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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 measures can be taken without notification to the European Commission?

There have always been ways for public bodies to assist without being required to notify these for approval. These continue to be available during the financial crisis, and are likely to be increasingly useful for measures which need to be introduced quickly. The measures include:

Those where it is possible to conclude that there is no effect on trade between Member States – for example, measures which are likely to have only a limited local effect. The European Commission has concluded, for example, that measures to assist locally-focused cultural activity can be assumed to have no effect on inter-State trade. 

Those where it is possible to conclude that the State is acting in a way consistent with a commercial operator (the so-called Market Economy Operator Principle) – particular care will need to be taken in the context of current economic conditions to ensure that it can reasonably be asserted that a commercial operator would act in the same way as the public body.

Measures under the General Block Exemption Regulation – this legislation allows various types of aid, or aid schemes, to be employed.

Examples include aid for SMEs, aid for research and development, aid for local infrastructure and aid to ports and airports.

De Minimis Measures – Member States are permitted to grant small amounts of aid to undertakings over three fiscal years (the current year and the previous two years). This allows undertakings to receive up to €200,000 (or €500,000 where they are providing public services).

Can I force ways of reducing employment costs onto the workforce?

Some of these can be implemented by you, some need agreement or consultation and some depend on the wording of contracts. We’ll explain more in relation to each option.

Can I dismiss someone who refuses to wear PPE?

Potentially, yes. If someone refuses to follow the health and safety measures that have been put in place to protect them, colleagues and possibly their customers, including (where appropriate) the use of PPE then this is a disciplinary issue and should be dealt with as such. Repeated failure to comply with the requirement to follow these measures, or a one off significant failure, may be sufficient to justify dismissal, depending on the circumstances.

Is it legally enforceable?

The guidance is non-statutory and is not binding on business. However, businesses should be aware that there might be reputational consequences if they do not follow the guidance; we have already seen in the context of taking advantage of furlough funding that not being in breach of the law is no protection against negative publicity. Further to the extent a contract expressly requires parties to act reasonably, it could be expected that this guidance is one of the factors a court would consider in determining what is reasonable.

My reserved matters application is due to be submitted, can I delay this?

The Business and Planning Act 2020 entered the statute books on 22 July 2020. Section 18 of the Act includes provisions for the extension of the date by which a reserved matters application must be submitted where the original date falls between 23 March 2020 and 31 December 2020. Where the original time limit for the submission of reserved matters is on or after 19 August 2020, the relevant conditions will be automatically read as requiring the reserved matters application to be submitted by 1 May 2021.

Where the original time limit for the submission of reserved matters is before 19 August 2020, an application will need to be made to the LPA for an Additional Environmental Approval (“AEA”), which the LPA must determine within 28 days otherwise the approval is deemed to be provided. The purpose of the AEA is to consider whether the environmental assessments carried out at the time of the original outline determination remain valid and up to date, and where that is not the case, the AEA will be refused. In such circumstances a new planning application will be required where an application is now out of time to comply with the original date for submission of reserved matters.