The much-criticised Deprivation of Liberty Safeguards are helping
uncover failings in the care of vulnerable people that have been missed
by other assessments, according to professionals.
A survey of 92 best interests assessors (BIAs),
the group of mostly social workers qualified to coordinate DoLS
assessments, revealed the most commonly reported ‘positive outcome’ from
BIA input was the reversal of incorrect decisions that people lacked
capacity to make decisions about their care.
BIAs also shared examples where DoLS assessments had led to people
being supported to return home, sometimes from inappropriate care home
placements, and instances where the checks had uncovered problems in the
way the Mental Capacity Act was being used in care homes and hospitals.
The DoLS are used to authorise deprivations of liberty in care homes
and hospitals, with BIAs playing a pivotal role by coordinating cases
and carrying out the critical best interests assessment.
The survey was carried out by Steven Richards, Director at Edge
Training, after a Law Commission consultation found most respondents
felt the DoLS had “failed to deliver improved outcomes for people”. The
Law Commission consultation received 43 responses from BIAs.
Richards asked BIAs for up to 10 examples of positive outcomes, and
received 468 submissions. He said the findings revealed how BIAs had
managed to identify and address poor care and “overly restrictive”
practice.
“Where other assessments (care reviews for example) and other health
or social care staff have failed to identify these very real and
concrete problems, it is the BIA assessment – a direct independent
legally based professional assessment – that does,” he said.
“The assessment also provides a means to change the situation and deliver improved outcomes for people. As one respondent noted: ‘I
feel extremely strongly that this safeguard has and continues to raise
the standard of care for individuals who lack capacity.’”
The snapshot survey will trigger questions as to how common these
positive outcomes are in a system that has seen DoLS caseloads rise from
10,900 in 2013-14 to more than 100,000 a year since the Supreme Court’s
March 2014 ‘Cheshire West’ ruling effectively lowered the threshold for
deprivation of liberty.
The pressure the ruling has placed on services, with huge case
backlogs racked up by local authorities, led ministers to order the Law
Commission to develop proposals to replace the DoLS.
The commission will present its final proposals by the end of the
year but an interim statement published in May opened the door for the
independent scrutiny role currently offered by BIAs to be radically
pared back. The additional oversight could be restricted to a defined
group, rather than all people who meet the deprivation of liberty
threshold.
The government has put pressure on the commission to cut the costs of
any DoLS replacement, and delivered a highly critical response to an
initial set of more comprehensive draft proposals.
There are concerns this will lead to any new system being
increasingly reliant on assessments from care staff, without additional
scrutiny.
In his report, Richards said: “What appears not to be working
effectively in many cases are existing care assessments and reviews for
people in care homes or hospitals.
“The 400+ examples given in the survey appear to be for many for
people who had had care assessments and reviews of care already but
these had failed to identify and address concerns that BIAs subsequently
found during their assessment.
“Why? Because they do not have the legal rigour or focus of a BIA
assessment, they can be undertaken by unqualified staff and may not even
involve the person having a face to face assessment as under DoLS for
the BIA assessment. A serious concern therefore is that one of key
proposals to replace DoLS is to rely on these assessments instead.”
Richards acknowledged his survey had limitations, most notably that
it only asked practitioners to submit positive examples of outcomes, and
said he would welcome further research in this area.
DoLS checks ‘exposing care failings missed by other assessments’ https://t.co/cdBkwPDnJ8— edithellen (@edithellen2013) September 14, 2016
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