Skip to content

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 additional costs for the end user if the contractor is deemed employed?

The immediate impact is accounting for payroll purposes for the additional cost of 13.8% employers NIC’s and 0.5% apprenticeship levy on top of the payment to the contactor’s PSC.

Secondary NIC’s cannot be recovered from payments due to employees and the same applies under the new IR35 regime. However, new terms can be agreed with reduced level of fees to reflect this additional cost.

What is the current guidance relating to Private Finance Initiatives and PF2 Projects in light of coronavirus?

On 2 April 2020, the Government issued guidance relating to Private Finance Initiatives and PF2 Projects. The guidance, which is to be enforced with immediate effect (currently due to stay in place until 30 June 2020), is one of several guidance notes issued to date.

A link to the guidance is set out below:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877804/2020_04_01_PFI_and_COVID19_final.docx.pdf

Key messages to contracting authorities

  • PFI contractors should very much consider themselves as being part of the public sector response to the current pandemic
  • Covid-19 is not regarded as, and is not to be classified as a force majeure event
  • PFI contractors must ensure that contingency plans are up to date and have been reviewed and discussed with contracting authorities to enable the continuity of full services to respond to the pandemic and maintain vital public services
  • Contracting authorities should work closely with PFI contractors to use all available options to maintain public services during the emergency period
  • Local arrangements should be made where PFI contractors can’t deliver the agreed requirements and performance standards
  • “Best efforts” should be made by all parties for the continuation of service provision
Can employees take annual leave during a period of furlough?

Yes, however holiday pay during furlough must remain at the normal rate of pay and not the reduced furloughed rate. You can still claim for this period under the scheme but you will be responsible for any amounts beyond the maximum you can claim. Employers have flexibility to restrict when leave can be taken both during and after period of furlough in the normal way.

If an employee usually works bank holidays then the employer can agree that this is included in the grant payment. If the employee usually takes the bank holiday as leave then you would either have to top up their usual holiday pay, or give the employee a day of holiday in lieu.

Can I reduce the risk of IR35 applying?

It is possible to review working arrangements for contractors before the new rules come into effect. This will require immediate action.

You could consider terminating current contracts and entering into new terms that reflect working arrangements for a self-employment arrangement.

Another possibility is encouraging contractors to abandon the PSC model and provide services under a compliant umbrella company.

In the event of a determination of employed status you should seek to enter new terms that at the very least reflect the new tax arrangements .

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).