E-Newsletter for Managing Authorities January 2016
Welcome to the January newsletter! Please share this newsletter with interested colleagues.
Firstlywe wish you, your residents and families a very a Happy New Year.
We would also wish a speedy return to normal, if you or your family have been affected by the recent floods.
ADASS Screening Tool
In the November Newsletter, we document the process around DoLS applications in light of the ADASS screening Tool.And we would like to thank you the Managing Authorities in working with this screening tool when submitting your applications. And also the referrals we receive are much more informative enabling us to process applications much more efficiently.
Recent CQC Audit on monitoring the Deprivation of Liberty Safeguards in 2014/15
Findings
- There has been a tenfold rise in the DoLS application in 2014/2015.(Since the ruling by the Supreme Court March 2014 (Cheshire West) applications went from 13,715 in the year ending March 2014 to 137,540, by March 2015
Provider’s use of DoLS is variable. Also staff awareness of DoLS varies from provider to provider, some providers do not have clear up-to-date policies and process in place .This includes making sure that peoples capacity is properly assessed and decisions are made in their best interest. The CQC continue to find examples of providers who may be unlawfully depriving people of their liberty .There is also evidence of low notifications to the CQC about the outcomes of DoLS applications and there outcomes when known
- Improvement is needed across health and social care sector. This is around the implementation of the process under the DoLS and wider MCA this is essential to make sure that people are receiving treatment that is in line with the law and is in their best interest.
Actions and Recommendations for Providers
- Take action to meet the requirements of the MCA, in line with the Code of Practice for it and the DoLS. This includesproviders making sure that their staff understands MCA including the DoLS, have access to training, consistently undertake capacity assessments, where appropriate for them to do so, and apply best interest decision-making process for people who do not have capacity.
- Make sure that as providers they have in place clear policies and processes relating to DoLS.
- Continue to request authorisations when they think that people may need to be deprived of their liberty, while always seeking the less restrictive options to meet individual needs.
- Make sure that providers notify CQC about DoLS authorisation applications and their outcomes when they are know so that the CQC can fulfil their monitoring role.
The report also recognises that some providers are doingwell, but they also note that the variation they found in providers practice in the implementation of DoLS, is unacceptable as DoLS remain an important protection for individuals.
The report also documents that the CQC believes that the current pressure on the system is unsustainable. They welcome the Law Commission consideration on the process for authorising DoLS and await its final proposals for reforming the system.
For the full report /summary please go to the website
Mental Capacity Act Care Planning Guidelines.
Following on from the recent CQC Audit where they highlighted the importance of providers adhering to the principles of the Mental Capacity Act,it’s worth reemphasising when writing care/support plans for people who may lack capacity,the importance of ensuring that the 5 principles of the Mental Capacity Act is imbedded into the body of the plans . It is important to note that a blanket statement at the beginning of someone’s care /support plan, stating they have not got capacity, is not acceptable as their capacity needs to be establish for each element of the plan.
“For example all care / support plans can and should:
• consider questions of autonomy and liberty
• encourage staff to maximise people’s capacity to be involved and to make
decisions.
• respect the right of people, who have capacity, to make unwise decisions.”
Also it’s worth remembering that “Mental Capacity is ‘decision-specific’. A person may have capacity to make decisionsabout some aspects of their care and support but not others. When writing plans you should look at acquiring consent to each element of the care plan where the person is able to give it.
Where there are restrictions in place they need to be least restrictive also when they will be reviewed.
Where a person lacks capacity to express their choices, how their families and others who are interested in their welfare have been consulted.
Also Best Interest decisions need to be noted in the plan
For more information please go to the web site
planning-report.pdfc
Respite Dates
Just a reminder that if you are sending a referral for a respite stay, please can you make the dates that the individual is staying, clear on the form 1 and also document the home address, advising family that the individual may need to be assessed at their home address if they are unable to arrange their assessment in the home.
Supported Living DoLS
We are currently putting together proposals regarding the next steps around DoLS authorisation in regards of people living in Supported Living .The DoLS will need to be processed via the Court of Protection, a different system to the one for Care Homes and Hospitals.
21A Part 8 change of care plans
A decision to deprive a person of liberty may be challenged by the relevant person or by the relevant person’s representative, by an application to the Court of Protection. However managing authorities (and supervisory bodies) should always be prepared to try to resolve disputes locally and informally. Please ensure that the care plan addresses areas where the individual demonstrates a disagreement with part of the regime, and actions taken to ensure that the individual’s concerns have been addressed
Conditions and RPR Audit
Between August and beginning of December,80 of the people subject to DoLS who had conditions identified as part of their authorisation were part of the above audit. To ensure the conditions laid down in the DoLS authorisation were being acted upon and also that the relevant person was being visited by their representative at least every 6 weeks. The findings were very positive and encouraging.
