Agenda item

Report of the Deputy Leader and Cabinet Member for Health, Care and Wellbeing

( Peter Hampton, Adult Safeguarding Manager, in attendance for this item.)

The Deprivation of Liberty Safeguards (DoLS) provide protection for the most vulnerable people living in residential homes, nursing homes or hospital environments. The safeguards enshrine in law the requirement that care will always be provided in a way that is consistent with the human rights of people lacking capacity, who are not otherwise protected or safeguarded through the use of the Mental Health Act or Court of Protection powers. Referrals for DoLS had steadily risen up until March 2014, and had significantly risen since the Supreme Court judgement on P verses Cheshire West and Chester Council. DoLS application data indicated that assessments had risen from 69 in 2009-2010 to 2927 in 2017-2018.

As a response to the nationwide surge in DoLS referrals the Department of Health provided a grant in 2015/16, which in Staffordshire amounted to £377,000. This enabled the Council to commission assessments through a social work agency and the backlog of outstanding assessments was kept to a minimum. However this grant had not continued into 2016/17.

The NHS had funded the Mental Health Assessors (MHA) since 2009. MHAs complete part of the DoLS assessment process, however CCGs had indicated that they did not intend to continue this funding. Having sought legal advice it has been confirmed that the Council is responsible for funding this assessment. A commissioning process is currently being identified to support this for 2019/2020. The cost of these assessments is not clear but is anticipated to be in the region of £130,000 per annum. This has been built into the Medium Term Financial Strategy (MTFS) as a cost pressure.

Members were informed that there had been 227,400 applications for DoLS received during 2017/18, with almost three quarters of these relating to people aged 75 years and over. This represented a 4.7% increase on the 2016/17 figures. There were more DoLS applications received than were completed during 2017/18.

Analysis of the 2017/18 data showed a wide variation across the country in the volume of DoLS applications, their outcomes and how they were administered. The Association of Directors of Adult Social Services (ADASS) issued a guidance note in November 2014 which looked at a prioritisation process to identify the risk and complexity of DoLS applications. Staffordshire used a prioritisation tool to classify applications into three bands; high, medium and low priority. Cabinet considered this issue in 2016 and agreed a focus on high priority cases for assessment, with an appreciation that this may result in all other applications not being assessed. Members were informed that the Local Government and Social Care Ombudsman had raised a concern about DoLS that was currently being investigated. This might have implications for Staffordshire’s prioritisation approach.

In March 2017 the Law Commission published a report and draft bill which put forward proposals to change the legal framework for Deprivation of Liberty. Proposed legislation was introduced in July 2018 (currently in committee stage in the House of Lords) with an expected implementation date of April 2020. The new legislation proposed a change to responsibility for Dols. Currently the County Council was the supervisory body for all Staffordshire (excluding Stoke) DoLS. The new legislation proposed that in future responsible bodies for DoLS would be the Local Authority, CCGs and Trust Boards of hospitals.

Members heard that the number of assessments undertaken was good in relation to the resource available. Other authorities differed in the amount of resource provided and in the number of referrals received. Members had concerns that there was a potential for significant cost implications from legal challenges, particularly in light of the current Ombudsman case, and suggested that the Cabinet should consider again whether the resource allocation for DoLS was appropriate.

RESOLVED – That the Cabinet Support Member, Adult Safeguarding, take back to Cabinet the Select Committee’s request that they consider again the DoLS resource allocation and prioritisation approach, particularly in light of the Ombudsman case.