Transcript Slide 1

The Deprivation of Liberty
Safeguards
Practitioner Level
Including
Housekeeping
Toilets
Fire Procedure
Breaks
Including
Mobile Phones /
Devices
Smoking
Finishing
Time
Training Transfer
Getting learning into practice
• “50% of learning fails to transfer to the
workplace”
(Sak, 2002)
Including
• “The ultimate test of effective training
is whether it benefits service users”
(Horwath and Morrison, 1999)
Training Transfer
Individual
Characteristics
Workplace
Factors
Including
Training
Design and
Delivery
Introductions
• Name
• Place and nature of work
• What do you want to get out of today’s session?
Including
Outcomes
• Understand the legal framework for providing
care, treatment and support
• Consider the implications of using restraint to
keep people safe from harm
• Be aware of cumulative effects of restrictions
and ways of minimising their use / impact
• Understand what is meant by Restriction,
Restraint and Deprivation of Liberty and the
significance of the differences between them
Including
Ground Rules
Including
Safeguarding is a dynamic world and we
continue to learn about how to prevent
people from being harmed on both a
strategic / organisational level and as
individual practitioners.
Safeguarding is about partnership, it is not
about blame. All agencies and individuals
need to take responsibility, to reflect and
learn to safeguard people who may be
vulnerable.
Ground Rules
Confidentiality within the group will be
respected but may need to be broken if a
disclosure of unsafe practice, abuse or
neglect is made during the course – this
will usually be discussed with you first.
Including
Emerging Changes / Considerations
• Many of you will be aware that there has been a
Supreme Court Judgement “Cheshire West”
• This is currently being considered on a national
basis and some elements are being reflected in
this training but can not be discussed at length.
• Additional information is available by
organisations such as CQC web site and
decisions need to be taken by providers at a
local level at this time
Including
The MCA “Process”
Is there a concern about a persons capacity ?
(with regard to a specific decision)
Undertake a Capacity Assessment
Or
Their own decision
(even if we think it is unwise)
Including
Best Interest decision
(multi-agency)
Best Interest Checklist
Including
• Assess whether the person will regain capacity
• Encourage participation
• Find out the person’s views (past and present
wishes, feelings, values and beliefs; including
any advance decisions to refuse treatment)
• Identify all relevant circumstances
• Consult others (IMCA?)
• Avoid discrimination
• Avoid restricting rights
• Don’t be motivated by a desire to bring about the
person’s death
Principle 4: Best Interest
If a person has been assessed as lacking
capacity then any action taken, or any decision
made for, or on behalf of that person, must be
made in his or her best interest.
Principle 5: Least Restrictive
Before the act is done, or the decision is made,
regard must be had to whether the purpose for
which it is needed can be as effectively achieved
in a way that is less restrictive of the person’s
rights and freedom of action.
Including
Case study – Val & Vernon
Including
Human Rights & Mental Capacity
• Vernon has been admitted to hospital. Val
lacks capacity to make decisions about
her care needs.
• No-one has any legal authority (i.e.
Lasting Power of Attorney or Deputyship)
to make decisions on her behalf.
• A decision will need to be made about
what is in Val’s Best Interests.
Including
The Best Interest Decision
What are the
options?
How restrictive
are they?
Including
What could you do if Val refuses:
1. To go to the care home?
2. To take her medication?
3. To stay at the care home?
(Least to most restrictive)
Including
What is Restraint?
Someone is using restraint if they:
• Use force – or threaten to use force – to
make someone do something that they
are resisting, or
• Restrict a person’s freedom of
movement, whether they are resisting
or not
Including
Section 6 (4), MCA, 2005
Examples of Restraint
•
•
•
•
Including
•
•
•
•
Chemical
Financial
Manual
Physical/ environmental e.g. Barriers,
Locks
Removal of equipment, clothing
Preventing contact
IT / phone removal
Psychological
Restraint
Any action intended to restrain a person who
lacks capacity must follow the following two
conditions:
– The person taking action must reasonably
believe that restraint is necessary to prevent
harm to the said person
– The amount or type of restraint used and the
amount of time it lasts must be a proportionate
response to the likelihood and seriousness of
harm
Including
- (Plus Principles 4 & 5)
Guidance / good practice
• Social Care Institute for Excellence (SCIE)
ADULTS’ S ERVICES REPORT 25
Minimising the use of ‘restraint’ in care homes:
Challenges, dilemmas and positive approaches
www.scie.org.uk
Including
Limits of Section 5 Decisions
Restriction/
Restraint
Type
Duration
Manner
Deprivation of
Liberty
Best Interest Decision -> -> -> -> -> -> -> -> -> Deprivation of Liberty Authorisation
Including
Human Rights Act, 1998
“All human beings are born free
and equal in dignity and rights.”
