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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

Can I be fined for failing to take steps to try to ensure that my staff comply with the requirements to self-isolate?

Yes.

An employer which is aware that a worker or agency worker is or ought to be self-isolating, should not knowingly allow that worker or agency worker to leave the place that they are self-isolating in (“the designated place”).  To do so without reasonable excuse would amount to an offence which could result in the employer being issued with a fixed penalty notice.

The value of the fixed penalty varies depending on if it is the first or subsequent fixed penalty notice to be issued:

First fixed penalty notice £1,000
Second fixed penalty notice £2,000
Third fixed penalty notice £4,000
Fourth, and any subsequent fixed penalty notice £10,000
What rate of pay applies to an employee returning from statutory leave who is furloughed?

Statutory leave includes family related leave, sick leave or parental bereavement leave. Claims for furloughed individuals returning from statutory leave should be based on their salary, before tax, and not the pay they received while on statutory leave.

Similarly, claims for furloughed employees returning from a period of unpaid leave on sabbatical should be based on their pay they would have had on paid leave.

How do I remain compliant and cover any risk?

Data on properties, and people, has never been more important.

Given that compliance is at risk here, such a decision must be made by the Board to ensure good governance. Board approval should be sought and recorded for the approach the organisation is taking.

It is essential that you continue to record your data on compliance and report to your board at all times, and that there is a clear audit trail for issues with access, and if appropriate to the Regulator. Access issues as a result of self-isolation should be readily identifiable.

Operatives need to be provided with the tools to operate in as safe a way as possible:

  • Checklist of questions to ascertain occupant’s current health
  • Protective equipment (masks, gloves, over clothing)

The Gas Safe website is a useful resource for updates: https://www.gassaferegister.co.uk/help-and-advice/covid-19-advice-and-guidance/

What support is available for Start-ups?

According to the guidelines laid down by the Treasury, many Start-up businesses will not be considered “viable” as they are at an early stage in the investment cycle (i.e. delivering negative returns but with strong growth prospects). This means they are unlikely to qualify for CBILS although for primarily UK based Start-ups it is still worth making enquiries as policies are rapidly evolving.

For early-stage businesses in their first two years of trading, the British Business Bank’s Start-Up Loans programme (loans £500 to £25,000 at 6% p.a. interest) may be more suitable. Visit www.startuploans.co.uk for more information.

For start-up businesses that are unable to access CBILS, the Government launched The Future Fund in May 2020 via the British Business Bank, which provides convertible loans to UK-based innovative companies ranging from £125,000 to £5 million, subject to at least equal match funding from private investors. This scheme is available until 30 September 2020 initially.

Your business is eligible if:

  • it is UK-incorporated – if your business is part of a corporate group, only the parent company is eligible
  • it has raised at least £250,000 in equity investment from third-party investors in the last five years
  • none of its shares are traded on a regulated market, multilateral trading facility or other listing venue
  • it was incorporated on or before 31 December 2019, and
  • at least one of the following is true: (i) half or more employees are UK-based; and/or (ii) half or more revenues are from UK sales.

Further information is available on the Government website, www.gov.uk/guidance/future-fund

The Government is also offering additional support for small and medium size firms that are primarily focused on research and development. This targeted support is available through a continuity grant and loan scheme. The grant scheme is only available until 29 May 2020 while the loan scheme is open for applications until all the money is allocated or 31 December 2020 (whichever is earlier). This scheme is administered by Innovate UK, the national innovation agency, and this support will mostly only be available to existing Innovate UK customers.
Further information is available on the on the Government website, www.gov.uk/government/publications/access-coronovirus-business-innovation-support-package

How do you prevent MHFA from handling situations that are for qualified individuals such as their GP or EAP?

The MHFA training makes this clear, it should be made clear in the MHFA role specification and procedures and discussed during regular MHFA peer support and MHFA surgery sessions. It is important to ensure that where an Employee Assistance Programme is in place, all MHFAs have details of that scheme available so they are able to instantly share details of the scheme with those who require support. If in doubt due to serious concerns then using 999 or Samaritans is an option.