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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 an employee still do training when on Flexible Furlough?

Employees on Flexible Furlough can engage in training during hours which you record your employee as being on furlough, as long as in undertaking the training the employee does not provide services to, or generate revenue for, or on behalf of their organisation or a linked or associated organisation.

Where training is undertaken by furloughed employees during hours which you record your employee as being on furlough, at the request of their employer, they are entitled to be paid at least their appropriate national minimum wage for this time.

What rules has the European Commission introduced?

The Commission has provided guidance as to measures which Member States can introduce without notification. These include:

  • Measures which apply to all businesses within a Member State (for example the furloughing measures introduced by the UK Government)
  • Measures providing support direct to consumers
  • Measures which are already exempt from the notification requirement (discussed further below).

To respond to the crisis the European Commission has also issued a temporary framework to provide a basis for emergency aid to be notified for approval. The framework is initially in place until 31 December 2020. The Commission continues to keep this under review and has twice widened its scope to allow more types of aid to be notified. The type of measures covered include:

  • The provision of guarantees (including guarantees for 100% of loans)
  • The provision of loans at low interest rates, at zero interest rates or subordinated to senior debt
  • Measures to support liquidity needs or to alleviate difficulties caused by the current crisis
  • Measures to recapitalise businesses
  • Measures to assist sectors hit particularly hard by the current crisis (eg transport)
  • Measures targeted at COVID-19 such as research and development or production of products related to tackling the virus

The Commission has approved a UK Government “umbrella” notification to allow UK public authorities to adopt the measures permitted by the Commission framework. Therefore public authorities in the UK can use the Framework without notifying individual measures or schemes to the Commission.

What is the NICE guidance around Service organisation?
  • Trusts should allow for telephone advice rather than face-to-face review from critical care when clinically appropriate.
  • Hospitals should discuss the sharing of resources and the transfer of patients between units, including units in other hospitals, to ensure the best use of critical care within the NHS.

Please note, the above is intended to provide a summary of the key recommendations which emerge from this guidance. Access to the full guidance can be found here.

Is there anything else I should consider from a health and safety perspective?

Increased hygiene measures should be introduced to limit the spread of infection. Increase the frequency of cleaning, particularly higher risk contact points such as door handles. Avoid the use and sharing of hardcopy in favour of electronic documents; avoid sharing of tools and work equipment; increase the availability of handwashing facilities and hand sanitisers; issue anti-bacterial wipes and tissues to staff, and remind everyone to maintain good personal hygiene practices, including regular hand washing. Prominent and repeat signage will be vital in reminding workers of these steps they can take to protect themselves.

PPE – e.g. disposable gloves and face masks – are not currently legally required in the UK, but especially where social distancing might not be possible, it may be necessary to make appropriate PPE available to staff. If so, you will need to make sure there is enough available train everyone so it used properly and provide for safe disposal of used items.

MOST IMPORTANTLY – communicate with your people; invite their input and suggestions and act on them. Communication and participation in the process of a safe return to work are going to be crucial to its’ success.
Monitor for illness: train managers how to spot the symptoms of COVID-19 and have a clear process if someone is potentially infected. Continue to remind staff to only come into work if they are well and not experiencing any symptoms. A number of businesses are planning on using testing and screening methods, such as temperature checks. Remember, these steps create data privacy considerations which you will need to consider.

Do not forget existing health and safety obligations, such as maintaining sufficient numbers of fire marshals and first aiders on-site. Employers should also be aware that the Health and Safety Executive must be notified under RIDDOR of any workplace incidents that lead to exposure to COVID-19 and any cases where there is “reasonable evidence” that it was caused by exposure in the workplace. Be aware that workers are being encouraged to report to HSE failures of their employers to keep them safe from the threat of the virus.

I’m a doctor. Should I work outside my field of practice during the pandemic?

Whilst it is acknowledged that doctors may be working in unfamiliar circumstances or surroundings, or in clinical areas outside their usual practice. Doctors should consider the best course of action to take in these circumstances by utilising the following:

  • What is within their knowledge and skills
  • What support other members of the healthcare team could offer
  • What will be best for the individual patient given available options
  • The protection and needs of all patients they have a responsibility towards
  • Minimising the risk of transmission and protecting their health.