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What is the guidance in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards during the Covid-19 pandemic?

The Department of Health & Social Care has published guidance for hospitals, care homes and supervisory bodies on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) during the coronavirus pandemic.

In many scenarios created or affected by the pandemic, decision makers in hospitals and care homes will need to decide:

  • if new arrangements constitute a ‘deprivation of liberty’ (most will not), and
  • if the new measures do amount to a deprivation of liberty, whether a new DoLS authorisation will be required (in most cases it will not be).

If a new authorisation is required, decision makers should follow their usual DoLS processes, including those for urgent authorisations.

A summary of the key points to be taken from the guidance is outlined below:

Use of the MCA and DoLS due to Covid-19

  • During the pandemic, the principles of the MCA and the safeguards provided by DoLS still apply.
  • It may be necessary to change the usual care and treatment arrangements, for example to provide treatment for people with Covid-19, to move them to a new hospital or care home to better utilise resources or to protect them from becoming infected.
  • All decision makers are responsible for implementing the emergency Government health advice  and any decision made under the MCA must be made in relation to a particular individual, it cannot be made in relation to groups of people.

Best interest decisions

  • In many cases, a best interests decision will be sufficient to provide the necessary care and treatment for a person who lacks the capacity to consent to the care and/or treatment arrangements during this emergency period.
  • If an individual has made a valid and applicable advance decision to refuse the treatment in question, then the relevant treatment, even for Covid-19, cannot be provided.

Delivering life-saving treatment

  • Where life-saving treatment is being provided in care homes or hospitals, including for the treatment of Covid-19, then the person will not be deprived of liberty as long as the treatment is the same as would normally be given to any person without a mental disorder.
  • The DoLS will therefore not apply to the vast majority of patients who need life-saving treatment who lack the mental capacity to consent to that treatment, including treatment to prevent the deterioration of a person with Covid-19.

The full guidance can be found here.

Related FAQs

Who is eligible for CBILS?

To be eligible for CBILS, the British Business Bank has confirmed that businesses should be able to answer YES to the following points:

  • Your application must be for business purposes
  • You must be a UK-based SME with an annual turnover of up to £45m. This includes sole traders, freelances, body corporates, limited partnerships and limited liability partnerships. For sole traders to be eligible it is expected that sole traders will need to have a business account with its funders and not be operating via a personal account
  • Your business must generate more than 50% of its turnover from trading activity
  • Your CBILS-backed facility will be used to support primarily trading in the UK
  • You wish to borrow up to a maximum of £5m.

Businesses meeting these criteria from all sectors can apply save for Banks, Building Societies, Insurers and Reinsurers (but not insurance brokers), the public sector including state-funded primary and secondary schools, employer, professional, religious or political membership organisation or trade unions which are not eligible.

Your borrowing proposals must be considered viable by the relevant lender under normal circumstances aside from the Covid-19 outbreak, and the lender believes the provision of finance will enable the business to trade out of any short-to-medium term difficulty. Lending decisions are delegated to the accredited lenders and lenders will need further information to confirm eligibility.

The eligibility criteria for CBILS does not require lenders to take into account other forms of Government support that SME’s may already be benefiting from, most notably business rate relief.

We understand that ownership structure is not taken into account when confirming eligibility and that businesses back by a PE funder or a subsidiary of an overseas entity can be eligible if it meets the other criteria.

An update on eligibility – 3 April 2020

Previously, for facilities above £250,000, the lender must establish a lack or absence of security prior to businesses using the Scheme. The requirement for insufficient collateral has been removed allowing those SMEs who are considered to have sufficient collateral to access the Scheme. We would expect that where security is available, a lender will seek to take security over the relevant assets.

How do I remain compliant and cover any risk?

Data on properties, and people, has never been more important.

Given that compliance is at risk here, such a decision must be made by the Board to ensure good governance. Board approval should be sought and recorded for the approach the organisation is taking.

It is essential that you continue to record your data on compliance and report to your board at all times, and that there is a clear audit trail for issues with access, and if appropriate to the Regulator. Access issues as a result of self-isolation should be readily identifiable.

Operatives need to be provided with the tools to operate in as safe a way as possible:

  • Checklist of questions to ascertain occupant’s current health
  • Protective equipment (masks, gloves, over clothing)

The Gas Safe website is a useful resource for updates: https://www.gassaferegister.co.uk/help-and-advice/covid-19-advice-and-guidance/

How do I go about registering a death at this time?

