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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

Can I enact a rent suspension clause in my commercial lease?

Most rent suspension clauses in commercial property leases are unlikely to come to the assistance of the tenant. These clauses normally apply only where the premises has suffered substantial physical damage and are, as a consequence, incapable of being occupied, used or accessed. The coronavirus pandemic does not involve any physical damage to a property, loss from the crisis will be purely financial. Such losses then will not be covered by the landlord’s buildings insurance policy in a way that will allow a tenant to claim rent suspension.

What will my case look like going forward and what are the courts doing?

During the Covid 19 crisis lawyers and the courts have had to adapt with hearings being heard remotely and with more electronic communication. It is clear that going forward, some of these changes will become more permanent.

The Lord Chancellor, Robert Buckland QC MP, has spoken last week regarding changes to the justice system following the COVID-19 pandemic and we know that there is a significant backlog of work that needs to be processed.

Firstly, 10 sites have been identified for ‘Nightingale courts’ which will allow for better social distancing. The authorities have suggested that it is a possibility that courts will need to stay open for a longer time or at weekends, to increase the number of cases that can be heard safely on any given day. This will enable more cases to be heard in a day and therefore a swifter outcome for your case. The standard of video technology will also continue to improve, with plans for new technology being rolled out across all courts form July onwards. The enhanced use of technology may result in matters being heard more efficiently, decreasing the time spent during each hearing.

HMCTS is working to expand access to audio and video technology to support more and new types of hearings. There has been an increase in the use of new and varying equipment over the lock-down period. With the appropriate systems in place, many more hearings could take place on platforms such as the Cloud Video Platform (CVP). Throughout July, the CVP will be more readily available to Country courts. There will be further hardware rolled out to improve the quality of video hearings, and there will be more efficient methods used to organise video lists.

The increased use and training of CVP means that witnesses and advocates may not need to attend court and could attend the hearing remotely. This will give you increased flexibility, enabling you to attend from your office or home. The CVP is efficient and simple to use, with no complex functions; making it user-friendly. This should make litigation more time and cost effective (albeit that there will be the cultural challenge of having less contact with your legal team or the court experience).

Are all employees now required to wear face coverings?

The guidance states that people should aim to wear a face-covering in indoor spaces where social distancing is not always possible and they come into contact with others, for example on public transport or in some shops, and potentially in the workplace. Face coverings do not mean face masks such as clinical masks worn by certain key workers as PPE, which should be reserved for those people.

Staff working in areas that are open to the public must wear face coverings, this includes:

  • shops
  • supermarkets
  • bars
  • pubs
  • restaurants
  • cafes
  • banks
  • estate agents
  • post offices
  • public areas of hotels and hostels

If these businesses have taken steps in line with Health and Safety Executive guidance for COVID-19 secure workplaces to create a physical barrier between workers and members of the public then staff behind the barrier will not be required to wear a face covering.

For other indoor settings, employers should assess the use of face coverings on a case by case basis depending on the workplace environment, other appropriate mitigations they have put in place, and whether reasonable exemptions apply.

What happens if I need to sign a new commercial lease in the future?

The outbreak is certainly going to have an impact on new lease negotiations.

Undoubtedly many transactions will be put on hold or indeed stop entirely. Where matters are ongoing, tenants may well look to strengthen rent suspension provision.

It is also possible that tenants and their representatives will also now seek to include termination rights for unseen events. In this regard, the concept of force majeure may start to appear more often in leases.

In both of the examples above, such attempts are not likely to be well received from landlords who will undoubtedly suggest that tenants ensure that their business interruption insurance policies are robust enough to protect the tenant in the event of any future pandemic events.

Another approach tenants might adopt going forwards in negotiations for a new lease (or indeed seeking to vary existing leases), is to move away from the traditional market rent model to a turnover rent arrangement. This will offer some protection going forward if trading conditions deteriorate, but again getting institutional landlords to agree such an approach may prove difficult.

What other factors may be considered?
  • Integration:
    • Is the individual held out as being employed by the business by having a company email address, uniform, how would they introduce themselves to customers?
  • Exclusivity:
    • Is the contractor restricted from working for other organisations without the consent of the end user client?
  • Length of engagement:
    • Is the contractor engaged to work on a specific project for a defined period? Or are they engaged for an indefinite period with no reference to a specific task or project?
  • Pay:
    • Are there regular fixed payments or is payment on completion of specific task or commission based? Is the contractor entitled to benefits or bonuses?
  • Facilities:
    • Does the contractor provide their own equipment and materials to provide the services?
  • Financial risk:
    • Is the contractor personally responsible for any loss arising from their work in performing the services? Will they have to rectify unsatisfactory work at their own time and expense? Will they have the opportunity to profit from the success of a project?