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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

Should I continue to carry out housing inspections during the coronavirus outbreak?

As the pandemic progresses, more and more people will be forced to self-isolate and, inevitably, both tenants and staff will be affected. Put plans in place to mitigate the impact that this may have, particularly regarding staff shortages. The most important focus here should be communication.

The Covid-19 outbreak will affect the pace of everyday life and delays will be expected. Rather than allowing the pandemic to take over completely, it is important to maintain open communication with tenants as much as possible and inform them of any front-facing challenges that you may face.

The Protocol does envisage that delays may occur and allows for some degree of flexibility. Whilst all efforts should be made to conduct inspections where practical and possible, it should be expected by all parties that timescales will be extended during this crisis. It is fundamental, however, that all changes made to standard practice are communicated and explained to tenants to manage expectations.

Similar flexibility should be afforded to tenants. As households are required to isolate it will not always be possible to gain access to properties as would usually be expected and required. Likewise, vulnerable people will wish to protect themselves and their families and may refuse access on this basis. During this period, a degree of understanding must be exercised and concessions made.

Inspections may be delayed if anyone in the household has  symptoms. A questionnaire should be prepared for those visiting properties to assess so far as possible the risk; Personal Protective Equipment should be issued to those visiting, and government guidelines followed.

VIDEO: An update from cashflow.co.uk expert Chris Silverwood about access to finance

Partner at Ward Hadaway Adrian Ballam catches up with corporate finance expert and CBILS specialist Chris Silverwood (CorpFin and cashflow.co.uk) a month after their initial conversation to talk about what the last couple of months have taught us about access to finance.

Sections of the video and their timings are as follows:

(01.06) – example of continuing appetite for certain businesses (e.g. tech sector)

(02.06) – conflict between incumbent bank and different CBILS lenders, plus brief discussion of CBILS II

(05.36) – bounce back loans have been a distraction

(06.27) – muted impact of fintech CBILS lenders

(07.52) – discussion about invoice discounting

(11.59) – looming insolvency environment

(12:52) – emerging themes

 

What happens if that means a particular service might need to close?

Ultimately closing a service will be a decision that is taken at the highest level and that decision will depend on risk appetite.  Often these types of higher risk are mitigated by way of insurance but that still depends on an insurer being willing to accept that risk. This decision will depend on accepting a known risk and its consequences.

I'm a doctor. What should I do if I think I may be infected with coronavirus?

The GMC recognises the challenges the doctors may face as the situation continues to develop. This includes concerns about the risks to the health of the doctors when treating patients with coronavirus. Doctors should follow the current public health advice including self-isolating if they know or suspect that they are infected or are at a higher risk of infection.

 

Finally, all necessary steps should be taken to ensure that doctors have access to protective equipment and minimise the risk of transmission when treating patients. It is imperative that a record is kept of all decisions made and how any safety or health concerns have been handled.

 

The GMC continues to work with NHS England and UK’s Chief Medical Officers to provide updates and advice to all doctors as the situation develops. Click here for more information.

Can I renegotiate a s106 agreement if the viability on my site has changed as a result of the current climate?

The Government acknowledges that there may need to be some flexibility to enable developers to meet any existing s106 obligations, in particular financial contributions, during the current health crisis and in recent guidance it encourages Councils “to consider whether it would be appropriate to allow the developer to defer delivery”. However, the Government considers that the existing arrangements for varying a section 106 agreement by way of a deed are sufficient and will not be legislating for any additional temporary mechanisms.

In the absence of any formal variation, the Government does however advise Councils to take a “pragmatic and proportionate approach” to enforcement of planning obligations at the current time.

The Government’s advice does not refer to concerns over the quantum of any planning obligations but is concerned only with the timing for delivery. However, the viability behind many sites is likely to change as a result of temporary site closures, or the availability of construction materials and labour once sites can re-open. Where there is already a s106 agreement in place, a developer may wish to renegotiate their position on the basis that certain planning obligations are no longer affordable.

Where a s106 agreement was entered into longer than 5 years ago, an application can be made to the Council to formally vary a planning obligation that is now “without purpose”. Any refusals can be appealed to the Secretary of State.
Where a s106 agreement was entered into within the last 5 years, the agreement can only be modified with the agreement of the Council. The ability to renegotiate a s106 agreement will therefore come down to the willingness of the Council to accept the revised viability position. Where Councils are willing to consider this, a robust viability assessment agreed with the Council is likely to be needed.