would not be able to discharge Mrs Fox until the
DOLS process was concluded.
Mrs Fox - outcome
• The outcome was for authorisation of DOL
but the Best Interest Assessor also added
conditions to the authorisation which
would minimise the impact of the DOL
upon Mrs Fox and maximise her freedoms
as much as possible.
WE WORK TO TIGHT
DEADLINES
• 7 calendar days for urgent authorisations
• Extensions to urgent authorisations for an
extra 7 days can be granted in exceptional
circumstances
• 21 calendar days for standard
authorisations
Applications via the
Hub
Application forms (DH Forms 1 and 4)
and care home’s care plan received by Hub
via email or fax.
Fax 01772 536199
[email protected]
DOLS – BIA TEAM
• Our address - DOLS-BIA Team. Unit D,
Clayton Green Business Park, Library
Road, Clayton Green PR6 7EN
• A duty officer is available at all times for
advice and support Mon-Fri 8.45am 17.00pm.
• Tel 01772 310905
Dignity in Care and
DOLS
THANK YOU