The methodology was to identify people with conditions and who were their RPR on our DoLS spread sheet .The relevant care facility was then contacted. Once contacted, they were ask about the persons care/support plan, to see if the conditions were imbedded into the plan also asked the staff in charge were they aware of the conditions. Also, did the RPR visit at least every 6 weeks, and how would these visits been evidenced.
The outcomes to the Audit was as follows
RPR
One person identified had no RPR; the person was referred to Cloverleaf Advocacy for a paid RPR
Seven people had paid RPR’s who visit every 6 weeks at least and write reports that are sent to the DoLS team and are read and action upon if need be and filed electronically.
The majority of people were visited by their RPR at least every 6 weeks most visited weekly, all visits noted in the Homes signing in book or in the persons support plan.
These outcomes are very encouraging; we will need to review the RPR’s identified who do not physically visit every 6 weeks.
Conditions
There were approximately 108 conditions identified for the 80 people audited.
2 of the conditions were not adhered to (both are currently being followed up)
106 had been meet.
Conclusions.
As mentioned this is a very encouraging audit, all Homes bar one were aware of the DoLS conditions for their Residents and they had acted upon them. The conditions varied from referrals to other professional teams for advice and support, for the person needing to participation in more activities, to a person needing a different type of bed etc.
Well doneall!
Law Commission Review
A recent updateon the review, as published in a recent Community Care magazine article states:
“The government feels the Law Commission’s proposals for a legal framework to replace the deprivation of liberty safeguards could be “unnecessarily” complex and costly to deliver.
The Department of Health’s response to a consultation on the proposals raised concerns that parts of the Law Commission scheme failed to meet ‘three tests’ – that any system should be user-friendly, a good use of public money and deliver ‘real’ benefits to people lacking capacity to consent to their care arrangements.
Frontline staff have said reforms to the current system are badly needed as the pressure on deprivation of liberty caseloads is unsustainable.
The Law Commission’s project has long been seen as the best hope of an improved system. However, the government’s critical response to the consultation suggests that unless substantial changes are made, ministers won’t back the commission’s final proposals. The situation raises questions over whether legislative change will happen. Under the current timetable, the commission is due to publish a draft parliamentary bill setting out its final proposals next year, and the government will decide whether to adopt, reject or amend this.
The DH response expressed fears that some of the Law Commission’s proposals would create more legislation to improve practice around existing laws, such as the Care Act and Mental Capacity Act. For these issues, officials believe working with professionals to achieve “cultural” change may be a better approach.
Signalling a wish for the commission to come up with a simpler, cheaper system in the final proposals put to ministers in December 2016, the DH said: “We are concerned that the proposed system is unnecessarily complex”.
Any revisions to the proposals should also be ‘simulation tested’ with professionals, service users and families to make sure they work in practice, it added.”
Paperwork
A reminder of the current paperwork.
Forms 1 and 4, urgent and standard are now combined and form 2 is much shorter please find templates below.
Usual Reminders !
When someone is subject to a DoLS dies, please let the DoLS office and Coroner’s office know immediately.
Also the DoLS team need to know when someone is discharged from hospital or moved from one Care Home to another. Any changes in Residency has an impact on the DoLS.. Thank you very much for your cooperation in these matters.
Also please note if a person needs an interpreter to support them in the DoLS assessment process please enter this on the referral form, to enable the DoLS team to arrange for an interpreter to be present during the assessments.
If you give us an email address to contact you, please make sure it’s an address that is checked regularly
If you aware of any good practice around MCA or DoLS we would be very interested to share in the future newsletter
Website
Please visit our website,all the forms and supporting information is on the site If you feel we could improve the content in any way please let us know. Shortcut to the site is
Contact Us
The NYCC MCA/DOLS Office is open:
Monday –Thursday 8:30am- 5:00pm and Friday 8:30am- 4:30pm
DoLS helpline number 01609 536829. Calls will be monitored and returned between 10am-2pm. Please note that this number is for follow up/queries only. We have a general email address which is monitored for queries but not referrals –
If you require DOLS authorisation outside of these times or during a bank holiday period please process the application in the usual way and it will be acted on upon our return.
Sending Referrals
All completed forms should be faxed to our Customer Service Centre on: 01609 532009
Or emailed to: .
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