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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

How are the Courts applying the new guidance?

Overall it is our experience that the Courts are quickly adapting in the context of the Coronavirus epidemic and making pragmatic decisions. The Judges seem live to the difficulties currently been faced by practitioners dealing with litigation and they are applying the new guidance.

The Courts are also mindful of pressures on NHS frontline staff and are taking steps not to put additional pressures on them at this time, including in our experience vacating an imminent Trial.

Is there anything I need to put in place for their return? What are my responsibilities?

The basics of health and safety law requires that employers take “all reasonably practicable steps” to ensure workers’ safety and that a suitable and sufficient assessment of risk is undertaken. It is the individual assessment of Covid-19 risk in each workplace that will be central. Employers will be required to conduct a robust risk assessment and then, following the hierarchy of controls, put robust processes and safeguards in place to address those risks.

UK government guidance and HSE advice is continually evolving, which in practice means that any risk assessment will need to be reviewed very regularly as that guidance develops. There is flexibility for individual businesses within the overall government framework and there will need to be a process of evaluation to ensure that the measures in place continue to meet the requirements.

The starting point of avoid, eliminate and control means looking at individuals continuing to work from home where possible (the fewer the number of people back in the workplace the lower the risk), and if not look at risk management, which leads to administrative controls – i.e. changing work practices before ending up at PPE. PPE is generally seen as control of last resort but in practice – facemasks, disposable gloves and constant prompts to wash hands for example.

In terms of changing working practices, employers should be thinking about:

  • the workspace and how this is laid layout
  • how do we make sure it is kept clean and hygienic
  • how do we keep people apart
  • how can we use toilets, canteens or other shared spaces/facilities safely
  • how do we promote and enable higher levels of workplace hygiene
  • if we are going to rely on PPE – can we get it, and is it suitable
  • what about limiting customer interactions
  • will there be enough first aiders on site
  • can we manage fire safety, deliveries etc
  • what about higher risk workers
  • should work tools and equipment be allocated on an individual basis to employees.

These decisions need to be recorded and clearly communicated to staff members.

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 do I do if my visa is due to expire but I can't travel?

If your visa has expired or will do before you are able to safely leave the UK, you can apply for “Exceptional Indemnity” by contacting the Coronavirus Immigration Team. You will need to provide evidence as to why you cannot leave, which could include a positive Covid-19 test or evidence of being unable to make travel arrangements to leave the UK in time.

You should note that “Exceptional Indemnity” does not extend your leave, but temporarily protects you from adverse action being made against you as result of overstaying your visa.

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