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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 is the over-riding statutory duty for employers to ensure the health and safety of employees?

It is worth pointing out that, despite all the guidance, survey results and other advice about managing Covid-19 H&S risk in the workplace, the law has not been changed. None of the guidance is codified by regulation/legislation, which means that you are managing this risk in the context of existing H&S law.

In very simple terms, HASWA74 requires employers to take “all reasonably practicable steps” to ensure the health and safety of its employees (and anyone else affected by your business).

“Reasonably practicable” means to balance risk reduction against the time, money and effort required. If measures are grossly disproportionate, you wouldn’t be expected to take them, but there is a strong presumption in favour of taking any steps which will protect workers.

As part of managing the health and safety of your people, you must control the risks in your workplaces. To do this, look for what might cause harm to people while they work and decide whether you are taking reasonable steps to prevent that harm. This related duty under MHSWR is to ensure you undertake a “suitable and sufficient assessment of risks.”

Does the introduction of CLBILS assist private equity-backed businesses?

Under CBILS, for the purposes of calculating the applicant’s annual turnover, approved lenders have been aggregating turnover across the whole of the private equity investor’s portfolio meaning they failed to qualify for the scheme as they were deemed to exceed the £45 million threshold.

For private equity-backed businesses, the removal of the upper limit on annual turnover criteria for CLBILS seemingly avoids the issue of turnover aggregation across investment portfolios seen with the CBILS, potentially enabling more private equity sponsor portfolio companies to be able to access the CLBILS funding.

What is the NICE guidance around clinical decision-making?
  • Be alert to the fact that guidance on treating Covid-19 may change with emerging knowledge/scientific data and this may require subsequent modifications to treatment.
  • Critical care staff should support healthcare professionals who do not routinely work in critical care but need to do so.
What will happen with inquests during the coronavirus outbreak?

The Chief Coroner adopts the approach taken by the Lord Chief Justice in that no physical hearing should take place unless it is urgent and essential business, and it is safe for all involved. If a hearing is to take place, social distancing must be maintained. All hearings that can take place remotely should do so, if it is not possible for social distancing requirements to be met. The expectation is that some hearings will go ahead, most notably Rule 23 hearings. Coroners are reminded that they must however conduct any remote hearings from a court. Decisions as to the most appropriate approach will be left to the senior coroner in that jurisdiction.

As we have already seen, some inquests will be adjourned, most notably those with multiple witnesses and/or a jury.

The guidance stresses the need, when dealing with medical professionals, for coroners to recognise their primary clinical commitments, particularly in these high-pressured times. This could mean avoiding or deferring requests for lengthy reports/ statements and accommodating clinical commitments if clinicians are called as witnesses.

The guidance encourages proactive reviews of outstanding responses to Prevention of Future Death reports and extending timescales for Trusts to respond.

Do all contractors have to be assessed?

Individual contractors who are not operating via an intermediary (eg sole traders) do not need to be assessed under IR35. However, you will always have the risk with those individuals that there is no intermediary – therefore if their tax status is wrong, HMRC are very likely to consider that responsibility for this would fall on the hiring company in any event.