The Government has introduced legislation to expand the list of those who can register deaths to include Funeral Directors who are dealing with the funeral arrangements and who has been authorised by a relative of the deceased to register the death. Also, the medical cause of death certificate can be emailed to the Registrar’s office and arrangements made to have a telephone appointment to provide the Registrar with information to register the death. The requirement to attend the Registrar in person to sign the Register has been relaxed so that this is not necessary. It will however still be necessary to register the death within 5 days.

What is a small company?

The changes will not apply to end users who are a small company. If you meet two out the following 3 conditions, you will meet the small company definition and are therefore exempt from the changes to IR35:

  1. Annual turnover is no more than £10.2 million
  2. Balance sheet total is no more than £5.1 million
  3. No more than 50 employees

Companies will always be classified as small in their first financial year. Public companies will always be considered to be medium or large businesses and cannot fall under this exemption.

For a group company to be a small company its parent company must also meet the small company definition.

What tips can you share for remote mediations?

Remote mediations have become increasingly popular as a way of settling a dispute before it goes to court. There are a number of ways in which you can mediate remotely, but the most common platform is Zoom, due to its easy-to-use nature and the ability to have ‘break-out rooms’. We have answered some FAQs and set out a quick guide to remote mediations below.

What is remote mediation?

  • Mediation is a form of assisted negotiation, in which a neutral 3rd party mediator seeks to help the parties resolve their dispute. The process on the day is managed by the mediator and adopts certain key ground-rules. These are that discussions are private and cannot be referred to in court; and the process is entirely voluntary and non-binding, if and until a settlement is finalised. In the current pandemic mediations are now usually conducted remotely by video conference, instead of an in-person meeting.
  • The structure of the mediation will depend on the matters that are in dispute. Before the mediation the parties will exchange their views in position papers and prepare a bundle of the key documents.
  • Generally the parties will start the mediation in the same ‘room’ as the mediator, where they will be invited to set out their positions. The mediator will then put the parties into ‘break-out rooms’. These rooms serve as your own private ‘room’ which the mediator will join. You will therefore be able to have private discussions with the mediator without the other side being able to hear those discussions. The mediator will go between the ‘break-out rooms’ to discuss a party’s position further in order to attempt to reach a settlement.
  • If an agreement is reached, at the end of the mediation the Settlement Agreement will be drafted. The Settlement Agreement works as an enforceable contract. The Settlement Agreement will outline the details of what has been agreed and the intentions of the parties, such as any actions required, payments to be made and appropriate timescales. Each party will sign the Settlement Agreement, which can be done electronically.
  • It is not always possible to reach a resolution/agreement by mediation, but the mediator serves as an impartial third party in order to aid the process. If no agreement has been reached, the mediation may still prove useful as it will give you a better understanding of the other side’s position.

What should I do before the mediation to prepare?

  • Ensure that you are in an area with minimal distractions. Mediation is a confidential process, so make sure that you are in a private location.
  • Ensure that your microphone and camera work and that you have access to the online platform that will be used. We send our clients a link to the website in advance so that this can be tested out.
  • Consider any agreed dress code and dress appropriately.
  • Have a copy of the mediation bundle to hand, whether in hard or soft copy, and be aware of what documents are in there.

Any tips on what to do on the day?

  • Remember to make sure that before you have any private conversations with the mediator you are in your break-out room.
  • You may contact the mediator whilst being in the break-out room. On Zoom there is an ‘Ask for Help’ button on the screen. The mediator will then be prompted to join your room.
  • Ensure that you inform the mediator if you or others enter/leave the room. It is important that the mediator knows who is present.
  • Be mindful of body language and facial expressions as these can appear more enhanced on the screen, and they are easier to pick up in a remote mediation.
  • Stay calm and focussed at all times. When you have a dispute it is sometimes tricky to maintain a calm manner, but this is always vital in attempting to reach an agreement.
  • When engaging with the mediator avoid any external distractions such as text messages and emails, as it may come across that you are not interested in the process. It is important to pay attention so that you do not miss any dialogue which may be key to any agreement that is reached.
  • When you are in the break-out room without the mediator make sure that you take breaks and keep refreshed, as virtual mediations can be tiring.