It appears that even though there is current legislation on Deprivation of Liberty Safeguards and Mental Capacity not enough is clearly understood by Care Services and the staff working within the Care Sector.
Campaigners have voiced concern that some residents, including dementia patients, are being wrongly denied their freedom and treated as “second-class citizens” – for example, by being locked in their rooms.
In 2015-16, care homes in England asked local councils to approve 195,840 applications to deprive a resident of their liberty – most of them older people – under the deprivation of liberty safeguards (DoLS) legal framework. The figure was the highest since the system began in 2009 and a big jump on the 137,540 applications in the previous year.
Hospitals occasionally seek permission to keep a patient locked up, but care homes make by far the most DoLS applications and have been entering requests much more regularly since a supreme court ruling in March 2014. That judgment, which clarified the form of an “acid test” for what constitutes a deprivation of liberty, sparked an immediate and sustained increase in the number of applications.
DoLS requests are usually made to avoid someone harming themselves. Councils have to assess if applications have fulfilled six criteria and respond within 21 days, or within seven days if it is an urgent case. The system is meant to ensure independent assessment of decisions to deny the liberty of people deemed to lack the mental capacity to consent to the care they receive.
Of last year’s 195,840 applications, councils processed 105,055. They approved 76,530 (73%) of those and rejected the rest as inappropriate – a big rise on the 10,520 rejected in the previous year. However, applications are usually considered only after someone has been denied their freedom, which means that last year about 28,500 people were restrained, locked in or given medication before the move was deemed inappropriate.
Martina Kane, senior policy officer at the Alzheimer’s Society, said: “The safeguards granted by deprivation of liberty safeguards are an essential part of protecting the right to liberty of people with dementia. It is disgraceful that nearly 30,000 people were wrongfully deprived of their liberty, and in over a quarter of cases practitioners are still locking people in, sedating them, restraining them or otherwise treating them as second-class citizens.
“Depriving someone of their liberty should always be a last resort and only ever done in someone’s best interests. It is crucial that the quality of care provided to people with dementia is improved to ensure that.”
Understaffing in care homes could lead to every door in an entire premises being locked overnight, Kane added.
The latest annual DoLS figures collated by NHS Digital show that applications are more likely to be made for older age groups; 44% are for people aged 85 or over. Many of these older people suffer from dementia.
The Local Government Association, which represents councils, said the figures were of great concern. “These alarming figures are further evidence of the significant added pressure facing local government as a result of increased DoLS assessments, which is estimated to be costing councils more than £170m a year,” a spokeswoman said.
“The government needs to fulfil its promise to overhaul the system as a matter of urgency and provide adequate funding so that councils have the time and money to do this properly.”