1. Deprivation of Liberty Safeguards Susanne Moffatt Team manager DOLS – BIA Team / Safeguarding Manager East Lancs

2. Dignity in Care and DOLS What is DOLS? DOLS was introduced in April 2009 as a supplement to the Mental Capacity Act

3. Who is covered by the Safeguards? -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

4. Capacity? People who lack capacity are likely to be those with: 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. 5 Principles Presume capacity Least restrictive Unwise decisions Maximise capacity Best interest

6. Why DOLS? 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

7. What is a DOL? 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

8. Continuum of Restriction Liberty >>> Restriction >>>Deprivation

9. The Process made simple 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

10. 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

11. Case Study 1 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?

12. 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?

13. 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.

14. 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.

15. 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.

16. 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?

17. Answer Yes, because it may be a DOL but without undertaking a full best interest assessment this could not be ascertained.

18. 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?

19. 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.

20. 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.

21. 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?

22. 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.

23. 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.

24. 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

25. 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 csc.acscustomerservices@lancashire.gov.uk

26. 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

27. Dignity in Care and DOLS THANK YOU