1. Including 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 Pre-read – 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 Human Rights Act, 1998 “All human beings are born free and equal in dignity and rights.” The HRA 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 It also establishes if, when and how our rights may be restricted or withdrawn.

10. Including Human Rights: A Balancing Act Some rights may be withdrawn or limited ‘in accordance with a procedure prescribed by law when necessary in a democratic society in the interests of national security, public safety or the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.’

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

12. 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)

13. 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.

14. Including Case study – Val & Vernon

15. Including Human Rights Val lacks capacity in many areas of her life. No one person has legal authority (e.g. LPA) to make decisions on her behalf. In which areas of her private life do you think the State has a duty to intervene in order to protect her Rights or the rights of others?

16. Including The Best Interest Decision What’s best for Val?

17. Including The Best Interest Decision

18. Including What could you do if Val refuses: 1.To go to the care home? 2.To stay at the care home? 3.To take her medication?

19. Including Break

20. 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

21. Including Examples of Restraint Chemical Financial Physical Barriers Removal of equipment Preventing contact No communications IT / phone removal Psychological

22. 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

23. 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

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

25. Including Key Considerations for DoL Constant supervision and control? Complete and effective control over care and movement for a significant period? Prevented from maintaining contact with the outside world or maintaining social contacts? Prevented from moving to another care setting or being taken out? Prevented from leaving or being released to the care of others? Cumulative effect of all the restrictions amount to deprivation of liberty even if the restrictions considered individually would not?

26. Including Your Rights if You are Arrested: be told in a language you understand why you have been arrested and what charges you face have a trial within a reasonable time go to court to challenge your detention if you think it is unlawful compensation if you have been unlawfully detained.

27. Including Your Rights if You are ‘Sectioned’: Be told in a language you understand why you have been detained and what the treatment is for Be told about any side-effects Support from an Independent Mental Health Advocate To appeal against your detention if you feel it is unlawful

28. 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

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 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

31. 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.

32. 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 Safeguarding Adults Team, The Annexe, County Hall, Topsham Road, Exeter EX2 4QR. Tel: 01392 382339 DLS Service

33. Including Case Studies In groups look at the following case Studies and decide: Does this appear to be restraint under s. 5 of the MCA or is the person being deprived of their liberty? Consider type of restraint, duration, effects, manner and purpose. What are the good practice issues ?

34. 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 decisions for others workers must 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.

35. Including Any Questions?

36. 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

37. Including Evaluation forms