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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 are the NICE protocols around a patient’s ongoing treatment whilst in critical care during the pandemic?
  • Start critical care treatment with a clear plan of how the treatment will address the diagnosis and lead to agreed outcomes.
  • Review critical care treatment regularly and when the patient’s clinical condition changes.
  • Stop critical care treatment when it is no longer considered able to achieve the desired outcomes. Record the decision and the discussion with family, carers and the patient (if possible).
Can employers reduce their pension contributions?
  • Yes, if contributions to a defined contribution (“DC”) scheme exceed statutory minimum for auto-enrolment purposes, it may be possible to reduce employer contributions to the statutory minimum, but not further.
  • However, the processes required for reduction of DC employer contributions will necessitate obtaining legal advice:
    • Reducing employer contributions may require changes to the employment contracts of affected staff (as does the furlough process).
    • Reducing employer contributions may also require negotiation with trade unions or other staff representative forums.
    • Where group personal pensions are used, the contractual format may not permit changes of employer contributions, and hence it may also be necessary to enter into a new contractual arrangement. Choosing a new group personal pension plan is a not insignificant task in itself.
    • Employers with at least 50 employees are required to conduct a 60-day consultation process with affected employees if they propose to reduce employer contributions (but please see below).
    • Finally, it may require a change to the scheme rules and engagement with the scheme trustees if the scheme is operated under trust.
  • For DB schemes, specific considerations apply (see the last section, below).
What are the publicity requirements for Traffic Regulation Orders?

In making a Traffic Regulation Order (“TRO”) local authorities must follow the regulations, which include provisions relating to publicity requiring publishing the notice in a local newspaper, making the orders available for public inspection at a Council’s offices (which are likely to be closed to the public during this time) and where considered appropriate, posting the notices on the streets.

In recognition of the potential difficulties with complying with the publicity requirements, the Department for Transport has issued guidance as to how a Council may still publicise a TRO. The guidance recognises that not everyone may be able to access local newspapers online and suggests that people and organisations could be adequately informed by means of letter, leaflet drops, or local radio. In respect of making the relevant document available at the Council’s offices, the guidance suggests that notices could be placed online or outside offices with brief details and including a telephone number or email to use to request a hard copy of the documents.

While the guidance is helpful, it is important to note that it is guidance only and that the regulations have not been relaxed. Authorities will still need to demonstrate that they have satisfied all of the publicity arrangements in respect of the TRO.

How do EWS1 form requirements apply to leasehold flats sold to secure tenants exercising their Right to Buy under the Housing Act 1985 whether in low, medium or high rise blocks?

Where a lender requires a EWS1 as part of the mortgage requirements for a flat this will apply regardless of its tenure and will therefore apply to applicable RTB properties. It may also be required in order to obtain a valuation for the disposal notices and issues in obtaining it could cause problems in serving this within relevant deadlines required by legislation.

What is Coronavirus Business Interruption Loan Scheme (CBILS)?

The Coronavirus Business Interruption Loan Scheme (“CBILS“) is open for applications to provide small businesses with a loan of up to £5m to assist with the Covid-19 outbreak. The Scheme is aimed at businesses who are experiencing lost or deferred revenues, and who otherwise would be denied support from lenders, to be supported by a Government backed guarantee. The Scheme will initially run for six months with the possibility to be extended where required, so businesses should only approach a lender under the Scheme as and when they require assistance.