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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

I am dealing with an estate where the bank has sent me an indemnity to obtain the funds. Will the bank accept my signature without it being witnessed by my solicitor?

If you have obtained a Grant of Probate or Grant of Letters of Administration there should be no need to complete an indemnity, merely an account closure form. If however you have not yet obtained a Grant but the bank is willing to release funds then they will generally require an indemnity to be executed. Several banks and building societies including Barclays, Lloyds, HSBC and Santander have signed up to the British Banking Association’s voluntary Bereavement Principles, one of which is to support the bereaved according to their personal needs and work with you to resolve everything as quickly as possible.

If the indemnity requires a solicitor to act as a witness, you should contact the bank to see what they are willing to do to get around the problem, given the current situation.

What technology is being used by the COP for remote hearings?

Interestingly, there is currently no ‘single’ technology to be used by the judiciary within the protocol. The court and parties must choose from a selection of possible IT platforms or audio/telephone hearing (further details available in the guidance e.g. Skype for Business, Microsoft Teams, Zoom etc.) The particular platform must be agreed at the outset of each case and then specified in the case management order. The guidance issued also sets out the basic principles which apply when conducting remote hearings.

What if the status determination is disputed?

You should have in place a dispute resolution procedure that sets out the appeal process or contractors or the agency as appropriate. You must respond to an appeal within 45 days.

If the status determination is disputed you should consider the contractor or agency’s reasons objections. You must consider if the original determination is to be maintained and give reasons for this. Or a new determination with reasons can be provided if appropriate.

Records of disputed determinations and the outcome of any appeal should be kept.

Is there a matched funding scheme for the National Emergencies Trust?

The government has also confirmed it will match donations to the National Emergencies Trust as part of the BBC’s Big Night In fundraiser on 23 April – pledging a minimum of £20 million.

Can NHS or local authority workers be furloughed?

It is envisaged that employees of organisations falling into the first two categories set out above and won’t be eligible for the job retention scheme in relation to the majority of their employees. It is envisaged that NHS Trusts for example are going to require their staff to be working at full capacity where possible. However, the guidance doesn’t definitely exclude public sector organisations from furloughing employees and notably the government expects such organisations to use public money to continue to pay staff and not furlough them, rather than say requires. In reality, it is difficult to see how such an organisation will be able to rely on the scheme, but the guidance doesn’t completely rule it out.