Deprivation of Liberty Safeguards Review (DoLS) Wales

The Care and Social Services Inspectorate Wales (CSSIW) has published with Healthcare Inspectorate Wales (HIW) a review into the use of Deprivation of Liberty Safeguards (DoLS) across Wales:

National Review of the use of Deprivation of Liberty Safeguards (DoLS) in Wales

The review found that there needs to be a greater awareness and understanding in care homes and hospitals of how the Safeguards can be used to support people who lack mental capacity and protect their human rights, though this is improving. It also found that training across Wales was fragmented and needs to be better coordinated.

The review was commissioned following the third annual monitoring report, 2011/12 which highlighted continued variations and inconsistencies in the number of applications by Health Boards and Local Authorities across Wales. It took place shortly after the Supreme Court judgment in March 2014 in the case of Cheshire West which has led to an increase in applications across Wales.

Key findings include:

• The Review found examples of good practice across Wales; in some cases this had led to people being able to return to their own home in the community;
• There was a lack of awareness and understanding of the Safeguards in particular within care homes and amongst some  hospital staff though the situation in hospitals is improving.  Some thought that making an application would reflect badly on their organisation, rather than a means of supporting people who do not have mental capacity and their families to make decisions about their care and support arrangements;
• The training and skills development for staff involved in the delivery of the Mental Capacity Act (MCA) and DoLS was very fragmented;
• The use of conditions attached to the Safeguards was very variable and some areas rarely used them;
• Information for the public was not always available in a clear format;
• The role of Dols co-ordinators in hospitals and local authorities and their personal commitment had the biggest impact on the quality and quantity of applications.

Key recommendations include:

• Local authorities and health boards need to carry out an audit to make sure that authorisations are used when needed and that they focus on improving outcomes for people, including reducing or removing the deprivation;
• Local authorities and health boards should develop robust quality assurance and reporting mechanisms to make sure that applications, assessments and authorisations comply with legislation, guidance and case law;
• Local authorities, health boards, care homes and hospitals should provide accessible information about DoLS and the MCA in a range of formats;
• Local authorities and health boards should have in place a workforce development strategy to make sure  they can meet the requirements of the MCA, DoLS legislation and the Supreme Court Judgment;
• An accredited BIA training programme needs to be established and the number of BIAs needs to increase as well as making sure Wales has the quantity and range of professionals to carry out this function;
• Local authorities and health boards should promote the role of the IMCA and encourage a better understanding of their potential to support vulnerable people in often very challenging circumstances.

Imelda Richardson, Chief Inspector of Care and Social Services Inspectorate Wales said:

The use Deprivation of Liberty Safeguards should not be seen as an add-on, but as an essential part of care practice.

The Deprivation of Liberty Safeguards were established to protect the human rights of the most vulnerable people in society. Making sure that people who lack capacity are helped to make their own decisions and are kept safe is essential, but they should not be subject to overly restrictive care arrangements that affects the quality of their life.

Kate Chamberlain, Chief Inspector of Healthcare Inspectorate Wales said: Depriving an individual of their liberty is a decision that requires careful and thorough consideration. The Safeguards provide a framework for medical and care professionals when deciding if depriving a person of their liberty is the safest and most appropriate way to care for them. 

It is therefore vital that the Safeguards are used appropriately, are well understood and embedded in every day practice. The findings of the National Review identify areas where improvements can be made to ensure those  who may become subject to the Safeguards are protected.