Including

The Deprivation of Liberty Safeguards

Practitioner Level

Including

Toilets Fire ProcedureSmoking

Mobile Phones / Devices

Finishing Time

Breaks

Housekeeping

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)

Including

Training Transfer

Including

Introductions

• Name

• Place and nature of work

• What do you want to get out of today’s session?

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

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.

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.

Including

Emerging Changes / Considerations

• Many of you will be aware that there has been a Supreme Court Judgement “Cheshire West”

• This is currently being considered on a national basis and some elements are being reflected in this training but can not be discussed at length.

• Additional information is available by organisations such as CQC web site and decisions need to be taken by providers at a local level at this time

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)

Including

Best Interest Checklist• Assess whether the person will regain capacity• Encourage participation• Find out the person’s views (past and present wishes,

feelings, values and beliefs; including any advance decisions to refuse treatment)

• Identify all relevant circumstances• Consult others (IMCA?)• Avoid discrimination• Avoid restricting rights• Don’t be motivated by a desire to bring about the

person’s death

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.

Including

Case study – Val & Vernon

Including

Human Rights & Mental Capacity

• Vernon has been admitted to hospital. Val lacks capacity to make decisions about her care needs.

• No-one has any legal authority (i.e. Lasting Power of Attorney or Deputyship) to make decisions on her behalf.

• A decision will need to be made about what is in Val’s Best Interests.

Including

The Best Interest Decision

What are the options?

How restrictive are they?

Including

What could you do if Val refuses:

1. To go to the care home?

2. To take her medication?

3. To stay at the care home?

(Least to most restrictive)

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

Section 6 (4), MCA, 2005

Including

Examples of Restraint • Chemical • Financial• Manual • Physical/ environmental e.g. Barriers, Locks• Removal of equipment, clothing • Preventing contact • IT / phone removal • Psychological

Including

RestraintAny 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

- (Plus Principles 4 & 5)

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

Including

Limits of Section 5 Decisions

Best Interest Decision -> -> -> -> -> -> -> -> -> Deprivation of Liberty Authorisation

Including

Human Rights Act, 1998

“All human beings are born free

and equal in dignity and rights.”

The HRA is known as a higher law.

It 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.

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.”

Including

Human Rights Activity

Match the statements with the Rights

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

Including

Key Considerations for DoL• Is the Person under continuous

supervision and control?

• Is the Person free to leave (or would they be if they could)?

• Is the Placement imputable to the State?

• Impact, relative normality and purpose are no longer relevant

Including

Your Rights if You are Imprisoned:

• Formal process for detention – a trial

• Representation - access to a solicitor during the Criminal Justice process

• Opportunity for the detention to be reviewed - parole

• A Right of Appeal

Including

Your Rights if You are ‘Sectioned’:

• Formal process for detention – Mental Health Act Assessment

• Representation - support from an Independent Mental Health Advocate

• Opportunity for the detention to be reviewed and monitored

• A Right of Appeal

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

Including

Case Study: Paul

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

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.

Including

Deprivation of Liberty

For those people who are not in a Care Home or Hospital but who are deprived of

their liberty, a S.16 Personal Welfare Application to the Court of Protection will

be required.

(Includes 16 / 17 year olds)

Including

• DLS info line Tel : 01392 381676• dols@devon.gov.uk (signed paper copy

will need to follow)

• DLS / MCA secure fax : 01392 383327

Call the team to discuss 3rd party referrals and S.16 Court of Protection applications

Be aware that the recent judgement has increased the number of calls. Your call will

be dealt with as soon as possible

DLS Service

Including

Case Studies Is the person being deprived of their liberty?• Consider type of restraint, duration &

manner of implementation. • Don’t forget that even those who are

compliant may be deprived of their liberty

Is it in their best interests?

Is it proportionate?

Is it the least restrictive option? • .

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 best interest decisions for people who lack capacity workers must follow the checklist and 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.

Including

Any Questions?

Including

• http://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.uk

Useful Websites

Including

Evaluation forms