Mental Capacity and Deprivation of Liberty - Consultation Analysis i Contents Paragraph Page GLOSSARY 1 CHAPTER 1: INTRODUCTION 3 The consultation process 1.2 3 CHAPTER 2: ANALYSIS OF THE DEPRIVATION OF LIBERTY SAFEGUARDS 6 Provisional Proposal 2-1 2.1 6 Should the DoLS be replaced? 2.2 6 General comments on “protective care” 2.22 10 Alternative schemes 2.33 12 Terminology 2.38 13 Provisional Proposal 2-2 2.49 15 Introduction of a new code of practice 2.50 15 Updating the existing mental capacity act code of practice 2.60 17 General comments 2.64 17 General Cheshire West 2.67 18 CHAPTER 3: PRINCIPLES OF PROTECTIVE CARE 21 Question 3-1 3.1 21 CHAPTER 4: THE SCOPE OF THE NEW SCHEME 25 Provisional Proposal 4-1 4.1 25 Domestic settings 4.11 26 Day centres 4.20 28 Question 4-2 4.25 29 CHAPTER 5: SUPPORTIVE CARE 31 Provisional Proposal 6-1 5.1 31 Provisional Proposal 6-2 5.17 33 Provisional Proposal 6-3 5.28 35 Provisional Proposal 6-4 5.42 38 Provisional Proposal 6-5 5.55 40 Provisional Proposal 6-6 5.71 43 Provisional Proposal 6-7 5.79 45 Question 6-8 5.89 46 Question 6-9 5.101 49 ii Question 6-10 5.115 52 Question 6-11 5.130 55 Question 6-12 5.148 58 Provisional Proposal 6-13 5.161 60 Question 6-14 5.173 62 Views of the regulators 5.183 63 General Comments 5.186 64 CHAPTER 6: RESTRICTIVE CARE AND TREATMENT 66 Provisional Proposal 7-1 6.1 66 Provisional Proposal 7-2 6.11 68 Provisional Proposal 7-3 6.20 70 Question 7-4 6.34 73 Question 7-5 6.44 75 Provisional Proposal 7-6 6.50 77 Question 7-7 6.60 79 Question 7-8 6.69 81 Provisional Proposal 7-9 6.81 83 Question 7-10 6.92 85 Provisional Proposal 7-11 6.103 87 Terminology 6.121 90 Eligibility to become an Approved Mental Capacity Professional 6.125 90 Provisional Proposal 7-12 6.133 92 Provisional Proposal 7-13 6.143 93 Question 7-14 6.146 94 Provisional Proposal 7-15 6.151 95 Provisional Proposal 7-16 6.161 97 Provisional Proposal 7-17 6.176 100 Views of the regulators 6.186 101 “Approved Mental Capacity Professional” training 6.187 102 Provisional Proposal 7-18 6.197 103 Views of the regulators 6.203 104 Question 7-19 6.205 105 Provisional Proposal 7-20 6.217 107 Provisional Proposal 7-21 6.224 108 Question 7-22 6.238 111 Question 7-23 6.250 113 Provisional Proposal 7-24 6.263 115 Provisional Proposal 7-25 6.272 116 Keeping the person’s care and treatment under review 6.273 117 Discretion to discharge 6.280 118 Provisional Proposal 7-26 6.283 119 Provisional Proposal 7-27 6.290 120 Provisional Proposal 7-28 6.298 121 Provisional Proposal 7-29 6.307 122 Provisional Proposal 7-30 6.314 124 iii Provisional Proposal 7-31 6.329 127 Provisional Proposal 7-32 6.341 129 Question 7-33 6.351 131 Question 7-34 6.360 132 Provisional Proposal 7-35 6.370 134 Provisional Proposal 7-36 6.377 135 General Chapter 7 6.388 137 CHAPTER 7: HOSPITAL SCHEME 139 Provisional Proposal 8-1 7.1 139 The acid test in hospitals and hospices 7.9 140 Hospices 7.15 141 Psychiatric hospitals 7.20 142 Provisional Proposal 8-2 7.22 143 The 28 day time limit 7.23 143 The role of health staff 7.29 144 Support for a hospital scheme 7.34 145 General comments 7.37 145 Question 8-3 7.44 147 Advocacy 7.45 147 Second medical opinions 7.52 148 General Comments 7.57 149 CHAPTER 8: ADVOCACY AND THE RELEVANT PERSON’S REPRESENTATIVE 151 Provisional Proposal 9-1 8.1 151 Provisional Proposal 9-2 8.10 153 Question 9-3 8.24 155 Question 9-4 8.34 157 Provisional Proposal 9-5 8.43 159 Provisional Proposal 9-6 8.54 161 Provisional Proposal 9-7 8.63 163 Provisional Proposal 9-8 8.71 164 Question 9-9 8.80 166 Question 9-10 8.88 167 General Comments 8.98 169 CHAPTER 9: THE MENTAL HEALTH ACT INTERFACE 171 Provisional Proposal 10-1 9.1 171 Fusion law 9.14 173 Mental Health Act and community powers 9.20 174 Guardianship 9.25 175 iv Learning Disabilities 9.30 176 Section 117 after-care 9.33 177 General comments 9.36 177 CHAPTER 10: RIGHT TO APPEAL 179 Provisional Proposal 11-1 10.1 179 Problems in the court of protection 10.2 179 Emergency Gains 10.4 180 Accessibility for users 10.8 180 Flexibility and simplicity 10.10 181 Resources 10.12 181 Disagreement with the proposal 10.15 182 Alternative reforms 10.21 183 Provisional Proposal 11-2 10.24 184 Question 11-3 10.32 185 Objections to the deprivation of liberty 10.33 185 Capacity and best interest disputes 10.36 186 Human rights treatment 10.39 186 Serious medical treatment 10.40 187 Other comments 10.42 