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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

How do I take “all reasonably practicable steps” to protect my employees during the coronavirus outbreak?

Follow up to date UK Government advice. This can be found at: https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19/guidance-for-employers-and-businesses-on-coronavirus-covid-19

For best practice and more detailed information; consult the HSE’s website at https://www.hse.gov.uk/news/coronavirus.htm

Failing to follow the guidance is likely to be regarded as failing to take all reasonably practicable steps.

I’m a housing provider. How do I continue to manage disrepair during the coronavirus outbreak?

The practicalities and processes regarding disrepair claims will undoubtedly be affected. Housing providers will have to adopt a risk-based approach and consider government guidance to handle claims going forward. Key points to consider are:

  • Compliance with the Pre-Action Protocol for Housing Conditions Claims (particularly disclosure)
  • The practicalities of inspection
  • Non-urgent repairs
Do you recommend a structured approach to MHFA supervision?

Yes – there should be a framework in place to ensure that MHFAs are fully supported themselves and so that individuals are supported beyond the support the MHFAs provide.

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.

Understanding of the extent of the Covid-19 risk to BAME colleagues is evolving – what does that mean for NHS employers?

In practice this means that any risk assessment will need to be reviewed constantly and adjusted as our understanding of the nature and level of the risk grows.

Some service-providers are instigating special Oversight Groups to keep this issue under review but engagement and consultation with those affected is critical and making sure they feel confident to raise concerns and refuse to work if they believe they are not safe.