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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 are the existing legal obligations to conduct a suitable and sufficient assessment of risk for a workforce, and where particular characteristics require it, for individuals?

It is the individual assessment by an organisation of its Covid-19 risk in its workplace that will be central. There may be common features across sites or areas of a site but every workplace will have a different risk profile depending on the service it offers and the workers who deliver those services.  No one size fits all.

The context of managing Covid-19 risk is the need to tie in with UK government guidance and HSE advice – which despite being a lot more comprehensive than it was, is not a panacea and will continue to evolve.  The difficulty we have with this in the context of the known increased risk to BAME employees from Covid-19 is that our understanding of the risk is, we would suggest, at a pretty early stage which makes it more difficult to address. However we know the increased risk exists and we owe our BAME workers a duty to manage that risk and keep them safe.

We also have a duty to consult employees.  This is critical in managing this risk – ensuring BAME workers have a loud voice in the assessment process will be very important.

Where an individual has a particular characteristic, for instance they’re pregnant, they have physical or mental disabilities etc, the law requires us to look at that individual or, where it is a group, that group of individuals and assess the risk to them and take any reasonably practicable steps to control the risk to them.

Risk control hierarchy is key. In “normal” businesses we reduce our Covid-19 risk by keeping people away from the workplace – “avoid, eliminate and substitute” then changing work practices (e.g. social distancing measures) before we arrive at PPE. In a healthcare context, we arrive at PPE a lot more quickly.

We need to ensure our people are given sufficient information, instruction and training so they can do their jobs safely and we must consult workers and involve them in workplace safety – this is going to be critical in the context of Covid-19.

ONLINE EVENT: How to avoid risks in customer agreements and supply chains during Covid-19

Hosted by Advanced Manufacturing Forum, Partner, Matt Cormack discussed in this webinar how to avoid risks associated with your customer and supply chain contracts during this challenging Covid-19 period.

The webinar covers common questions such as:

  • Can force majeure excuse me or my suppliers from paying on time?
  • What are the risks to my business if I can’t perform on time due to Covid-19?
  • What will happen to my contracts if the Government takes steps to require me to close down my facility?

To watch the full recording, please click here. (To note the recording begins at 10 minutes)

If you have any follow up questions, please do not hesitate to contact one of our lawyers detailed below or use our ‘ask us a question‘ feature.

Forcing annual leave

Employers have a statutory right to require employees to take annual leave at their direction, subject to providing staff with notice equal to at least double the length of the leave that you are directing them to take (e.g. 10 days’ notice for five days leave). However, this measure is not likely to achieve any urgent cost savings or alleviate immediate cash-flow pressure as holidays would need to be paid.

Clearly, annual leave can be taken on furlough so you could have staff on furlough and annual leave.

I am agreeing a financial settlement with my ex-spouse. Should we carry on negotiating despite COVID-19?

No. Before continuing any negotiations, you need to strongly consider whether now is the best time to settle. There is a myriad of uncertainty due to the pandemic, with unemployment rates increasing, volatility in the stock markets and difficulties regarding placing valuations on assets. This could all lead to the financial settlement being unfair to you and cause you financial difficulties in the future.

Any financial settlements reached following marital separation should be embodied in to a Court Order, to prevent future claims from your ex-spouse. As a general principle, although maintenance orders are always variable, financial orders in respect of capital (e.g. house, cash, investments, pensions) are final and it is very difficult to set aside a Court Order. The question will be whether or not the pandemic is judged as a Barder event, which broadly means something viewed as unforeseen. It would be challenging for you to argue that the effects of COVID-19 are unforeseen given the widespread expectation of an economic crisis. The Court previously found against a husband who wanted to revisit an Order that he said was unaffordable following the 2008 financial crisis, with one Judge commenting that a 90% drop in the Husband’s share price was a “natural process of price fluctuation”.

Even if you informally agree a settlement with your ex-spouse, and you do not have this reflected in a Court Order, your ex-spouse may still rely on this agreement within future Court proceedings and argue that you should be held to it.

It is, therefore, very dangerous to be reaching any financial settlements at this time with your ex-spouse without careful consideration and legal advice. Further, even if an agreement is reached, market volatility can mean longer implementation times, especially when a settlement relies on the sale of property.

Can I use my Business Interruption insurance to make a claim?

The FCA’s test case in the Supreme Court ruled overwhelmingly in favour of policyholders.  However, business interruption cover generally has the prerequisite of physical damage or loss to the property (or in some circumstances, the presence of a notifiable disease at the property or within a certain radius of it), to recover losses caused by the interruption to your business. The onus is on insurers to re-assess those claims which are impacted by the Supreme Court’s judgment and to make contact with the policyholders regarding next steps. If you have not already made a claim, in the first instance the terms of any policy should be checked carefully to see whether business interruption cover is provided.