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Agenda Item No. 5

 

 

THE VALE OF GLAMORGAN COUNCIL

 

SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH): 21 MAY 2015

 

REFERENCE FROM CABINET: 13 APRIL 2015

 

C2734            DEPRIVATION OF LIBERTY SAFEGUARDS (AS) (SCRUTINY COMMITTEE - SOCIAL CARE AND HEALTH) - 

 

Cabinet was updated on the emerging implications for the Council of the Supreme Court judgement on the Cheshire West and Surrey cases in March 2014, which related to the use of the Deprivation of Liberty Safeguards 2009, and the impact upon the Social Services Directorate's capacity to meet statutory obligations under the Safeguards.

 

The Cardiff and the Vale Deprivation of Liberty Safeguards/Mental Capacity Act (DoLS/MCA) Team continued to fulfil the Supervisory Body responsibilities required for DoLS on behalf of Cardiff and Vale UHB, City of Cardiff Council and the Vale of Glamorgan Council.  This was overseen by a partnership management board consisting of senior representatives from each Supervisory Body. On behalf of the three Supervisory Bodies, the team:

  • Coordinated DoLS assessments as requested by Managing Authorities
  • Supervised and managed the workload of over 40 Best Interest Assessors;
  • Advised and supported health and social care teams across the sector in relation to MCA/DoLS issues;
  • Provided training for care homes and all in-patient sites across the hospitals of Cardiff and the Vale of Glamorgan.

Since the Supreme Court ruling, the team had seen a 10 to 15 fold increase in the number of referrals, particularly from Care Homes. 

 

Table A below showed the number of DoLS referrals per Supervisory Body:

 

REFERRALS (Table A)

2013/14

2014/15 (April 2014 to end Jan 2015)

% of the Team's Activity

Cardiff Council (Care Homes arranged by CCC)

32

640

48%

Vale Council (Care Homes arranged by VOG)

6

401

30%

C&V UHB (Hospital Wards)

55

285

22%

Total

93

1326

100%

 

Table B below showed the number of completed DoLS assessments per Supervisory Body.

 


ASSESSMENTS

(Table B)

Completed Assessments

% Activity

Outstanding Assessments

Cardiff Council

183

32%

457

Vale Council

119

21%

282

Cardiff and Vale UHB

267

47%

18

 

Table B outlined the number of completed assessments and the number of DoLS Authorisation Requests that were outstanding.  Because the more unpredictable nature of hospital settings lead to a higher proportion of Urgent Authorisations, hospital-generated DoLS referrals were prioritised.

 

Where a Managing Authority (Care Home for the Local Authority or Hospital Ward for the LHB) made an Urgent Authorisation following a sudden and unforeseen event, they were in effect authorising themselves to deprive a person of their liberty for up to 7 days.  The Managing Authority must request a Standard Authorisation from the Cardiff and Vale MCA/DoLS Team at the same time as issuing their own urgent Authorisation.  The team then had 7 days to undertake a full DoLS assessment to consider an ongoing Standard Authorisation.

 

Standard Authorisation requests were made where a Managing Authority had reason to believe that they were depriving a person of their liberty or would deprive a person of their liberty within the next 28 days.  The Supervisory Body then had 21 days to undertake a comprehensive DoLS Assessment to consider authorising the Deprivation of Liberty.

 

Supervisory Bodies were at risk of legal challenge for not complying with the statutory timescales within the DoLS process.  Essex County Council was recently ordered to pay damages of £60,000 following a breach of statutory timescales.

 

Team Capacity and Outstanding Assessments

 

Table B showed that the Vale of Glamorgan Council was currently operating with 282 outstanding Standard Authorisation requests.  This was an unacceptable position. A breakdown of team demand and capacity was provided below:

 

·         Number of requests for DoLS Authorisations per month was between 150 and 200 per month.

          -   Each DoLS assessment took between half and a full day to complete.

          -   Each DoLS assessment must then be authorised by a senior manager within the Supervisory Body (half-an-hour per authorisation).

·         Team Best Interests Assessors (BIAs) were currently undertaking approximately 60 to 70 DoLS assessments per month.

·         Rota BIAs were undertaking approximately 20 assessments per month.

·         A shortfall of between 50 and 100 DoLS assessments per month was leading to an increasing backlog of outstanding referrals.

 

The team would require an additional two full time Best Interest Assessors to reduce the backlog of care home DoLS and to ensure compliance for all new DoLS Requests.  This would cost the Cardiff and Vale Local Authorities in the region of £60,000 and £40,000 respectively.

 

People Living in Domestic Settings

 

Supported living arrangements provided care and support that may necessitate continuous supervision and control and require the person to live in a particular property where the support could be provided.  This would constitute a deprivation of liberty.  The table below set out the number of such places in each local authority area.

 

Area

(Table C)

Total Supported Living places

Total number of people potentially deprived of their liberty

Cardiff

345

202

Vale

150

75

 

It was noted that people living in supported accommodation stood outside the Deprivation of Liberty Safeguards, so care managers/care coordinators for all identified individuals should consider an application to the Court of Protection for authorisation of the care regime. On the basis of legal advice, the Vale had identified 2 cases and Cardiff 4 cases where individual care arrangements needed to be taken to the Court of Protection for consideration.

 

The Court of Protection was experiencing significant challenges in hearing the increased volume of cases and it has recently revised application arrangements to speed up the process.

 

At the meeting the Cabinet Member for Adult Services commented that this was a very important report that highlighted the increasing amount of Deprivation of Liberty Assessments that were being undertaken.

 

At the meeting the Director of Social Services commented that the report highlighted the need to balance competing priorities in terms of enhanced safeguards for vulnerable people and the considerable increase in the costs to the Council.

 

This was a matter for Executive decision

 

RESOLVED –

 

(1)       T H A T the emerging implications of the Cheshire West judgement in respect of arrangements for safeguarding vulnerable adults who are unable to consent to their health and social care arrangements and the increased risk to the Council of legal challenge where statutory timescales are not met be noted.

 

(2)       T H A T the report be referred to the Scrutiny Committee (Social Care and Health) for information.

 

Reasons for decisions

 

(1)       To note the impact of the Supreme Court Ruling which extended the scope of the Deprivation of Liberty Safeguards whereby the local authority had a duty to ensure that all care arrangements for people lacking mental capacity did not deprive a person of their liberty without an independent legal process to authorise the care regime.

 

(2)       To ensure that members of the Scrutiny Committee (Social Care and Health) could continue to exercise oversight of the service and the risks to the Council.

 

 

 

Attached as Appendix – Report to Cabinet – 13 APRIL 2015