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January 17, 2014

Yesterday the CQC published their latest annual report into DoLs. To me, it reads differently to all the previous ones. It’s punchier. It’s more proactive. It’s like someone has suddenly said: “let’s take this bull by the horns”. The previous reports, I felt, presented a state of play, with numerous supporting statistics, without ever really taking a position of action. It is just a report though – the proof will be in the pudding at a later date. Count up all the post Winterbourne View reports written and then compare their rhetoric with what is still happening in these places in reality. What would be great would be to read a report that isn’t talking about implementing change but one that is evidencing proof of real, for the good change that has actually happened.

The CQC report talks about “implementation of the MCA will become a routine part of inspection” and “the CQC is strengthening its approach to monitoring the legislation and will be working more closely with supervisory bodies”. All good stuff.

Before we get on to the good bits, there is one alarming part of the report where it states: “deprived of rights if its in their best interests”. Deprived of rights? I hope this is a bit of Freudian slippage because if it isn’t, we’re really up shit creek without a paddle. To have the body tasked with monitoring the safeguards get it so wrong is not good news.

Reading through the evidence of the House of Lords’ review into the MCA, time and again, people talk about the lack of scrutiny of the DoLs scheme. Without that scrutiny, the many figures we read about DoLs authorisations are completely meaningless. There has also been a call for tougher sanctions on authorities not complying with the legislation but that can only be done if their actions come under regular and consistent scrutiny. I read recently, a lead officer for DoLs at a local authority say, “we are still in a process of bedding in the MCA into our processes and culture” (2 processes in the same sentence!). The Act is nine years old – how long does it take for something to bed in? A latitude is given to public authorities that isn’t available to the rest of us. Self assessment tax procedures change in April but HMRC will expect me to get them right immediately – I won’t be allowed the grace of a bedding in period.

Anyway, I’ll indulge myself now with a wish list – the bulls that I’d really like the CQC to take by the horn:

One thing that I think will fundamentally have to change when the CQC inspect a care home is their emphasis for the inspection, certainly when considering the MCA and DoLs. At the moment, their focus is on the home – not the people living in it. Their inspection reports tackle systems and processes with little reference to the people on the receiving end of those systems. If decent scrutiny of DoLs is going to happen, it will not be enough to look at the home’s DoLs’ procedures. How each person in the home fares under the DoLs scheme must come under the CQC microscope.

If a thorough inspection is in place, the inspector will need to split all the residents into two categories: those under a DoL authorisation and those without a DoL. For the people already served a DoL, I guess the inspection would replicate the actions of the best interest assessor and examine whether it is in the person’s best interests to be under a DoL in this place and whether there are alternative less restrictive options for their care. In Steven’s case, would this have helped him? Only if the inspection questions the need for the person to be in the home in the first place. Possibly of greater need of CQC intervention, will be the people in care homes who are not under a DoL. I am regularly contacted by people who have a relative in a care home, who they feel is being deprived of their liberty in some way but are unable to persuade the local authority to instigate the DoLs process. This is massively problematic because without a DoL in place, challenges become near impossible. So, I’d like to see the CQC give as much attention to why some people are not under a DoL as they would to those with an authorisation. Only then, will the statistics begin to have a meaning – “Ah. I see. The reason this LA has only authorised 7 DoLs compared to the neighbouring borough who have authorised 177 is because a large proportion of their care homes haven’t carried out DoLs’ procedures. There are at least 50 people in that borough possibly being deprived of their liberty without any safeguards in place. Get on to it please chaps”.

Because it is a particular bee in my bonnet, I’d like the CQC to pay specific attention to “assessment and treatment units”. It seems to me that they can get away with murder and bypass the DoLs process purely by virtue of how they identify themselves. People get admitted to one of these places under the pretext of “assessment” and are left to languish there for years. And in Steven’s case, the very nature of how he was being assessed, led to him being deprived of several things that may constitute his liberty. The Unit never saw it that way – they just saw this was a necessary part of the assessment process. Simple questions, like: “why is this person here?”, “how long have they been here?”, “what is their assessment and treatment plan?”, should reveal whether abuses of the safeguards are taking place.

To conclude, and this may be material for another post, I believe that the starting point should be that a person entering a care home/hospital/assessment unit will always be experiencing a deprivation of their liberty to some extent. To me, that’s a given. Home/Unit rules and systems can add considerably to that deprivation. So perhaps, instead of asking if the person is being deprived of their liberty, the monitoring has to pass through another filter. And that brings us back again to establishing genuine best interests and whether we really want to give the person the best care they can get.


From → Social Care

One Comment
  1. Alice Moore permalink

    Very good post about a complex issue.

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