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Home › FAQs › What is the guidance in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards during the Covid-19 pandemic?

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 form does the relaxation take?

The European Commission has reintroduced its “comfort letter” system for cooperation in relation to shortage of supply. This allows cooperating businesses to check what the Commission’s view of their proposals are before implementing them.

In the UK context the SMA has introduced an exemption for suppliers of healthcare services to the NHS. This allows:

  • Sharing information about capacity
  • Coordination of staff deployment
  • Joint purchasing of goods, services and facilities
  • Sharing or lending of facilities
  • Division of activities, including agreeing whether to expand or reduce the volume or type of services provided by suppliers

In relation to whether the CMA will investigate cooperation, it has indicated:

  • The CMA will use its discretion as to the prioritisation of its enforcement action to permit some agreements/collaboration which would otherwise potentially give rise to enforcement action (including potentially attracting fines of up to 10% of group worldwide turnover)
  • The CMA will use its existing power to exempt certain agreements under the Competition Act 1998 where these are in the public interest

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What about someone who refuses because they are against the vaccine (the anti-vaxers)?

It is a theoretical possibility that “anti-vax” beliefs could be a philosophical belief under the Equality Act 2010 and therefore anti-vaxers have the right not to be discriminated against for their beliefs. Much will depend on why the individual is against the vaccine. Conspiracy theorists (the vaccine is being used as an opportunity to monitor you or it’s all because of 5G) are highly unlikely to be treated as having a philosophical belief!

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Do leaseholders who have more than three properties in the UK have to pay the full contribution for building safety works and is there a way of finding out how many properties out leaseholders have in the UK?

The first point to note is that it is the position as at 14 February 2022 which is relevant, as whether or not a lease is a ‘qualifying lease’ for the purposes of recovering costs under the Building Safety Act was effectively frozen at that time.

If a leaseholder owned more than three properties in the UK (and the property in question was not their principal home) at that time, then the lease will not be a qualifying lease. The protections under the Act which prevent or restrict the landlord’s ability to recover the cost of remedial works through the service charge will not therefore apply to that lease (save potentially for the provision that costs cannot be recovered where the landlord is responsible for the defects, which does not expressly refer to qualifying leases).

The lack of a searchable database to assess how many properties a leaseholder has in the UK is however one of the difficulties to be resolved in this regard, as there is currently no way of searching the Land Registry to obtain a list of properties owned by one individual. The guidance appears to rely on the leaseholder completing the leaseholder deed of certificate being open and honest in this regard, and that deed of certificate being passed onto subsequent owners. Making false representations or failing to disclose required information in the deed of certificate may be a criminal offence, although reliance on this to discourage mis-reporting is clearly less satisfactory than having a searchable register.

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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.

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What can I do as an employer if employees are known to be breaking the local lockdown rules?

This will depend on the particular facts and the employee’s circumstances but an employee should co-operate with the employer so far as is necessary to enable compliance with any statutory duty or requirement relating to health and safety.

In addition, conduct outside of work can result in an employee’s dismissal if the conduct pertains to the employment relationship. If an employee breaches their lockdown rules and it affects their ability to work, such as it being no longer safe for them to attend work, or the reputation of the employer, these may be grounds for disciplinary action and subsequent dismissal.

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