The Vaccuum of The DoLs
Today saw the publication from the NHS Information Centre of their third annual DoLs report for 2011/12. (The full report is here: http://www.ic.nhs.uk/webfiles/publications/005_Mental_Health/dols2011-12/mca_dols_eng_2011_12_3rd_rep.pdf)
There’s an awful lot of figures and statistics in this report: I needed a Red Bull to help me get through it. This blog is just a series of thoughts and questions that popped up for me whilst trying to absorb it.
The first big stat is that during 2011/12, 56% of all DoLs were authorised; meaning of course that 44% weren’t authorised. So, here are my first two questions:
1. How many of the 56% of DoLs authorisations were challenged? I think it would be rash to assume that all of the 56% were necessary, appropriate, or indeed lawful.
2. What happened to the 44% that weren’t authorised? Presumably these people were in a care home or hospital – are they still there but not under a DoL?
The number of authorisations has increased steadily since the safeguards were introduced in 2010. However, for the most recent quarter (December 2011 to March 2012), the figures went down for the first time. Is it a coincidence that this drop coincides with the Cheshire ruling (Thank goodness, that is going to appeal). DoLs are only meant to be authorised for up to a year, so what have happened to all those people whose DoL has passed a year? No explanation for the drop is given in the report, which I find quite worrying.
As in previous reports, there is an enormous variation in the number of DoLs sought across the country. The latest report reveals a variance from 0 to 463. I find it very hard to believe that the LAs who declared 0 authorisations, don’t have anyone in their care homes or hospitals who are being deprived of their liberty? Without external scrutiny, it must be quite possible for people to be left in a home or hospital with no safeguards being applied. There are at least two members of the Get Steven Home group who have relatives in a care home and both the person and their family don’t want them to be in the home but have found it impossible to persuade the LA to authorise a DoL. And without a DoL, a challenge becomes very difficult.
Following on from that, there isn’t a single mention in the report of IMCAs. There are enough judgements out there now stressing the entitlement to an IMCA but they obviously weren’t considered important enough to make it into the report. So, my question is how many of the 56% of authorisations were referred to the IMCA service?
I had an horrendous experience with the Hillingdon Best Interest Assessors but having attended the Yorkshire DoLs conference and having met several committed assessors on-line, I know that my experience wasn’t typical. One of my favourite stats is that 93 DoLs authorisations were not granted by the supervisory body but the BIA insisted that a deprivation of liberty was occurring. That shows that 93 people were prepared to challenge the supervisory body. The report does flag up the potential conflict if interest for BIAs when they are employed by the supervisory body. I don’t believe the BIAs in our case were incompetent; I believe they were weak and allowed themselves to be told what to write by their managers. Hopefully, they are in the minority.
I know it wasn’t the remit of the report but I would love to know some of the stories behind the statistics. How else does one make sense of the 44% of cases where a DoL wasn’t authorised? What does that mean for the lives of those people? Have their lives improved or got back on track as a result of not being under a DoL? Someone wrote to me the other week about her son who has been in a “temporary” care home for four years; he went there for an assessment. Last summer after several DoLs cases hit the news, his parents asked the home to consider a DoL. They met with the BIA for four hours and he agreed that a DoL was occurring. However, his report was squashed and a DoL wasn’t authorised. The young man is still in the home without a DoL.
Overall, the report leaves me wanting more. I’d love someone to take the DoLs by the scruff of the neck and review them from beginning to end. The NHS report relies on the returns from LAs and NHS trusts. This is only one part of the story. What about the monitoring of the initial stage of the process – does anyone look into the fact that some LAs aren’t authorising a single DoL. Why? Where are their residents safeguards? And what about the data from the courts? Are LAs/NHS trusts referring all matters of dispute to the courts? How many people have been released from their detainment by the courts? These seem to me important figures to understand how the Act is working?
This report feels like it exists in a vacuum. I feel like I’ve read one part of a trilogy but the other parts aren’t available to me.
From → Social Care