1. Including The Deprivation of Liberty Safeguards Practitioner Level

2. Including Toilets Fire Procedure Smoking Mobile Phones / Devices Finishing Time Breaks Housekeeping

3. Including Training Transfer Getting learning into practice “50% of learning fails to transfer to the workplace” (Sak, 2002) “The ultimate test of effective training is whether it benefits service users” (Horwath and Morrison, 1999)

4. Including Training Transfer Individual Characteristics Training Design and Delivery Workplace Factors

5. Including Introductions Name Place and nature of work What do you want to get out of today’s session?

6. 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

7. Including Ground Rules 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.

8. Including 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.

9. 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

10. 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 Best Interest decision (even if we think it is unwise) (multi-agency)

11. Including Best Interest Checklist 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

12. Including 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.

13. Including Case study – Val & Vernon

14. 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.

15. Including The Best Interest Decision What are the options? How restrictive are they?

16. 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)

17. 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 Section 6 (4), MCA, 2005

18. Including Examples of Restraint Chemical Financial Manual Physical/ environmental e.g. Barriers, Locks Removal of equipment, clothing Preventing contact IT / phone removal Psychological

19. Including 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 - (Plus Principles 4 & 5)

20. Including 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

21. Including Limits of Section 5 Decisions Restriction/ Restraint Type Duration Manner Deprivation of Liberty Best Interest Decision -> -> -> -> -> -> -> -> -> Deprivation of Liberty Authorisation

22. Including Human Rights Act, 1998 “All human beings are born free and equal in dignity and rights.” 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.

23. Including Human Rights: A Balancing Act 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.”

24. Including Human Rights Activity Match the statements with the Rights

25. 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 ECtHR – illegal - no formal procedure for admittance or appeal against detention

26. Including 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

27. 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

28. 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

29. 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 A Right of Appeal

30. Including Case Study: Paul

31. Including 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) Must be proportionate to the risk of harm Deprivation of Liberty Safeguards

32. Including 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.

33. 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)

34. Including DLS info line Tel : 01392 381676 dols@devon.gov.uk (signed paper copy will need to follow)dols@devon.gov.uk DLS / MCA secure fax : 01392 383327 Call the team to discuss 3rd party referrals and S.16 Court of Protection applications Be aware that the recent judgement has increased the number of calls. Your call will be dealt with as soon as possible DLS Service

35. Including Case Studies 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?.

36. Including 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. Deprivation of Liberty must be authorised by a Best Interest Assessor.

37. Including Any Questions?

38. Including http://www.devon.gov.uk/index/socialcarehealth /adult-protection/mentalcapacityact.htmhttp://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 workforcedevelopmentsafeguarding-mailbox@devon.gov.ukwww.scils.co.uk Useful Websites

39. Including Evaluation forms