Behind closed doors: our insights into the real challenges of care provision Liz Anderson, October 2018 Mazars will discuss their recent work assisting care providers in preparing for inspection by the CQC and share insights into themes arising in terms of the core challenges and risks   Mazars will also consider how providers are applying the Mental Capacity Act 2005 the ongoing difficulties around the authorisation of Deprivation of Liberty Safeguards applications (and applications to the Court of Protection from settings where DoLS do not apply). Delegates will have the opportunity to share their own experiences and approaches

content Mazars Health and Social Care Advisory Team – what we do Themes from our recent work in terms of core challenges and risk An update on DOLS – where have we been, where are we now? An opportunity to discuss your experiences and approaches INTRODUCE MYSELF Idea is to prompt discussion – how do they handle some of these challenges? If their org is great they might have a laugh and a few minutes being smug, might otherwise give them thoughts of what they can do better/differently, how well they deal with these risks Either way – enjoy What I’m going to do is explain a bit about the kinds of work the team does and some themes emerging in our work about key challenges and risks to consider

WHAT WE DO Mock CQC inspection (or part inspection) Advice on compliance with CQC Key Lines of Enquiry Care quality assurance Advice on compliance with the Mental Capacity Act 2005 (including best interests decision making and DoLS) Advice on Safeguarding responsibilities Independent investigation (or review of investigation or action plan) introduce myself and background. A bit of background of the team Mock CQC E.g. working with housing provider some residential and supported living provision. Identified issues which would have compromised CQC rating (and patient safety) including – COSSH, food hygiene, mental capacity, response to service users’ health needs, providing meaningful activity Care quality assurance: An assignment for a major NHS commissioning organisation to design the board assurance framework Advice to NQB and CQC on Learning from Deaths and speaking widely on Mortality Governance/public reporting (MAB) Series of workshops for Non-Executive Directors & board members on transforming public reporting & governance of NHS deaths (MAB) Advice on safeguarding responsibilities: Working with a large health charity to review their SG arrangements and staff confidence in using them. Also harassment/bullying Working with group of nurseries following a SG incident. Identified issues in terms of policy/procedure, training, documentation, how staff act on identified concerns and how their actions are recorded/communicated Independent investigations: Major independent review of Mental Health and Learning Disability deaths at a large NHS Trust and the governance processes around them – high profile published report

Core challenges and risks Risk assessments in support plans Safeguarding COSHH Record keeping Access to healthcare services Understanding and application of the Mental Capacity Act 2005 DoLS Notes in separate doc

doLs – where have we been? Introduced the plug the “Bournewood gap” in relation to Article 5 ECHR Mental Health Act 2007 The Deprivation of Liberty Safeguards The Cheshire West judgement A system under strain – breaches of timescales Many care providers in a situation where they are depriving individuals of their liberty without any legal authorisation for doing so But care providers should still be applying!!! MH Act 2007 introduced amendments to MCA 2015 The Deprivation of Liberty Safeguards can only be used if the person will be deprived of their liberty in a care home or hospital. In other settings the Court of Protection can authorise a deprivation of liberty. Care homes or hospitals must ask a local authority if they can deprive a person of their liberty. This is called requesting a standard authorisation. There are six assessments which have to take place before a standard authorisation can be given. If a standard authorisation is given, one key safeguard is that the person has someone appointed with legal powers to represent them. This is called the relevant person's representative and will usually be a family member or friend. Other safeguards include rights to challenge authorisations in the Court of Protection, and access to Independent Mental Capacity Advocates (IMCAs).

Consideration of amendments doLs – where are we now? Law Commission report and recommendations March 2017 “Liberty Protection Safeguards” less role for the Court of Protection – by extending protections to supported living, domestic settings etc Involvement of AMCP only in “serious” cases Mental Capacity (Amendment Bill) published July 2018 role of care homes in assessments First reading Second reading Committee stage Report stage Third reading House of Lords House of Commons Consideration of amendments Royal Assent Law commission Liberty Protection Safeguards: The “responsible body” (widened to include NHS trusts/CCGs) can authorise deprivations in supported living/domestic therefore avoiding need to apply to Court or Protection Responsible body authorises its own applications avoiding the carousel (LA places, setting applies for authorisation, LA authorises) An Approved Mental Capacity Professional would only be involved in more “serious cases” where the arrangements are contradictory to the person’s wishes (goes back on Cheshire West) Role of care homes in government bill is a departure from the Law Commission proposals. Care home managers to be responsible for coordinating the 3 LPS assessments and submitting a statement to the local authority (Law Commission gave LA or NHS responsibility for assessing and authorising the placements they had commissioned). Extra duty on care home managers – will they have the skills or capacity? Could there be a conflict of interest by homes who might in some way benefit from more restrictive care plans e.g. under staffed. Doesn’t provide scrutiny of care homes

Your experiences/approaches How do you make sure the services you commission are safe and compliant? Mention their responsibilities as commissioners Make sure I take the notes on quality assurance methods

Questions