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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

What is the most important thing employers should do from a health and safety perspective?

Conduct risk assessments! Your RA must cover every foreseeable risk arising from a return to the workplace, including the impact of reduced staff levels and any operational/administrative changes necessary to ensure social distancing.

Appropriate steps should be taken to manage and mitigate identified risks. Where this is not possible, businesses need to decide whether certain activities are necessary for the business to operate or if they can be temporarily put on hold.
Keep a close eye on the comprehensive Government guidance: https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19

In particular focus on social distancing and workplace health measures. This guidance will evolve over time and you will need to be sure that your organisation is sticking to it AND reviewing and updating its risk assessment.

How can RPs carry out Person Centred FRAs/PEEPs on tenants within directly managed supported living units where the RP is not providing support and any floating support provider doesn't see it as part of their responsibility?

There is no simple answer.

The NFCC guidance states:

“The person-centred fire risk assessment is intended only as a simple means for non-specialists who have suitable understanding of relevant fire risks to determine whether additional fire precautions might be needed. The person who carries out the person-centred fire risk assessment will depend on the circumstances of the housing and support provision. It can be carried out by those who regularly engage with the resident, with input from specialists where necessary. Assessments will normally be undertaken with residents themselves.

In sheltered housing with scheme managers, the scheme managers normally engage with residents on a routine basis, enabling residents who need a person-centred fire risk assessment to be identified. Many vulnerable residents will be in receipt of care, so enabling the care provider to identify residents in need of a person-centred fire risk assessment. Providers of regulated care are required to take into account risks to people from their wider environment, to take steps to help people ensure that they are dealt with by appropriate agencies, or to raise safeguarding alerts when this is appropriate. Where a ‘stay put’ strategy is adopted, there will be a need to identify residents who need assistance from the fire and rescue service to evacuate the building.

In supported housing, the number of residents in each property is usually quite small. This, and the nature of the care service normally provided, enables person-centred fire risk assessments to be carried out asa matter of course, when a resident first moves into the property.

Where additional fire precautions cannot be provided in the short term, the risk should be reduced as far as reasonably practicable and an adult at risk referral should be made to Adult Social Care.”

Ideally then the RP will need to engage with any care providers in order to conduct the PCRA and identify risk mitigation measures. If they are reluctant to do so, the RP should engage with the individual in any event in undertaking the assessment.

Can I be fined for failing to take steps to try to ensure that my staff comply with the requirements to self-isolate?

Yes.

An employer which is aware that a worker or agency worker is or ought to be self-isolating, should not knowingly allow that worker or agency worker to leave the place that they are self-isolating in (“the designated place”).  To do so without reasonable excuse would amount to an offence which could result in the employer being issued with a fixed penalty notice.

The value of the fixed penalty varies depending on if it is the first or subsequent fixed penalty notice to be issued:

First fixed penalty notice £1,000
Second fixed penalty notice £2,000
Third fixed penalty notice £4,000
Fourth, and any subsequent fixed penalty notice £10,000
I work in construction. Should construction sites continue to operate?

The formal Government position relating to construction sites is that construction work should continue on site if it can be conducted safely, and the Business Secretary, Alok Sharma, has written an open letter to the UK Construction Industry thanking it for all its help in the current crisis. The letter also confirms the Government’s current official policy of keeping construction sites open. The full text of the letter can be downloaded.

This also remains the formal position of the Construction Leadership Council (CLC) with the qualification that sites should operate in accordance with Public Health England instructions; without compromising health and safety; and in accordance with the Site Operating Procedures issued last week by the CLC.

In practice, many construction sites have been closed by national developers and house builders due to difficulties with staffing and supply chain, and practical issues with compliance with the social distancing and site operating procedures.

The Scottish Government has recently issued guidance that all non-essential construction sites, which includes housing, office, leisure, schools and retail sites, must close to reduce the risk of the spread of Covid-19.

How do I determine contractor status?

You must exercise reasonable care in assessing status and making a status determination, considering what the position would be if the contractor was engaged directly by the end user client instead of via a PSC.

Status is usually determined by looking a number of factors and how they apply to the contractor’s working arrangements. This is a difficult exercise that is usually carried out by employment and tax lawyers and it is full of grey areas. We have a toolkit that can help you navigate this process which Paul will tell you more about at the end of the session.

The key factors used to determine status  are:

  • Control:
    • How much control does the end user client have over the contractor in terms of working arrangements (hours, place of work) and how the work is carried out? Or is the individual contractor able to determine how and when they work and without direct supervision of the end user client?
  • Personal service:
    • Is the contractor required to perform the services personally without the right to send a substitute? If there is a right to appoint a substitute is this subject to end user client approval?
  • Mutuality of obligation:
    • Is the end user client obliged to provide the contractor work with a mutual obligation on the contractor to accept that work?