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.

If a tenant continues to refuse to take heed of the government’s social-distancing guidelines, for example by inviting large groups of people who do not reside there to their property, it can constitute a nuisance. One housing association successfully applied for an injunction. The injunction ordered by the Court stipulated that no persons, other than the children of the tenant, are to attend the property until the current social-distancing restrictions are lifted by the government.

A representative of the housing association highlighted the need for the current guidelines to be followed and the need for housing providers to ensure that all residents living in their communities are kept safe during this time of ‘unprecedented risk’.

This case demonstrates that flouting of the current restrictions is likely to be considered anti-social in the eyes of the courts – a point which all housing providers should bear in mind during this period. Further, it highlights the availability of an alternative remedy to the issuing of possession proceedings (in light of the government’s moratorium on evictions) to deal with anti-social behaviour during the next three months, Covid-19 related or not.

What happens if an employee refuses to attend work because they are afraid of being exposed to COVID-19 particularly the new more transmissible strain?

An employee can refuse to attend work but their refusal to do so will have to be based on a reasonable belief that their health and safety is in danger. Whether or not their refusal is reasonable will take into consideration factors such as the employee’s own health and whether they are at a higher risk of becoming seriously ill if they contract Covid-19 and the steps their employer has out in place to mitigate the danger of contracting Covid-19 at work.

In such circumstances where the employee’s belief is deemed to be reasonable, they will be entitled to stay at home and receive full pay.

If an employee is subsequently dismissed for refusing to attend work in these circumstances, they may be able to bring a claim for unfair dismissal.

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.

Do I need to obtain consent from a member of staff if we have taken the decision to restrict/alter their duties?

If the duties are so fundamentally different from their contracted role, then yes. For example, if you are asking a frontline clinical member of staff to undertake administrative tasks in another area, then this will be a fundamental change to their terms and conditions for which you need their consent.

If there is a minor alteration to their duties, or the clause within their contract is wide enough to cover their amended duties, then arguably to do not need their consent but best practice would be to obtain their agreement.

What is the Clinical Negligence Scheme for Coronavirus?

The Government has recently passed the Coronavirus Act 2020 in a response to the challenges posed by the pandemic, especially in relation to those facing the NHS during this time of crisis. NHS Resolution worked closely with the Department for Health and Social Care to draft a clause within the Coronavirus Act providing indemnity for clinical negligence for any coronavirus related activity not currently covered by an existing arrangement. In order to implement this clause, NHS Resolution has launched the Clinical Negligence Scheme for Coronavirus (“CNSC”).

It is intended that the CNSC will cover new contracts put in place for healthcare arrangements to respond to coronavirus, such as organisations supporting testing arrangements or Independent Contractors making agreements with NHS England and NHS Improvement to release capacity to the NHS. Membership is not required for this scheme and the contracts entered into will automatically provide indemnity under the scheme.

The CNSC will not replace existing indemnity provisions made under the Clinical Negligence Scheme for Trusts (“CNST”) and it has been confirmed that the new Nightingale Hospitals will be covered by CNST rather than CNSC. Similarly, NHS Resolution have confirmed that those doctors and nurses returning to practice from retirement, or those joining as students will be covered by the CNST or, where applicable the Clinical Negligence Scheme for General Practice (“CNSGP”). The CNSC will not cover returning midwives to the profession, but the Royal College of Midwives have confirmed that they will extend all of the benefits of membership including Medical Malpractice Insurance to returning retired midwives.

For more information regarding this please click here.

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

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