187 Provisional Proposal 11-4 10.49 188 Question 11-5 10.64 191 Question 11-6 10.71 192 Paper reviews 10.72 192 Single member tribunals 10.76 193 Straightforward cases 10.81 194 Other comments 10.83 194 Question 11-7 10.87 195 Question 11-8 10.102 198 Question 11-9 10.116 200 Lack of availability of non-means tested legal aid 10.117 200 Legal aid funding for representatives and family members 10.120 201 Parity with the mental health act 10.125 202 Other issues 10.129 202 General comments 10.134 203 CHAPTER 11: SUPPORTED DECISION-MAKING AND BEST INTERESTS 205 Provisional Proposal 12-1 11.1 205 Provisional Proposal 12-2 11.20 208 v CHAPTER 12: ADVANCE DECISION-MAKING 212 Provisional Proposal 13-1 12.1 212 Provisional Proposal 13-2 12.20 215 Question 13-3 12.29 217 General comments 12.42 219 CHAPTER 13: REGULATION AND MONITORING 221 Provisional Proposal 14-1 13.1 221 Responses from the DoLS regulators 13.18 224 Question 14-2 13.22 225 Responses from regulatory bodies 13.28 225 Question 14-3 13.30 226 Responses from the DoLS regulators 13.39 228 General 13.42 228 CHAPTER 14: OTHER ISSUES 230 Provisional Proposal 15-1 14.1 230 Question 15-2 14.17 233 Question 15-3 14.29 236 Current difficulties in identifying the supervisory body 14.30 236 Areas which could be clarified under the new scheme 14.35 237 Question 15-4 14.40 238 Question 15-5 14.48 239 Provisional Proposal 15-6 14.63 242 Question 15-7 14.78 245 Question 15-8 14.95 247 General comments on our coroners reforms 14.116 251 Personal experiences 14.117 251 The impact of Cheshire West 14.124 252 Question 15-9 14.129 253 Question 15-10 14.144 256 Question 15-11 14.149 257 CHAPTER 15: OTHER COMMENTS 259 Implementation of the mental capacity act and DoLS 15.2 259 Implentation of the proposed protective care scheme 15.8 260 Fluctuating capacity 15.10 260 personal experiences 15.12 261 APPENDIX 1: LIST OF CONSULTEES 263 APPENDIX 2: LIST OF CONSULTATION EVENTS 287 vi APPENDIX 3: LIST OF ALTERNATIVE NAMES FOR THE NEW SCHEME 292 vii Glossary ADASS Association of Directors of Adult Social Services ADSS Cymru Association of Directors of Social Services Cymru ARCO Associated Retirement Community Operators BABICM British Association of Brian Injury Case Managers BIA Best interests assessor Buckinghamshire Local authorities, CCGs, IMCA providers and healthcare staff and multi-agency the Service User and Carer Organisation (SUCO) response CCG Clinical Commissioning Group Cheshire West P v Cheshire West and Chester Council and P v Surrey County Council [2014] UKSC 19, [2014] AC 896. CQC Care Quality Commission DoLS Deprivation of Liberty Safeguards DoLS Code of Ministry of Justice, Mental Capacity Act 2005: Deprivation of Practice Liberty Safeguards: Code of Practice to Supplement the Main Mental Capacity Act 2005 Code of Practice (2008). EACH East Anglia’s Children’s Hospice ECHR European Convention on Human Rights EKHUFT East Kent Hospital University NHS Foundation Trust GP General Practitioner Housing LIN Housing Learning and Improvement Network IMCA Independent Mental Capacity Advocate IMHA Independent Mental Health Advocate LGA Local Government Association MCA Mental Capacity Act 2005 MDDUS Medical and Dental Defence Union of Scotland 1 Mental Capacity The Mental Capacity Act Project is an initiative to support health Act Project teams within the NHS to implement the Mental Capacity Act. Mental Capacity Department for Constitutional Affairs, Mental Capacity Act 2005: Act Code of Code of Practice (2007). Practice MHA Mental Health Act Mental Health Act Department of Health, Mental Health Act 1983: Code of Practice Code of Practice (2015). NASS National Association of Independent Schools and Non-Maintained Special Schools National Panel for The National Panel for Registration is the local authorities’ forum to Registration enable strategic dialogue between central and local government on issues that impact on local authority registration (births, deaths, marriages and civil partnerships), celebratory and nationality functions. NELFT North East London NHS Foundation Trust NUTHFT Newcastle upon Tyne Hospitals NHS Foundation Trust OPCAT Optional Protocol to the United Nationals Convention Against Torture SAB Safeguarding Adults Board SARCP Staffordshire Association of Registered Care Providers SEND Special Educational Needs and Disability Sitra A membership organisation for supported housing providers.