Including
The HRA is known as a higher law.
It defines the role of the State in upholding
our freedom, dignity and rights; this includes
protecting us from each other.
It also establishes if, when and how our rights may
be restricted or withdrawn.
Human Rights: A Balancing Act
Including
Some rights may be withdrawn or limited “in
accordance with a procedure prescribed by law
when necessary in a democratic society in the
interests of national security, public safety or the
economic well-being of the country, for the
prevention of disorder or crime, for the protection of
health or morals, or for the protection of the rights
and freedoms of others.”
Human Rights Activity
Match the statements with the Rights
Including
HL v. UK
HL was an autistic man with a Learning
Disability who lacked capacity to consent to
treatment
Admitted to hospital in emergency
Not treatable under MHA
Discharge to carers refused
Including
ECtHR – illegal - no formal procedure for
admittance or appeal against detention
Key Considerations for DoL
• Is the Person under continuous
supervision and control?
• Is the Person free to leave (or would they
be if they could)?
• Is the Placement imputable to the State?
• Impact, relative normality and purpose are
no longer relevant
Including
Your Rights if You are Imprisoned:
• Formal process for detention – a trial
• Representation - access to a solicitor
during the Criminal Justice process
• Opportunity for the detention to be
reviewed - parole
• A Right of Appeal
Including
Your Rights if You are ‘Sectioned’:
• Formal process for detention – Mental
Health Act Assessment
• Representation - support from an
Independent Mental Health Advocate
• Opportunity for the detention to be
reviewed and monitored
• A Right of Appeal
Including
Your Rights if You Are ‘Deprived’:
 Formal process for deprivation of liberty
 Representation/advocacy during
assessment and if authorised (IMCA)
 Opportunity for the Deprivation of Liberty
to be reviewed and monitored
Including
 A Right of Appeal
Case Study: Paul
Including
Deprivation of Liberty Safeguards
Allow the lawful deprivation of liberty of an individual
(who lacks capacity) in a care home or hospital
• Must be necessary to prevent them coming to
harm (not others)
• Must be in their best interests (not the
organisation’s)
Including
• Must be proportionate to the risk of harm
Referral for DoL Authorisation
The managing authority
(the person or body with management responsibility for the
care home or hospital where the person is being, or may
be, deprived of their liberty)
must apply to the supervisory body
(the Local Authority)
for DoL authorisation where it appears that a person is, or
may be, deprived of their liberty.
Including
Deprivation of Liberty
For those people who are not in a Care
Home or Hospital but who are deprived of
their liberty, a S.16 Personal Welfare
Application to the Court of Protection will
be required.
(Includes 16 / 17 year olds)
Including
DLS Service
• DLS info line Tel : 01392 381676
• [email protected] (signed paper copy
will need to follow)
• DLS / MCA secure fax : 01392 383327
Call the team to discuss 3rd party referrals and
S.16 Court of Protection applications
Including
Be aware that the recent judgement has
increased the number of calls. Your call will
be dealt with as soon as possible
Case Studies
Including
Is the person being deprived of their liberty?
• Consider type of restraint, duration &
manner of implementation.
• Don’t forget that even those who are
compliant may be deprived of their liberty
Is it in their best interests?
Is it proportionate?
Is it the least restrictive option?
• .
Summary
• If a person lacks capacity to make a particular decision,
a decision will need to be made in their best interest
• When making best interest decisions for people who lack
capacity workers must follow the checklist and be able
to show what they did and why they did it
• Restraint is permissible if necessary to prevent harm to
the person, it is in the person’s best interests, it is
proportionate to the likelihood and seriousness of that
harm and there is no less restrictive alternative.
Including
• Deprivation of Liberty must be authorised by a Best
Interest Assessor.
Any Questions?
Including
Useful Websites
• http://www.devon.gov.uk/index/socialcarehealth
/adult-protection/mentalcapacityact.htm
• www.dh.gov.uk
• www.publications.parliament.uk
• www.cqc.org.uk
• www.scie.org.uk
• www.scils.co.uk Password available from
[email protected]
Including
Evaluation forms
Including