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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 if I get the status wrong?

As long as you can demonstrate that you have exercised reasonable care in determining status you have discharged your obligations in that respect. However, if you are unable to demonstrate this, you may as the end user client be responsible for the contractor’s tax and NIC’s.

How do I carry out a Right to Work check during the Covid-19 pandemic?

The Home Office has provided useful guidance on how to carry out a compliant Right to Work check using the temporary adjustments in place for Covid-19. In summary:

  • You will need to ask the job applicant to send you digital copies of their original documents, for example by scan, photo or mobile app.
  • Hold a video call with the job applicant and ask them to show their original documents on camera so you can check them against the digital copies you have already received.
  • On the date you made the check, record that you have done this by using the following wording “adjusted check undertaken on [insert date] due to Covid-19”. Evidence of right to work checks still need to be held securely either in paper or electronic format.
  • You can use the online RTW checking service where the job applicant has Biometric Residence Permit or pre-settled or settled status under the EU Settlement Scheme. You should do this whilst on the video call with the applicant/employee, and you must first obtain their permission to view their details on this scheme.
What actions and measures should be avoided?

The CMA is particularly concerned about certain activities, its guidance highlights:

  • Exchange of commercially sensitive information where this is not necessary in response to the crisis
  • Collaboration which unfairly excludes third parties
  • Abuse of a dominant position (including a dominant position held as a result of the crisis) – particularly to charge excessive prices
  • Seeking to maintain prices or prevent reductions in prices
  • Cooperation going beyond what is necessary to respond to the crisis in the interests of consumers
What measures can be taken without notification to the European Commission?

There have always been ways for public bodies to assist without being required to notify these for approval. These continue to be available during the financial crisis, and are likely to be increasingly useful for measures which need to be introduced quickly. The measures include:

Those where it is possible to conclude that there is no effect on trade between Member States – for example, measures which are likely to have only a limited local effect. The European Commission has concluded, for example, that measures to assist locally-focused cultural activity can be assumed to have no effect on inter-State trade. 

Those where it is possible to conclude that the State is acting in a way consistent with a commercial operator (the so-called Market Economy Operator Principle) – particular care will need to be taken in the context of current economic conditions to ensure that it can reasonably be asserted that a commercial operator would act in the same way as the public body.

Measures under the General Block Exemption Regulation – this legislation allows various types of aid, or aid schemes, to be employed.

Examples include aid for SMEs, aid for research and development, aid for local infrastructure and aid to ports and airports.

De Minimis Measures – Member States are permitted to grant small amounts of aid to undertakings over three fiscal years (the current year and the previous two years). This allows undertakings to receive up to €200,000 (or €500,000 where they are providing public services).

What is the position if my turnover is more than £45 million?

With the exception of the Covid-19 Corporate Financing Facility (see below), there was initially little dedicated financial assistance for medium-sized and larger businesses affected by the coronavirus outbreak (the so-called “stranded middle”); however, from 20 April 2020 such businesses (with a turnover above £45 million) have been able to access finance via the Coronavirus Large Business Interruption Loan Scheme (“CLBILS“).

CLBILS operates in a similar manner to CBILS except that a lender can provide:

  • up to £25 million to businesses with turnover from £45 million up to £250 million; and
  • up to £50 million to businesses for those with a turnover of over £250 million.

Finance is available in the form of:

  • term loans
  • revolving credit facilities (including overdrafts)
  • invoice finance and
  • asset finance,

in each case available on repayment terms of up to three years.

Several changes to CLBILS took effect from 26 May 2020. The maximum amount available through CLBILS to a borrower and its group increased from £50m to £200m. Term loans and revolving credit facilities over £50m will be offered by CLBILS lenders which have secured additional accreditation. The maximum size for invoice finance and asset finance facilities remains at £50m. Companies borrowing more than £50m through CLBILS will be subject to further restrictions on dividend payments, senior pay and share buy-backs during the period of the loan. Further information on the most recent changes, including new provisions on seniority of CLBILS facilities, can be found on the CLBILS page on the British Business Bank website. There is also an in-depth FAQs section for businesses, which has the full details of the changes to the scheme.

Unlike CBILS, the UK government will not make payments to cover the interest and any lender-levied fees in the first 12 months of any facility so these larger businesses will not benefit from the no upfront costs and lower initial repayments that smaller businesses eligible for CBILS benefit from. The other key provisions of CLBILS, such as the eligibility criteria, the 80% government-backed guarantee and security, are similar to those of CBILS.

Eligibility is similar to CBILS and businesses must:

  • Be UK-based in its business activity
  • Have an annual turnover of more than £45 million
  • Have a borrowing proposal which the lender would consider viable, were it not for the current pandemic, and for which the lender believes the provision of finance will enable the business to trade out of any short-term to medium-term difficulty
  • Self-certify that it has been adversely impacted by the coronavirus (COVID-19)
  • Not have received a facility under the Bank of England’s Covid Corporate Financing Facility.

Businesses from any sector can apply, except the following:

  • Credit institutions (falling within the remit of the Bank Recovery and Resolution Directive), insurers and reinsurers (but not insurance brokers)
  • Building Societies
  • Public-sector bodies
  • Further-education establishments, if they are grant-funded
  • State-funded primary and secondary schools

All lending decisions remain fully delegated to the accredited lenders.