Includin g Deprivation of Liberty Safeguards Practitioner Level
Including
Deprivation of Liberty Safeguards
Practitioner Level
Including
Toilets Fire ProcedureSmoking
Mobile Phones / Devices
Finishing Time
Breaks
Housekeeping
Including
Training Transfer
Getting learning into practice
• “50% of learning fails to transfer to the workplace”
(Sak, 2002)
• “The ultimate test of effective training is whether it benefits service users”
(Horwath and Morrison, 1999)
Including
Training Transfer
Including
Introductions
• Name
• Place and nature of work
• Pre-read – what do you want to get out of today’s session?
Including
Outcomes
• Understand the legal framework for providing care, treatment and support
• Consider the implications of using restraint to keep people safe from harm
• Be aware of cumulative effects of restrictions and ways of minimising their use / impact
• Understand what is meant by Restriction, Restraint and Deprivation of Liberty and the significance of the differences between them
Including
Ground Rules
Safeguarding is a dynamic world and we continue to learn about how to prevent people from being harmed on both a strategic / organisational level and as individual practitioners.
Safeguarding is about partnership, it is not about blame. All agencies and individuals need to take responsibility, to reflect and learn to safeguard people who may be vulnerable.
Including
Ground Rules
Confidentiality within the group will be respected but may need to be broken if a disclosure of unsafe practice, abuse or neglect is made during the course – this will usually be discussed with you first.
Including
Human Rights Act, 1998
“All human beings are born free
and equal in dignity and rights.”
The HRA defines the role of the State in upholding
our freedom, dignity and rights; this includes
protecting us from each other.
It also establishes if, when and how our rights may
be restricted or withdrawn.
Including
Human Rights: A Balancing Act
Some rights may be withdrawn or limited ‘in accordance with a procedure prescribed by law when necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.’
Including
Human Rights Activity
Match the statements with the Rights
Including
The MCA “Process”
Is there a concern about a persons capacity ? (with regard to a specific decision)
Undertake a Capacity Assessment
Or
Their own decision Best Interest decision (even if we think it is unwise) (multi-agency)
Including
Principle 4: Best Interest
If a person has been assessed as lacking capacity then any action taken, or any decision made for, or on behalf of that person, must be made in his or her best interest.
Principle 5: Least Restrictive Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.
Including
Case study – Val & Vernon
Including
Human Rights
Val lacks capacity in many areas of her life.
No one person has legal authority (e.g. LPA) to make decisions on her behalf.
In which areas of her private life do you think the State has a duty to intervene in order to protect her Rights or the rights of others?
Including
The Best Interest Decision
What’s best for Val?
Including
The Best Interest Decision
Including
What could you do if Val refuses:
1. To go to the care home?
2. To stay at the care home?
3. To take her medication?
Including
Break
Including
What is Restraint?
Someone is using restraint if they:
• Use force – or threaten to use force – to make someone do something that they are resisting, or
• Restrict a person’s freedom of movement, whether they are resisting or not
Including
Examples of Restraint • Chemical • Financial• Physical • Barriers• Removal of equipment • Preventing contact • No communications• IT / phone removal • Psychological
Including
Restraint
Any action intended to restrain a person who lacks capacity must follow the following two conditions:
– The person taking action must reasonably believe that restraint is necessary to prevent harm to the said person
– The amount or type of restraint used and the amount of time it lasts must be a proportionate response to the likelihood and seriousness of harm
Including
Guidance / good practice
• Social Care Institute for Excellence (SCIE)
ADULTS’ S ERVICES REPORT 25
Minimising the use of ‘restraint’ in care homes: Challenges, dilemmas and positive approaches
www.scie.org.uk
Including
Limits of Section 5 Decisions
Best Interest Decision -> -> -> -> -> -> -> -> -> Deprivation of Liberty Authorisation
Including
Key Considerations for DoLConstant supervision and control?
Complete and effective control over care and movement for a significant period?
Prevented from maintaining contact with the outside world or maintaining social contacts?
Prevented from moving to another care setting or being taken out?
Prevented from leaving or being released to the care of others?
Cumulative effect of all the restrictions amount to deprivation of liberty even if the restrictions considered individually would not?
Including
Your Rights if You are Arrested:
• be told in a language you understand why you have been arrested and what charges you face
• have a trial within a reasonable time
• go to court to challenge your detention if you think it is unlawful
• compensation if you have been unlawfully detained.
Including
Your Rights if You are ‘Sectioned’:
• Be told in a language you understand why you have been detained and what the treatment is for
• Be told about any side-effects
• Support from an Independent Mental Health Advocate
• To appeal against your detention if you feel it is unlawful
Including
HL v. UK
HL was an autistic man with a Learning Disability who lacked capacity to consent to treatment
Admitted to hospital in emergency
Not treatable under MHA
Discharge to carers refused
ECtHR – illegal - no formal procedure for admittance or appeal against detention
Including
Your Rights if You Are ‘Deprived’:
Formal process for deprivation of liberty
Representation/advocacy during assessment and if authorised (IMCA)
Opportunity for the Deprivation of Liberty to be reviewed and monitored
A Right of Appeal
Including
Allow the lawful deprivation of liberty of an individual (who lacks capacity) in a care home or hospital
• Must be necessary to prevent them coming to harm (not others)
• Must be in their best interests (not the organisation’s)
• Must be proportionate to the risk of harm
Deprivation of Liberty Safeguards
Including
Referral for DoL Authorisation
The managing authority (the person or body with management responsibility for the care home
or hospital where the person is being, or may be, deprived of their
liberty)
must apply to the supervisory body(the Local Authority)
for DoL authorisation where it appears
that a person is, or may be, deprived of
their liberty.
Including
• DLS info line Tel : 01392 381676• [email protected] (signed paper copy
will need to follow)
• DLS / MCA secure fax : 01392 383327
• Safeguarding Adults Team, The Annexe, County Hall, Topsham Road, Exeter EX2 4QR. Tel: 01392 382339
DLS Service
Including
Case Studies
In groups look at the following case
Studies and decide:
• Does this appear to be restraint under s. 5 of the MCA or is the person being deprived of their liberty? Consider type of restraint, duration, effects, manner and purpose.
• What are the good practice issues?
Including
Summary
• If a person lacks capacity to make a particular decision, a decision will need to be made in their best interest
• When making decisions for others workers must be able to show what they did and why they did it
• Restraint is permissible if necessary to prevent harm to the person, it is in the person’s best interests, it is proportionate to the likelihood and seriousness of that harm and there is no less restrictive alternative.
• Deprivation of Liberty must be authorised by a Best Interest Assessor.
Including
Any Questions?
Including
• http://www.devon.gov.uk/index/socialcarehealth/adult-protection/mentalcapacityact.htm
• www.dh.gov.uk• www.publications.parliament.uk • www.cqc.org.uk• www.scie.org.uk• www.scils.co.uk Password available from
Useful Websites
Including
Evaluation forms